Association of surgical timing and operative outcomes in multiple ligaments knee injuries: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

MAO Yunhe ¹ , TANG Jiexi ² , LI Jian ¹ ,  FU Weili ¹ , ZHENG Jun ³ , YANG Yuan ³ , XIONG Yan ¹ , LI Qi ¹ , CHEN Gang ¹ , TANG Xin ¹

1. Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. West China School of Medicine, Sichuan University, Chengdu, 610207, P.R.China;
3. Neurosurgery Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

FU Weili, Email: foxwin2008@163.com

Keywords：

Multiple ligament injuries of knee; Early surgery; Delayed surgery; Curative effect; Systematic review; Meta-analysis; Cohort study

DOI：

10.7507/1672-2531.201810001

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Objectives To systematically review the differences of operative outcomes between early surgery and delayed surgery in multiple ligament injury of knee joint (MLIK) patients.Methods PubMed, The Cochrane Library, EMbase, CNKI, CBM, WanFang Data and VIP databases were searched to collect cohort studies about operative outcomes of different surgery times in MLIK patients from inception to September 23^rd, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.Results A total of 8 cohort studies involving 153 early and 90 delayed operatively treated patients were included. The results of meta-analysis showed that: compared with delayed surgery, early surgery received higher Lysholm score (MD=7.52, 95%CI 2.00 to 13.04, P=0.008) and superior IKDC score rate (OR=2.97, 95%CI 1.51 to 5.84, P=0.002). There were no significant differences in Tegner score (MD=–0.08, 95%CI –1.07 to 0.92, P=0.88) and ROM (MD=4.08, 95%CI –2.38 to 10.55, P=0.22) between two groups. The main adverse reactions of MLIK included neurovascular injury, deep venous thrombosis of lower extremities, common peroneal nerve injury, tourniquet paralysis and limited joint activity. Early surgery had a lower incidence of complications than delayed surgery (7.1% vs. 30%).Conclusion The current evidence shows that early surgery can receive higher Lysholm score and superior IKDC score rate in treatment of MLIK, and have a lower incidence of complications. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.

Citation： MAO Yunhe, TANG Jiexi, LI Jian, FU Weili, ZHENG Jun, YANG Yuan, XIONG Yan, LI Qi, CHEN Gang, TANG Xin. Association of surgical timing and operative outcomes in multiple ligaments knee injuries: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(4): 418-423. doi: 10.7507/1672-2531.201810001 Copy

1.	Levy BA, Fanelli GC, Whelan DB, et al. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg, 2009, 17(4): 197-206.
2.	Mook WR, Miller MD, Diduch DR, et al. Multiple-ligament knee injuries: a systematic review of the timing of operative intervention and postoperative rehabilitation. J Bone Joint Surg Am, 2009, 91(12): 2946-2957.
3.	Schenck RC Jr. The dislocated knee. Instr Course Lect, 1994, 43: 127-136.
4.	Levy BA, Dajani KA, Whelan DB, et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy, 2009, 25(4): 430-438.
5.	Howells NR, Brunton LR, Robinson J, et al. Acute knee dislocation:an evidence based approach to the management of the multiligament injured knee. Injury, 2011, 42(11): 1198-1204.
6.	Fanelli GC, Stannard JP, Stuart MJ, et al. Management of complex knee ligament injuries. J Bone Joint Surg Am, 2010, 92(12): 2235-2246.
7.	Schenck R. Classification of knee dislocations. Oper Tech Sports Med, 2003, 11: 193-198.
8.	Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction. Arthroscopy, 1996, 12(5): 521-530.
9.	Peskun CJ, Whelan DB. Outcomes of operative and nonoperative treatment of multiligament knee injuries: an evidence-based review. Sports Med Arthrosc Rev, 2011, 19(2): 167-173.
10.	Wright RW. Knee injury outcomes measures. J Am Acad Orthop Surg, 2009, 17(1): 31-39.
11.	Bin SI, Nam TS. Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation. Arthroscopy, 2007, 23(10): 1066-1072.
12.	Zhao J, Huangfu X, He Y, et al. Simultaneous double-bundle anterior cruciate ligament and posterior cruciate ligament reconstruction with autogenous hamstring tendons. Arthroscopy, 2008, 24(11): 1205-1213.
13.	Tzurbakis M, Diamantopoulos A, Xenakis T, et al. Surgical treatment of multiple knee ligament injuries in 44 patients: 2-8 years follow-up results. Knee Surg Sports Traumatol Arthrosc, 2006, 14(8): 739-749.
14.	Harner CD, Waltrip RL, Bennett CH, et al. Surgical management of knee dislocations. J Bone Joint Surg Am, 2004, 86-A(2): 262-273.
15.	Fanelli GC, Edson CJ. Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2-to 10-year follow-up. Arthroscopy, 2004, 20(4): 339-345.
16.	Wascher DC, Becker JR, Dexter JG, et al. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts. Am J Sports Med, 1999, 27(2): 189-196.
17.	Liow RY, McNicholas MJ, Keating JF, et al. Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg Br, 2003, 85(6): 845-851.
18.	Stannard JP, Brown SL, Farris RC, et al. The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med, 2005, 33(6): 881-888.
19.	Ríos A, Villa A, Fahandezh H, et al. Results after treatment of traumatic knee dislocations: a report of 26 cases. J Trauma, 2003, 55(3): 489-494.
20.	毕海勇, 孙秀江, 慕宏杰, 等. 膝关节脱位早期与延期手术疗效分析. 中华损伤与修复杂志 (电子版), 2010, 5(5): 629-636.
21.	邬春虎, 宋登峰, 张笑峰, 等. 分期治疗膝关节多发伤 22 例. 武警医学, 2014, 25(1): 87-88.
22.	李维礼, 赵崎慧, 李笑雨, 等. 关节镜下重建治疗膝关节多发韧带损伤的临床观察. 临床和实验医学杂志, 2018, 17(1): 80-83.
23.	Dwyer T, Marx RG, Whelan D. Outcomes of treatment of multiple ligament knee injuries. J Knee Surg, 2012, 25(4): 317-326.
24.	Howells NR, Brunton LR, Robinson J, et al. Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee. Injury, 2011, 42(11): 1198-1204.
25.	McKee L, Ibrahim MS, Lawrence T, et al. Current concepts in acute knee dislocation. The missed diagnosis? Open Orthop J, 2014, 8(Suppl 1): 162-167.
26.	Richter M, Bosch U, Wippermann B, et al. Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med, 2002, 30(5): 718-727.
27.	吴泰相, 刘关键, 赵娜, 等. 观察性研究系统评价/Meta 分析的方法. 中国循证医学杂志, 2004, 4(5): 337-341.
28.	商洪才, 卞兆祥. 随机对照实况试验的概念、设计和实施. 中国循证医学杂志, 2009, 9(12): 1277-1280.

1. Levy BA, Fanelli GC, Whelan DB, et al. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg, 2009, 17(4): 197-206.
2. Mook WR, Miller MD, Diduch DR, et al. Multiple-ligament knee injuries: a systematic review of the timing of operative intervention and postoperative rehabilitation. J Bone Joint Surg Am, 2009, 91(12): 2946-2957.
3. Schenck RC Jr. The dislocated knee. Instr Course Lect, 1994, 43: 127-136.
4. Levy BA, Dajani KA, Whelan DB, et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy, 2009, 25(4): 430-438.
5. Howells NR, Brunton LR, Robinson J, et al. Acute knee dislocation:an evidence based approach to the management of the multiligament injured knee. Injury, 2011, 42(11): 1198-1204.
6. Fanelli GC, Stannard JP, Stuart MJ, et al. Management of complex knee ligament injuries. J Bone Joint Surg Am, 2010, 92(12): 2235-2246.
7. Schenck R. Classification of knee dislocations. Oper Tech Sports Med, 2003, 11: 193-198.
8. Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction. Arthroscopy, 1996, 12(5): 521-530.
9. Peskun CJ, Whelan DB. Outcomes of operative and nonoperative treatment of multiligament knee injuries: an evidence-based review. Sports Med Arthrosc Rev, 2011, 19(2): 167-173.
10. Wright RW. Knee injury outcomes measures. J Am Acad Orthop Surg, 2009, 17(1): 31-39.
11. Bin SI, Nam TS. Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation. Arthroscopy, 2007, 23(10): 1066-1072.
12. Zhao J, Huangfu X, He Y, et al. Simultaneous double-bundle anterior cruciate ligament and posterior cruciate ligament reconstruction with autogenous hamstring tendons. Arthroscopy, 2008, 24(11): 1205-1213.
13. Tzurbakis M, Diamantopoulos A, Xenakis T, et al. Surgical treatment of multiple knee ligament injuries in 44 patients: 2-8 years follow-up results. Knee Surg Sports Traumatol Arthrosc, 2006, 14(8): 739-749.
14. Harner CD, Waltrip RL, Bennett CH, et al. Surgical management of knee dislocations. J Bone Joint Surg Am, 2004, 86-A(2): 262-273.
15. Fanelli GC, Edson CJ. Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2-to 10-year follow-up. Arthroscopy, 2004, 20(4): 339-345.
16. Wascher DC, Becker JR, Dexter JG, et al. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts. Am J Sports Med, 1999, 27(2): 189-196.
17. Liow RY, McNicholas MJ, Keating JF, et al. Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg Br, 2003, 85(6): 845-851.
18. Stannard JP, Brown SL, Farris RC, et al. The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med, 2005, 33(6): 881-888.
19. Ríos A, Villa A, Fahandezh H, et al. Results after treatment of traumatic knee dislocations: a report of 26 cases. J Trauma, 2003, 55(3): 489-494.
20. 毕海勇, 孙秀江, 慕宏杰, 等. 膝关节脱位早期与延期手术疗效分析. 中华损伤与修复杂志 (电子版), 2010, 5(5): 629-636.
21. 邬春虎, 宋登峰, 张笑峰, 等. 分期治疗膝关节多发伤 22 例. 武警医学, 2014, 25(1): 87-88.
22. 李维礼, 赵崎慧, 李笑雨, 等. 关节镜下重建治疗膝关节多发韧带损伤的临床观察. 临床和实验医学杂志, 2018, 17(1): 80-83.
23. Dwyer T, Marx RG, Whelan D. Outcomes of treatment of multiple ligament knee injuries. J Knee Surg, 2012, 25(4): 317-326.
24. Howells NR, Brunton LR, Robinson J, et al. Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee. Injury, 2011, 42(11): 1198-1204.
25. McKee L, Ibrahim MS, Lawrence T, et al. Current concepts in acute knee dislocation. The missed diagnosis? Open Orthop J, 2014, 8(Suppl 1): 162-167.
26. Richter M, Bosch U, Wippermann B, et al. Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med, 2002, 30(5): 718-727.
27. 吴泰相, 刘关键, 赵娜, 等. 观察性研究系统评价/Meta 分析的方法. 中国循证医学杂志, 2004, 4(5): 337-341.
28. 商洪才, 卞兆祥. 随机对照实况试验的概念、设计和实施. 中国循证医学杂志, 2009, 9(12): 1277-1280.

Chinese Journal of Evidence-Based Medicine

Association of surgical timing and operative outcomes in multiple ligaments knee injuries: a meta-analysis

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