Multiligament knee surgical planning checklist: Introducing a conceptual shift in the reporting of surgical management protocols with mid-term outcomes.

BACKGROUND

Multiligament knee trauma is a heterogenous and exceptionally challenging area of knee-preserving surgery. Currently, there is a lack in reporting standards of treatment protocols and outcomes. The aim of this study is to present a novel way for reporting multiligament injury management protocols with their outcomes which could become a basis for future standardization.

METHODS

To address acute multiligament knee injury management, a lesion-specific surgical planning checklist was developed. Patients managed according to the checklist were evaluated at 4.5- to 10-year follow-up incorporating reported and disease-specific outcome scores alongside knee function measures. Descriptive statistics included means with standard deviations and medians with ranges. Tegner activity level at follow-up was compared to before the injury. Statistical significance threshold was set at 0.05.

RESULTS

Of 25 patients with multiligament injured knees treated between 2013 and 2020, the checklist was applicable to 17, which were managed early (i.e., within 3 weeks), of whom 15 were managed in accordance with the checklist items. Of these, 12 were evaluated at mid-term (12/15 = 80% follow-up rate). The follow-up International Knee Documentation Committee -subjective score was 75 ± 14, the Knee injury and Osteoarthritis Outcome Score-symptoms was 74 ± 17, KOOS-activities of daily living was 85 ± 15, KOOS-sports was 60 ± 28, the multiligament quality of life questionnaire-physical impairment score was 31 ± 20, and jump-squat performance was found symmetric in 75%. Tegner activity level was inferior compared to before the injury (median 4 vs. 7, p = 0.02). No infections, iatrogenic neurovascular injuries, or thromboembolic events were encountered in any of the 25 patients.

CONCLUSION

A lesion-specific 20-item checklist designed for surgical planning in acute multiligament knee trauma clearly defines the surgical protocol, facilitates the preparations for surgery, and is associated with favorable mid-term outcomes. Nevertheless, a multicenter collaboration is still required in order to transform this reporting method into a validated global registry system.

LEVEL OF EVIDENCE: 4, Case series.