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Multi-ligament reconstructions as a risk factor for adverse outcomes in arthroscopic surgery

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

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.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, 259 E Erie Street, 13th Floor, Chicago, IL, 60611, USA

    Justin Kyhos, Daniel Johnson, Bejan Alvandi, Michael Terry & Vehniah Tjong

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  1. Justin Kyhos
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  2. Daniel Johnson
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  3. Bejan Alvandi
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  4. Michael Terry
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  5. Vehniah Tjong
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Correspondence to Vehniah Tjong.

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Kyhos, J., Johnson, D., Alvandi, B. et al. Multi-ligament reconstructions as a risk factor for adverse outcomes in arthroscopic surgery. Knee Surg Sports Traumatol Arthrosc 29, 1913–1919 (2021). https://doi.org/10.1007/s00167-020-06252-6

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  • DOI: https://doi.org/10.1007/s00167-020-06252-6

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