Delayed multiligament PCL reconstruction is associated with a higher prevalence of intraarticular injury and may influence treatment

• Published in: BMC musculoskeletal disorders 2023-06, Vol.24 (1), p.502-502, Article 502
• Main Authors: Zsidai, Bálint, Engler, Ian D, Narup, Eric, Lin, Ryan T, Nazzal, Ehab M, Winkler, Philipp W, Samuelsson, Kristian, Irrgang, James J, Musahl, Volker
• Format: Article
• Language: English
• Subjects: Anterior Cruciate Ligament Injuries - complications; Arthroplasty; Care and treatment; Complications; Complications and side effects; Health aspects; Humans; Injuries; Knee; Knee Injuries - complications; Knee Injuries - epidemiology; Knee Injuries - surgery; Knee injury; Knee Joint - surgery; Menisci, Tibial - surgery; Meniscus tear; Multiligament; Patient outcomes; PCL; Posterior cruciate ligament; Posterior Cruciate Ligament - surgery; Prevalence; Retrospective Studies; Statistics; Surgery; Surgical timing
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-023-06638-w

The aim of this study was to investigate differences in concomitant injury patterns and their treatment in patients undergoing early (≤ 12 weeks) and delayed (> 12 weeks) primary multiligament posterior cruciate ligament (PCL) reconstruction (PCL-R). This study was a retrospective chart review of patients undergoing primary multiligament PCL-R at a single institution between 2008 and 2020. Multiligament PCL-R was defined as PCL-R and concurrent surgical treatment of one or more additional knee ligament(s). Exclusion criteria included isolated PCL-R, PCL repair, and missing data for any variable. Patients were dichotomized into early (≤ 12 weeks) and delayed (> 12 weeks) PCL-R groups based on the time elapsed between injury and surgery. Between-group comparison of variables were conducted with the Chi-square, Fisher's exact, and independent samples t-tests. A total of 148 patients were eligible for analysis, with 57 (38.5%) patients in the early and 91 (61.1%) patients in the delayed multiligament PCL-R groups. Concomitant LCL/PLC reconstruction (LCL-R/PLC-R) was performed in 55 (60%) of delayed multiligament PCL-Rs and 23 (40%) of early PCL-Rs (p = 0.02). Despite similar rates of meniscus injury, concomitant meniscus surgery was significantly more prevalent in the early (n = 25, 44%) versus delayed (n = 19, 21%) multiligament PCL-R group (p = 0.003), with a significantly greater proportion of medial meniscus surgeries performed in the early (n = 16, 28%) compared to delayed (n = 13, 14%) PCL-R group (p = 0.04). The prevalence of knee cartilage injury was significantly different between the early (n = 12, 24%) and delayed (n = 41, 46%) multiligament PCL-R groups (p = 0.01), with more frequent involvement of the lateral (n = 17, 19% vs. n = 3, 5%, respectively; p = 0.04) and medial (n = 31, 34% vs. n = 6, 11%, respectively; p = 0.005) femoral condyles in the delayed compared to the early PCL-R group. Given higher rates of chondral pathology and medial meniscus surgery seen in delayed multiligament PCL-R, early management of PCL-based multiligament knee injury is recommended to restore knee stability and potentially prevent the development of further intraarticular injury. Level III.