Summary

While outcomes improve following reconstruction (MLKR) of multi-ligament knee injuries and outcomes may be delayed and/or worse compared with patients undergoing isolated anterior cruciate ligament reconstruction (ACLR), patients undergoing MLKR specifically due to a pivoting sport injury recover in a similar way and return to the same level of sports as their isolated ACLR counterparts.

Abstract

Introduction

Studies reporting outcomes in patients undergoing multi-ligament knee reconstruction (MLKR) often report limited outcome measures, with larger datasets and more comprehensive outcomes required to demonstrate the true recovery in such a heterogenous cohort. This study presents the clinical and functional outcomes in patients undergoing MLKR through a tertiary referral centre, further comparing outcomes over 24 months to a matched cohort undergoing isolated anterior cruciate ligament reconstruction (ACLR).

Methods

This study prospectively recruited 50 patients undergoing single-stage MLKR with a mean age of 32.0 years (range 16-50), of which 20 (40%, mean age 28.7 years, range 16-38) injured themselves participating in pivoting sports. Furthermore, a cohort that underwent isolated ACLR following injury during pivoting sports were also recruited and matched to the MLKR cohort primarily for age and body mass index. Patients were assessed with a range of patient-reported outcome measures (PROMs) pre-surgery and at 6-, 12- and 24-months post-surgery, including the International Knee Documentation Committee (IKDC) form, Lysholm score, Cincinnati Knee Rating Scale (CKRS) and the Tegner Activity Scale (TAS). At all post-operative time-points, the Anterior Cruciate Ligament Return to Sport after Injury Score (ACL-RSI), a Global Rating of Change (GRC) Scale and Patient Satisfaction were also assessed. Post-operatively, active knee range of motion, single-limb hop capacity and peak isokinetic knee extensor and flexor strength were assessed. Surgical complications and re-operations were reported. Limb Symmetry Indices (LSIs) were calculated for hop/strength measures, while outcomes were also compared across the MLKR and ACLR groups.

Results

Of the 50 MLKR patients recruited, 20 (40%) were from sporting injuries, 8 (16%) motor vehicle accidents and the remaining 22 (44%) via modes including work accidents and other recreational/sporting activities not considered pivoting sports. In the MLKR cohort, 4 patients (8%) underwent subsequent manipulation for stiffness, while 1 patient (2%) underwent revision fixation of a loose MCL screw. All PROMs significantly improved (p<0.05) in both groups over the 24-month post-operative period. Specifically at 24 months, the majority of PROMs remained significantly lower (p<0.05) in the MLKR cohort when compared to the ACLR group. However, while the MLKR group reported lower TAS scores than the ACLR group, there were no group differences (p=0.408) when comparing the ACLR group to the MLKR cohort that injured themselves specifically during pivoting sports. Similarly, while functional hop and strength LSIs were lower in the MLKR cohort at 12 and 24 months, there were no differences (p>0.05) in these lower limb functional recovery measures between the ACLR cohort and ‘pivoting sport’ MLKR cohort.

Conclusions

MLK injuries are traumatic and often present in a very heterogenous cohort, so it is of no surprise that recovery may be delayed and/or worse overall compared with patients undergoing isolated ACLR and specifically from (and looking to return to) pivoting sports. However, the current study shows that patients undergoing MLKR due to an injury sustained during pivoting sports, recover in a similar way and return to the same level of post-operative sports as their isolated ACLR counterparts.