Summary

Using propensity score matching, the purpose of this study was to compare the outcomes of MLKIs with and without patellar tendon ruptures and to investigate the overall predictors of these outcomes.

Abstract

Purpose

Multi-ligamentous knee injuries (MLKIs) are high energy injuries that may infrequently present with concomitant patellar tendon rupture. There is limited information in the literature regarding these rare presentations, with even less information regarding clinical outcomes. Using propensity score matching, the purpose of this study was to compare the outcomes of MLKIs with and without patellar tendon ruptures and to investigate the overall predictors of these outcomes.

Methods

Twelve patients who underwent surgical repair for combined MLKI and patellar tendon rupture from February 2011 to April 2020 with minimum 1-year follow-up data were identified from two separate institutions. Patients were propensity-score matched with a 1:1 ratio with controls based on age, body mass index (BMI), gender, and time from surgery. Patient-reported outcomes included International Knee Documentation Committee (IKDC) Subjective Knee Form, Lysholm and Tegner scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score.

Results

Twelve MLKIs with concomitant patellar tendon injuries were identified out of a multi-center cohort of 237 (5%) patients sustaining MLKI and were case matched 1:1 with 12 MLKIs without extensor mechanism injuries. The average follow up was 5.5 ± 2.6 years. There were no differences in Schenck Classification injury patterns. There were significant differences found across IKDC (Patellar Tendon mean: 53.1 ± 24.3, MLKI mean 79.3 ± 19.6, P<0.001) and Lysholm scores (Patellar Tendon mean: 63.6 ± 22.3,, MLKI mean 86.3 ± 10.7,, P<0.001) between the two, illustrating poorer outcomes for patients with concomitant patellar tendon ruptures.

Conclusion

In the setting of MLKI, patients who have a concomitant patellar tendon rupture have worse functional outcomes compared to those without. This information will be important for patient counseling and might be considered to be added to Schenck classifcation, reflecting its prognostic value.