Use of Internal Bracing in Multi-ligamentous Knee Injury Reconstruction: A Systematic Review.

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Abstract

Conflict of interest statement: Conflict of interestThe authors declare that they have no conflict of interest. 7. Knee. 2017 Oct;24(5):909-916. doi: 10.1016/j.knee.2017.06.011. Epub 2017 Jul 14. Early or delayed reconstruction in multi-ligament knee injuries: A systematic review and meta-analysis. Hohmann E(1), Glatt V(2), Tetsworth K(3). Author information: (1)Medical School, University of Queensland, Australia; Medical School, University of Pretoria, South Africa. Electronic address: ehohmann@houstonmethodist.org. (2)Department of Orthopaedic Surgery, University of Texas Health Center, San Antonio, TX, USA. (3)Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia; Department of Surgery, School of Medicine, University of Queensland, Australia; Queensland University of Technology, Australia; Orthopaedic Research Institute of Australia, Australia. BACKGROUND: Whether early or delayed surgical intervention in patients with multi-ligament injuries results in better outcomes, is of current and controversial debate. PURPOSE: The purpose of this study was to perform a meta-analysis comparing early versus late surgical treatment of multi-ligament knee injuries. METHODS: We performed a systematic review of Medline, Embase, Scopus, and Google Scholar to identify relevant studies in the English and German literature. Eligibility criteria included studies comparing early or delayed surgical interventions for multi-ligament knee injuries, with a minimum follow-up of two years, reporting the primary clinical outcome using a validated functional scoring system and range of motion. Exclusion criteria were patients treated with multi-trauma, head injury, non-union, lower extremity fractures, or a documented history of previous knee injuries. Publication bias was assessed by funnel plot, and the risk of bias was established using the Cochrane Collaboration's risk of bias tool. Heterogeneity was assessed using χ2 and I2 statistic. RESULTS: Eight studies (n=260 patients) were included in the analysis. 149 patients were treated early with a mean of 10.6days; 111 patients were treated late with a mean of 294days. The pooled estimate for clinical outcome demonstrated that early surgery resulted in significantly higher Lysholm scores (SMD 0.669, 95% CI: 0.379 to 0.959, p=0.0001, I2=0%). Thirty-one per cent of all patients with early surgery had a normal or near normal knee, whereas only 15% of patients with late reconstruction reported the knee to be normal or near normal. The pooled estimates for total ROM did not demonstrate a significant difference between the groups (SMD 0.113, 95% CI: -0.271 to 0.498, p=0.564, I2=35.57%). CONCLUSIONS: The results of this meta-analysis suggest that early surgical intervention in multi-ligament injuries of the knee produces a significantly superior clinical outcome, compared to late reconstruction. Although an overall trend of improved total range of knee motion was also demonstrated, this was very small and unlikely to be clinically relevant. LEVEL OF EVIDENCE: Level 4; Systematic review and meta-analysis. Copyright © 2017 Elsevier B.V. All rights reserved. DOI: 10.1016/j.knee.2017.06.011