BACKGROUND The purpose of this study was to compare outcomes following early compared with delayed reconstruction in patients with multiligament knee injury (MLKI). METHODS A retrospective cohort analysis of patients with MLKI from 2007 to 2019 was conducted. Patients who underwent a reconstructive surgical procedure with ≥12 months of postoperative follow-up were included. Patients were stratified into early reconstruction (<6 weeks after the injury) and delayed reconstruction (12 weeks to 2 years after the injury). Multivariable regression models with inverse probability of treatment weighting (IPTW) were utilized to compare the timing of the surgical procedure with the primary outcome (the Multiligament Quality of Life questionnaire [MLQOL]) and the secondary outcomes (manipulation under anesthesia [MUA], Kellgren-Lawrence [KL] osteoarthritis grade, knee laxity, and range of motion). RESULTS A total of 131 patients met our inclusion criteria, with 75 patients in the early reconstruction group and 56 patients in the delayed reconstruction group. The mean time to the surgical procedure was 17.6 days in the early reconstruction group compared with 280 days in the delayed reconstruction group. The mean postoperative follow-up was 58 months. The early reconstruction group, compared with the delayed reconstruction group, included more lateral-sided injuries (49 patients [65%] compared with 23 [41%]; standardized mean difference [SMD], 0.44) and nerve injuries (36 patients [48%] compared with 9 patients [16%]; SMD, 0.72), and had a higher mean Schenck class (SMD, 0.57). After propensity adjustment, we found no difference between early and delayed reconstruction across the 4 MLQOL domains (p > 0.05). Patients in the early reconstruction group had higher odds of requiring MUA compared with the delayed reconstruction group (24 [32%] compared with 8 [14%]; IPTW-adjusted odds ratio [OR], 3.85 [95% confidence interval (CI), 2.04 to 7.69]; p < 0.001) and had less knee flexion at the most recent follow-up (β, 6.34° [95% CI, 0.91° to 11.77°]; p = 0.023). Patients undergoing early reconstruction had lower KL osteoarthritis grades compared with patients in the delayed reconstruction group (OR, 0.46 [95% CI, 0.29 to 0.72]; p < 0.001). There were no differences in clinical laxity between groups. CONCLUSIONS Early reconstruction of MLKIs likely increases the likelihood of postoperative arthrofibrosis compared with delayed reconstruction, but it may be protective against the development of osteoarthritis. When considering the timing of MLKI reconstruction, surgeons should consider the benefit that early reconstruction may convey on long-term outcomes but should caution patients regarding the possibility of requiring an MUA. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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膝关节多韧带损伤的早期与延迟重建相比：回顾性倾向分析。


背景 本研究的目的是比较膝关节多韧带损伤 （MLKI） 患者早期重建与延迟重建后的结果。方法 对 2007年至 2019 年 MLKI 患者进行回顾性队列分析。纳入接受重建外科手术且术后随访 ≥12 个月的患者。将患者分为早期重建 （受伤后 <6 周） 和延迟重建 （受伤后 12 周至 2 年）。使用具有治疗加权逆概率 （IPTW） 的多变量回归模型将外科手术的时间与主要结局 （多韧带生活质量问卷 [MLQOL]）和次要结局 （麻醉下操作 [MUA] 、Kellgren-Lawrence [KL] 骨关节炎等级、膝关节松弛度和活动范围）进行比较。结果 共有 131 例患者符合我们的纳入标准，其中早期重建组 75 例，延迟重建组 56 例。早期重建组的平均手术时间为 17.6 天，而延迟重建组为 280 天。平均术后随访时间为 58 个月。与延迟重建组相比，早期重建组包括更多的侧侧损伤 （49 例患者 [65% ] 对 23 例 [41%];标准化均数差 [SMD]，0.44）和神经损伤 （36 例患者 [48%] 对 9 例患者 [16%];SMD，0.72），平均 Schenck 等级较高 （SMD，0.57）。倾向调整后，我们发现 4 个 MLQOL 结构域的早期重建和延迟重建之间没有差异 （p > 0.05）。 与延迟重建组相比，早期重建组患者需要 MUA 的几率更高 （24 [32%] 对 8 [14%];IPTW 调整比值比 [OR]，3.85 [95% 置信区间 （CI），2.04 至 7.69];p < 0.001），并且在最近的随访中膝关节屈曲较少 （β，6.34° [95% CI，0.91° 至 11.77°];p = 0.023）。与延迟重建组患者相比，接受早期重建的患者 KL 骨关节炎分级较低 （OR，0.46 [95% CI，0.29 至 0.72];p < 0.001）。两组间临床松弛度无差异。结论 与延迟重建相比，MLKIs 的早期重建可能会增加术后关节纤维化的可能性，但它可能对骨关节炎的发展有保护作用。在考虑 MLKI 重建的时间时，外科医生应考虑早期重建可能对长期结局的好处，但应提醒患者可能需要 MUA。证据级别 治疗 III 级。有关证据级别的完整描述，请参阅作者说明。