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Epidemiology of Multiligament Knee Reconstruction

  • Symposium: Management of the Dislocated Knee
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The multiple-ligament-injured knee represents a special challenge, being an uncommon injury that is both severe and complicated to treat. Many studies have evaluated patients treated for this injury, but most are limited in their scope. The evaluation of this injury and its treatment using an administrative database might provide a different perspective.

Questions/purposes

Using a large administrative database, we determined (1) the number of multiligament knee reconstructions in New York State, (2) the rate of 90-day hospital readmission, and (3) the frequency of subsequent knee surgery. We examined the rates of these outcomes as a function of diagnosis, admission type, discharge status, comorbidity burden, and patient demographic factors.

Methods

We used the New York Department of Health Statewide Planning and Research Cooperative System (SPARCS), a database with information on patient characteristics, diagnoses, and treatments, to identify patients who underwent a multiligament procedure in a nonfederal facility from 1997 to 2005 using ICD-9-CM and Current Procedural Terminology codes. SPARCS collects data from all nonfederal acute care facilities, with an estimated reporting completeness of almost 99% for the years in this study. We evaluated data on patient age, sex, admission type, discharge status, and comorbidity burden (using Elixhauser comorbidities) and developed a multivariable logistic regression model to assess the influence of confounding variables.

Results

We identified 1032 patients in this database who underwent multiligament knee reconstruction in New York State from 1997 to 2005. The frequency of readmission within 90 days was 4.8% (n = 49). Readmission was more likely for patients who underwent inpatient multiligament reconstruction (odds ratio [OR] = 2.3; 95% CI: 1.2–4.4; p = 0.014), had a diagnosis of dislocation (OR = 2.2; 95% CI: 1.2–3.9; p = 0.011), or had various Elixhauser comorbidities, including chronic lung disease (OR = 6.4; 95% CI: 1.5–27.2; p = 0.013), fluid and electrolyte disorders (OR = 19.7; 95% CI: 2.5–155.7; p = 0.005), and anemia deficiency (OR = 5.6; 95% CI: 1.05–29.4; p = 0.044). Two hundred eighty-seven patients (28%) underwent subsequent knee surgery between their index procedure and 2006. Subsequent surgery was more likely for patients who underwent inpatient multiligament reconstruction (OR = 1.4; 95% CI: 1.1–1.9; p = 0.011) or were readmitted within 90 days of the index surgery (OR = 4.2; 95% CI: 2.3–7.6; p < 0.001).

Conclusions

Our findings have the potential to aid clinicians in identifying their patients with multiligament reconstruction at highest risk for 90-day readmission and subsequent knee surgery. Future research, particularly large prospective studies evaluating surgical approaches and timing, will be critical in advancing the treatment of multiligament knee injuries.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Healthcare Research and Policy, Weill Cornell Medical College, New York, NY, USA

    Hassan Ghomrawi PhD

  2. Weill Cornell Medical College, New York, NY, USA

    Sean M. Wilson BA

  3. Healthcare Research Institute, Hospital for Special Surgery, New York, NY, USA

    Nabil Mehta BSE, Huong T. Do MA & Stephen Lyman PhD

  4. Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Robert G. Marx MD, MSc, FRCSC

Authors
  1. Sean M. Wilson BA
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  2. Nabil Mehta BSE
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  3. Huong T. Do MA
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  4. Hassan Ghomrawi PhD
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  5. Stephen Lyman PhD
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  6. Robert G. Marx MD, MSc, FRCSC
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Corresponding author

Correspondence to Robert G. Marx MD, MSc, FRCSC.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Hospital for Special Surgery, New York, NY, USA.

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Wilson, S.M., Mehta, N., Do, H.T. et al. Epidemiology of Multiligament Knee Reconstruction. Clin Orthop Relat Res 472, 2603–2608 (2014). https://doi.org/10.1007/s11999-014-3653-3

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  • DOI: https://doi.org/10.1007/s11999-014-3653-3

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