2017 ISAKOS Biennial Congress ePoster #1803
Factors Influencing Return to Sport or Return to Work after a Multiligament Knee Injury
Radhika Chalasani, MS, Delaware, Ohio UNITED STATES
David C. Flanigan, MD, Columbus, OH UNITED STATES
Robert A. Magnussen, MD, MPH, Columbus, OH UNITED STATES
Travis Frantz, MD, Columbus, OH UNITED STATES
Joshua Everhart, MD, MPH, Columbus, OH UNITED STATES
The Ohio State University - College of Medicine, Columbus, Ohio, UNITED STATES
FDA Status Not Applicable
Systematic review of Factors Influencing Return to Sport or Return to Work after a Multiligament Knee Injury
Multiligament knee injury represents a spectrum of complex knee injuries; functional outcomes can range from mild impairment to severe disability. The objective of this study is to identify factors influencing the time to return to sport or return to work after a multiligament knee injury to help providers more effectively counsel patients early in the treatment process.
A systematic review of the literature was performed on the PubMed database available until January 2016 using keywords “knee dislocation” or “multiple ligament–injured knee” or “multiligament knee reconstruction", resulting in 1586 hits. Prospective and retrospective patient outcome studies reported in English were included. After a thorough review 84 articles were identified as pertinent. A database was created with data from the identified articles including summary and individual case information. We investigated the effect of age, surgical timing, injury mechanism, treatment strategy, ligaments involved, BMI, vascular involvement and nerve injury on functional outcomes including return to sport or return to work.
Surgical treatment was generally reported to be superior to non-operative treatment of knees with clinical instability. Rate of return to sport in non-operatively treated (31%) patients is reported to be abysmally low compared to those that are operatively treated (74%). Earlier surgical treatment (within 3 weeks) in patients without vascular injury was associated with improved outcomes. A higher grade injury as defined by the KD classification is associated with worse outcomes. Morbidly obese patients often had poor outcomes even with low energy injury mechanism or low KD injury grade. Both vascular and neurologic injury were associated with low rate of return to work or sport as well as chronic pain medicine requirement. Injuries that occurred in polytrauma patients often required longer rehabilitation and carried a significant financial burden. Also patients who suffered a multi-ligament injury due to a Road Transportation Accident (RTA) had lower rates of return to work or sport compared to someone who had a multi-ligament injury due to a sports injury.
Injury severity, patient demographics and presence of associated injuries influence outcomes following multiligament knee injury and should be considered when counselling patients on reasonable expectations for return to sport or return to work.