The aim of this study was to evaluate the incidence of knee osteoarthritis, failure rate of reconstruction and clinical outcomes of patients with chronic multi-ligament knee injuries subjected to surgical treatment.
Sixty-two patients with chronic knee dislocation subjected to multiligament reconstruction between April 2008 and July 2016 were evaluated, with a minimum follow-up of 24 months. Anteroposterior and lateral radiographs were performed in the pre- and last postoperative evaluation; the progression of degenerative changes according to the Kellgren-Lawrence classification (KL) was assessed. The Schenck classification, Knee Injury and Osteoarthritis Outcome Score (KOOS), time between injury and surgery, type of post-operative rehabilitation protocol (brace versus external fixator) and physical examination for ligament instability were also evaluated. Univariate and multivariate analysis were performed, p<0.05 was considered significant.
Fifty-two (83.9%) patients were men and 16.1% (n=10) were women, with a mean age of 38.8 ± 1.3 years. The time from injury to surgery was 31.1 ± 6.1 months, and the follow-up time was 6.1 ± 0.5 years. The mean final KOOS was 79.3 ± 10.4 and the overall reconstruction failure occurred in 25.8%. Of all patients, 64.5% (n=40) presented a KL classification of =2 and were defined as having radiographic osteoarthritis (OA). As 11.7% (n=7) also presented arthritis in the contralateral knee, in 53.2% (n=33) the progression was most likely due to the initial injury. The failure of ligament reconstruction or residual instability was present in 15 (35,7%) of patients with OA and only one patient (4,5%) without OA. In the multivariate analysis, only reconstruction failure was an independent predictor of OA (O.R.=13.2 [p=0.028]).
There is a high incidence of knee OA following ligament reconstruction for chronic multi-ligament knee injuries. Ligament reconstruction failure was the only independent predictor for the development of OA in our study.