CORRInsights®: Increased Risk of Revision, Reoperation, and Implant Constraint in TKA After Multiligament Knee Surgery

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In the current study, Pancio and colleagues performed a retrospective case-control analysis of TKAs done during a period of 19 years in patients with a history of multiligament knee surgery, and found that such patients had lower long-term implant survival, higher use of constrained TKA designs, higher risk of major complications (including reoperation and infection), and comparable scores for pain and function compared with similar patients undergoing TKA for primary osteoarthritis.
Although there is plenty of research examining patients who undergo TKA after ACL reconstruction [4, 8], few data are available regarding multiligament injuries. TKAs in patients who have undergone multiligament reconstruction are more challenging to perform, as these knees generally have additional scarring, poor soft-tissue integrity, bony and ligamentous deficiencies, retained hardware, or distorted anatomy [2]. Multiligament knee injuries are also associated with chondral injuries and meniscal tears [5, 6], increasing the propensity for early arthritis. The best surgical management approach for these patients is still up for debate [7, 9]. Surgical options to deal with chondral or meniscus injuries can be considered in conjunction with options for injured ligaments, however, multiple factors including patient age, expected activity levels, altered limb alignment, and degree of joint destruction should be discussed. Accordingly, TKA is sometimes the only plausible option for this difficult clinical scenario.
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