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Concomitant periarticular fractures predict worse patient-reported outcomes in multiligament knee injuries: a matched cohort study

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Aim

There is a shortage of high-level evidence regarding periarticular fractures affect outcomes after MLKIs. The purpose of this study was to determine whether concomitant periarticular fractures with mutliligament knee injuries (MLKIs) predict worse patient-reported outcomes (PROMs) when compared to MLKIs without concomitant periarticular fractures after surgical repair and/or reconstruction.

Materials and methods

Medical records of patients who sustained MLKIs from January 1, 2009 to June 1, 2014 were retrospectively reviewed. All patients aged 18–65 years with grade III injuries of two or more knee ligaments and 1-year minimum follow-up were included. Patients with injuries or surgeries to either knee before their MLKIs were excluded. Radiographs and computed tomography imaging obtained at the time of injury were used to detect concomitant periarticular fractures. Patients with and without concomitant periarticular fractures were matched on a 1:2 basis, respectively. Multiple PROMs were collected, including the IKDC Subjective Knee Form (IKDC-SKF), and Knee Injury and Osteoarthritis Outcome Score (KOOS). The independent t-test was used to compare PROMs between patients with and without periarticular fractures.

Results

Eighteen patients (10 males, 8 females) with a mean follow-up of 4.0 years (range 1.1–8.6 years) were included in the final analysis, with six patients having MLKIs and concomitant periarticular fractures. Compared to patients with isolated ligamentous MLKIs (n   =  12), patients with concomitant periarticular fracture (n = 6) demonstrated significantly worse outcomes on the IKDC-SKF (54.2 ± 13.3 vs. 74.0 ± 19.6, p = 0.04) and KOOS-Sports and Recreation subscale (41.2 ± 32.4 vs. 70.8 ± 19.4, p = 0.03).

Conclusion

The presence of a periarticular fracture predicted significantly worse clinical outcomes in the setting of MLKI. These findings may be useful in determining the prognosis of MLKI with concomitant periarticular fractures treated with surgical repair and/or reconstruction.

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Acknowledgements

The support of the Albert B. Ferguson, Jr. MD Orthopaedic Fund is gratefully acknowledged.

Funding

The support of the Albert B. Ferguson, Jr. MD Orthopaedic Fund is gratefully acknowledged.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3200 S Water Street, Pittsburgh, PA, 15203, USA

    Andrew J. Sheean, James J. Irrgang & Volker Musahl

  2. Department of Orthopedic Surgery, NYU Langone Medical Center, 301 E 17th St, New York, NY, 10003, USA

    Ajay C. Kanakamedala & Michael J. Alaia

Authors
  1. Ajay C. Kanakamedala
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  2. Andrew J. Sheean
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  3. Michael J. Alaia
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  4. James J. Irrgang
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  5. Volker Musahl
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Contributions

ACK participated in the acquisition and statistical analysis of all data. ACK, AJS, MJA, JJI, and VM participated in the interpretation of all data. ACK drafted the original manuscript. ACK, AJS, MJA, JJI, and VM participated in the revision of the original manuscript. ACK, JJI, and VM were responsible for the conception and design of the original study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Volker Musahl.

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The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. IRB approval (PRO13080061) was obtained prior to commencing the study.

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Informed consent was obtained from all individual participants included in the study.

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Kanakamedala, A.C., Sheean, A.J., Alaia, M.J. et al. Concomitant periarticular fractures predict worse patient-reported outcomes in multiligament knee injuries: a matched cohort study. Arch Orthop Trauma Surg 140, 1633–1639 (2020). https://doi.org/10.1007/s00402-020-03344-3

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