Abstract
Postoperative knee stiffness can influence outcomes following operative treatment
of multiligament knee injuries (MLKIs). The purpose of this study was to evaluate
patient and surgical factors that may potentially contribute to stiffness following
surgery for MLKIs. All surgically managed MLKIs involving two or more ligaments over
a 10-year period at a single level one trauma center were included in this study.
A retrospective review was performed to gather objective data related to the development
of knee stiffness after surgery. Patients were classified as “stiff” postoperatively
if they (1) had a flexion contracture greater than 10 degrees, (2) failed to reach
120 degrees of flexion at final follow-up, or (3) underwent a manipulation under anesthesia
with or without arthroscopic lysis of adhesions to improve range of motion. Patient
and surgical factors were evaluated systematically to determine factors associated
with stiffness. The mean age of the cohort was 27.6 years at the time of surgery and
mean follow-up was 50 weeks. Overall, 26/121 (21.5%) knees were diagnosed with postoperative
stiffness. In the acute postoperative phase, 17 patients underwent manipulation under
anesthesia. There were no significant differences in age, body mass index, associated
injuries, mechanism, external fixation use or surgical timing (acute vs. chronic)
between stiff and normal knees. Factors associated with the development of postoperative
stiffness included knee dislocation (p = 0.04) and surgical intervention on three or more ligaments (p = 0.04). Careful attention to postoperative rehabilitation regimens should be given
to patients with knee dislocations and/or those undergoing reconstruction or repair
of three or more injured ligaments. Surgeons may utilize spanning external fixation
if necessary without increasing the rate of long-term stiffness. Further, acute surgery
does not appear to influence rates of postoperative stiffness or the need for manipulation.
Keywords
multiligamentous knee injury - knee dislocation - knee stiffness
