Does Delayed Ligament Reconstruction Surgery Lead to Poor Outcomes in Patients With Multiligament Knee Injuries?

Background and objective Multiligament knee injuries (MLKIs) are difficult to treat, and poor outcomes have been reported after conservative management. Controversy exists as to how to surgically manage these complex injuries. The aim of our study was to evaluate the midterm patient-reported outcomes after delayed multiligament knee reconstruction. Methods This was a review of a prospectively kept database of all patients undergoing surgery for multiligament reconstruction at a single institution. A total of 51 patients were included in the study, with a median follow-up of 48 months. In addition to the patient-reported outcomes, we also looked at other factors that could potentially affect the outcomes. Results At the final follow-up, there was no significant difference between the range of motion (ROM) of the injured knee compared to that of the healthy knee. Patients having surgery >6 months after injury had similar outcomes when compared to those having surgery <6 months post-injury. Female patients and patients with a BMI >30 had inferior outcomes. Conclusion Good midterm results can be expected after delayed multiligament knee reconstruction. Patients with a BMI >30 and female patients were observed to have inferior outcomes.

Length Matters: Short Base-Plate Angle Guides May Lead to Guide-Wire Mal-Positioning When Inserting a DHS. A Radiographic Modeling Study.

The dynamic hip screw (DHS) consists of a barrel-plate fixed to the relatively-straight proximal femoral shaft, and a screw which slides within the barrel at a fixed angle, usually 135°. The guide-wire is inserted using a guide at the set angle. Guide design varies between manufacturers, with some new guides being particularly short. We analysed the impact of guide design on the resulting trajectory of the guidewire, and its potential to cause a surgical error. Twenty AP hip radiographs were analysed. Trauma Cad (Brainlab, Munich, Germany) software was used to template a 4-hole 135° DHS onto the intact femur with the screw positioned in the center of the head. A template of a Stryker (Michigan, USA) 135° DHS guide (37 mm long) was then overlaid at the hip screw entry point, and the set trajectory marked. The divergence between the two trajectories was measured (α angle). The distance the guide would have to be moved inferiorly to attain the correct position in the head was then noted. The median divergence (α angle) caused by the guide relative to the ideal position was 6° (range 2-12). This led to the guidewire placement being a median of 9.1 mm (range 3-23) superior in the head (ß).To achieve the correct position of the wire in the head, the guide needed to be moved inferiorly a median of 8 mm (range 2-10). © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:574-577, 2020.