Purpose

Multi-ligament knee injuries are a serious consequence of knee dislocation with a poorly evaluated post-operative complication profile due to low incidence. The aim of this study is to assess the risk of adverse post-operative events associated with operative management of multi-ligament knee injuries.

Methods

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients undergoing surgical procedures for multi-ligament knee injuries from 2006 to 2016 using Current Procedural Terminology codes. We evaluated data on patient demographics and used a propensity score algorithm to adjust for baseline differences in these patients and developed univariate and multivariate logistic regression models to assess effects on minor and severe 30-day post-operative complications.

Results

We identified 444 patients in this database who underwent multi-ligament knee reconstructions between 2006 and 2016. After propensity matching, minor and major adverse post-operative events were more frequent in patients with multi-ligament knee injuries (1.4% vs 0.2%, p < 0.001 and 2.7% vs 1.1%, p = 0.002, respectively). Patients with multi-ligament knee injuries experienced a 55-fold increase risk of need for transfusion (p < 0.001) and a fivefold increased risk of pulmonary embolism (p = 0.025), with most occurring in bicruciate reconstructions (Schenck Classification KD-III and KD-IV injuries).

Conclusion

The surgical management of multi-ligament knee injuries confers significant increased risk of 30-day post-operative minor or severe adverse event over arthroscopic ACL reconstruction. These patients are most at risk for post-operative blood transfusion requirement, and pulmonary embolism, with patient’s undergoing surgery for bicruciate ligament injuries at particularly high risk of complication.

Level of evidence

IV.

中文翻译：

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多韧带重建术是关节镜手术不良结局的危险因素。

目的

多韧带膝关节损伤是膝关节脱位的严重后果，其术后并发症由于低发生率而评估不佳。这项研究的目的是评估与多韧带膝关节损伤的手术管理相关的不良术后事件的风险。

方法

美国外科医师学会国家外科手术质量改善计划（ACS-NSQIP）数据库用于使用当前程序术语代码识别2006年至2016年因多韧带膝关节损伤而接受外科手术的患者。我们评估了患者的人口统计学数据，并使用倾向评分算法调整了这些患者的基线差异，并开发了单因素和多因素逻辑回归模型来评估对轻度和重度术后30天并发症的影响。

结果

我们在该数据库中确定了444例在2006年至2016年之间进行多韧带膝关节重建的患者。在倾向匹配后，多韧带膝关节损伤患者的次要和主要不良术后事件更为频繁（1.4％vs 0.2％，p  <0.001和2.7％与1.1％，p  = 0.002）。患有多韧带膝关节损伤的患者发生输血的风险增加了55倍（p  <0.001），并且发生肺栓塞的风险增加了5倍（p  = 0.025），其中大部分发生在双十字形重建中（Schenck分类KD-III和KD-IV受伤）。

结论

与关节镜下ACL重建相比，多韧带膝关节损伤的手术治疗显着增加了术后30天轻微或严重不良事件的风险。这些患者的手术后输血和肺栓塞风险最高，患者接受手术治疗双韧带韧带损伤的并发症风险特别高。

证据水平

IV。