Summary

good-to-excellent PROMS maintained at long-term follow-up after PCL-based MLKI, excellent RTW and acceptable RTS rate to pre-surgery level

Abstract

Introduction

Due to the rarity and complexity of Multiple Ligament Knee Injuries (MLKI) their management is always extremely challenging for knee surgeons. So far, the best solution to improve clinical outcomes is represented by the surgical treatment. However, if good outcomes have been reported in the short-term there is a lack of studies investigating the outcomes of such procedures in the long-term. For this reason, the aim of the present study was to investigate the long-term patient’s reported outcomes (PROMS) and functional activity of a wide cohort of patients underwent PCL-based MLKI reconstruction.

Methods

42 consecutive patients (39 males and 3 females) were included and evaluated at an average of 11.9 years with minimum 2 years follow-up. The mean age at the treatment was 31.4 (13-59 years). 11 patients underwent isolated PCL-reconstruction, 2 ACL+PCL, 9 PCL+PMC, 6 PCL+PLC, 7 PCL+ACL+PLC and 7 PCL+ACL+PMC. The VAS, Lysholm, KOOS, and Tegner Activity level scores were collected for each patient before, after surgery and at final follow-up. The incidence and time of return to sport (RTS) and return to work (RTW) were collected. Descriptive statistics (mean, standard deviation, confidence intervals) were collected for each score at each time frame. The ANOVA was used to investigate the improvement in PROMS after surgery. A multivariate logistic regression was performed to investigate the outcomes associated with the patient’s acceptable symptoms state (PASS )for each sub-score of the KOOS.

Results

A significant improvement in all PROMS was noted from pre- to post-surgery (p<0.05) except for the Tegner score. No differences were noted between the post-op and the final follow-up (p>0.05). The pre-injury Tegner score was never reached after surgery, but a significant improvement was noted between the pre-surgery and the final follow-up (p<0.001). The RTW was achieved in the 95.2% (40/42) after 2.4 ± 1.9 months and RTS was achieved in 78.6% (33/42) after 6.7 ± 5.0 months. The higher number of surgeries and the presence of meniscal lesions were the significant negative predictors of PASS for the KOOS sub-scales Sport and Quality of Life.

Conclusion

The most important finding of the present study was that good-to-excellent PROMS could be obtained and maintained at long-term follow-up after surgery, with the higher number of surgeries and meniscal lesions as significant negative predictors of the PASS. Moreover, the RTW rate was excellent while the RTS acceptable since every patient could be able to return to pre-surgery but not pre-injury level.
The clinical relevance of the present study derives from the deepening of the knowledge in MLKI and their long-term outcomes which can help the surgeons to set patient’s expectations.