Summary: Traffic-related injury mechanism is associated with a 6-fold increased odds of 2-year revision surgery and inferior knee-related quality of life in patients with isolated primary PCL reconstruction

Background

The aim of this study was to determine the association between demographic and injury-related factors and total (surgical and clinical) failure at the 2-year follow up after primary isolated posterior cruciate ligament reconstruction (PCL-R) based on data from the Swedish National Knee Ligament Registry (SNKLR) and the Norwegian Knee Ligament Registry (NKLR).

Methods

Patients with primary isolated PCL-R registered between January 1, 2004 (NKLR) or January 1, 2005 (SNKLR) to December 31, 2020 in the SNKLR and NKLR were included. The primary outcome of the study was the risk of total isolated PCL-R failure at the 2-year follow up, defined either as surgical (new PCL-R registered for the same patient within 2 years of index surgery), or clinical failure (KOOS Quality of Life [QoL]<44). Demographic variables, injury mechanism, and subjective knee function were assessed as risk factors of total primary isolated PCL-R failure at the 2-year follow-up, estimated with univariable and stepwise multivariable logistic regression analyses.

Results

Among the included 189 patients, (36.0% from the SNKLR and 64.0% from the NKLR), the rate of 2-year surgical failure was 5.8%, while the rate of clinical failure was 45.0%. In the subgroup with PCL-R failure (n=96), the proportional rates of surgical and clinical PCL-R failure were 11.5% (n=11) and 88.5% (n=85), respectively. Multivariable analysis showed a negative association between the baseline KOOS QoL subscale and the risk of PCL-R failure (odds ratio [OR] 0.74, 95% CI 0.57-0.97; p=0.027). There was a positive association between traffic-related injury mechanism and PCL-R failure risk with univariable analysis (OR 3.11, 95% CI: 1.48-6.50, p=0.0026), with further positive association shown with the adjusted (OR 6.08, 95% CI: 2.00-18.50; p=0.0015) and multivariable (OR 6.11, 95% CI: 2.01-18.55; p=0.0014) models. An area under the curve (AUC) of 0.70 (95% CI: 0.60-0.80) was reported for the final multivariable logistic regression model.

Conclusion

A high rate of short-term clinical failure (45%) was seen in patients with isolated PCL-R. Traffic-related injury was associated with increased odds of total 2-year isolated primary PCL-R failure. Clinicians treating patients with isolated PCL-R should be aware of a greater than 6-fold increased odds of revision surgery and inferior knee-related quality of life associated with a traffic-related injury mechanism during the short-term follow-up, and counsel patients with respect to short-term postoperative expectations and the high risk of inferior knee-related quality of life.

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Injury Mechanism is Related to Short-Term Treatment Failure After Primary Isolated PCL Reconstruction: A Study From the Swedish and Norwegian Knee Ligament Registries

Injury Mechanism is Related to Short-Term Treatment Failure After Primary Isolated PCL Reconstruction: A Study From the Swedish and Norwegian Knee Ligament Registries

Background

Methods

Results

Conclusion

Multi-Ligament Knee Injury ePosters

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Injury Mechanism is Related to Short-Term Treatment Failure After Primary Isolated PCL Reconstruction: A Study From the Swedish and Norwegian Knee Ligament Registries

Injury Mechanism is Related to Short-Term Treatment Failure After Primary Isolated PCL Reconstruction: A Study From the Swedish and Norwegian Knee Ligament Registries

Background

Methods

Results

Conclusion