Comparative Success of Repair Versus Reconstruction for Knee Extra-articular Ligament Injuries

• Published in: Orthopaedic journal of sports medicine 2023-01, Vol.11 (1), p.23259671221143539
• Main Authors: Kahan, Joseph B., Burroughs, Patrick, Mclaughlin, William M., Schneble, Christopher A., Moran, Jay, Joo, Peter Y., Modrak, Maxwell, Richter, Dustin L., Wascher, Daniel, Treme, Gehron P., Schenck, Robert C., Grauer, Jonathan N., Medvecky, Michael J.
• Format: Article
• Language: English
• Subjects: Hypotheses; Joint and ligament injuries; Knee; Orthopedics; Sports medicine; Surgery
• ISSN: 2325-9671; 2325-9671
• DOI: 10.1177/23259671221143539

Background: Surgical techniques and associated outcomes in treating acute and chronic extra-articular ligament knee injuries are in evolution, and there is question as to whether repair or reconstruction is optimal. Purpose/Hypothesis: The purpose of this study was to compare the subsequent surgery rate between surgical repair versus reconstruction for all extra-articular ligament injuries of the knee utilizing a large database. Our hypothesis was that overall surgical repair of both lateral and medial extra-articular knee injuries would have a higher revision rate than those treated by reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: The PearlDiver Mariner data set (2010-2019), with 122 million patients, was utilized to generate 2 patient cohorts: those who underwent surgical repair and those who underwent surgical reconstruction of a knee extra-articular ligament injury. All patients had a minimum of 2 years follow-up. Rates of concomitant or subsequent cruciate ligament reconstruction and rates of secondary procedures were assessed and compared between the 2 cohorts. Results: In total, 3563 patients were identified: extra-articular ligament reconstruction was performed for 2405 (67.5%), and repair was performed for 1158 (32.5%). Cruciate ligament reconstruction was performed for 986 (27.7%), of which 888 of 986 (90.1%) were performed on the same day as their extra-articular ligament procedure. At 2-year follow-up, the reconstruction cohort had higher rates of revision surgery compared with the repair cohort (8.2% vs 2.5%; P < .001). Conclusion: Using a large national database, knee extra-articular ligamentous reconstructions (those on both the lateral and the medial side) had a 3.3 times higher rate of revision surgery compared with repair at 2-year follow-up. Further study is needed to investigate the causes leading to revision surgery and to determine the optimal surgical treatment for both medial and lateral extra-articular knee ligament injuries.