Eur J Orthop Surg Traumatol. 2025 Sep 11;35(1):391. doi: 10.1007/s00590-025-04516-w.
ABSTRACT
BACKGROUND AND OBJECTIVE: Multi-ligament knee injuries (MLKIs) are debilitating injuries, often managed with surgical reconstruction. Our purpose was to determine whether acute or delayed reconstruction led to better functional and patient-reported outcomes.
MATERIALS AND METHODS: An institutional dataset was queried for patients who underwent MLKI reconstruction from 2012 to 2019 and completed postoperative functional and patient-reported outcome surveys with minimum 2-year follow-up. Exclusion criteria included single ligament reconstruction, revision surgery, and periarticular tumors. Patient-reported outcomes measurement system (PROMIS) and multi-ligament quality of life (ML-QoL) outcomes were compared between patients who underwent acute (< 2 weeks) and delayed (> 2 weeks) reconstruction.
RESULTS: Thirty-three patients were included for analysis (16 acute, 17 delayed): mean follow-up 3.6 years, mean BMI 29.8 ± 5.9, mean age 37.7 ± 13.5, sex: 19(58%) females, 14(42%) males. At final follow-up, there was no statistical difference between groups in most PROMIS scores, including Lysholm knee score (63 vs. 72, p = 0.13), pain (53 vs. 47, p = 0.11), or mobility (45 vs. 49, p = 0.18). Patients who underwent delayed reconstruction demonstrated significantly higher physical function scores (46 vs. 53, p = 0.05). There was no statistical difference in majority of ML-QoL scores, including physical impairments (42 vs. 29, p = 0.09), emotional impairments (45 vs. 30, p = 0.12), and societal involvement (38 vs. 24, p = 0.09). Patients who underwent acute reconstruction reported statistically greater activity limitations than delayed reconstruction (36 vs. 21, p = 0.02). There were no significant differences in complication rates between groups.
CONCLUSION: Delayed MLKI reconstruction had comparable results to acute reconstruction for PROMIS and ML-QoL outcomes, and had greater physical function and lower activity limitation postoperatively. These data demonstrate that delayed reconstruction may be an appropriate management option for MLKI reconstruction.
LEVEL OF EVIDENCE: Level III, Retrospective Cohort study.
PMID:40932627 | DOI:10.1007/s00590-025-04516-w
