Early Compared with Delayed Reconstruction in Multiligament Knee Injury

Background: The purpose of this study was to compare outcomes following early compared with delayed reconstruction in patients with multiligament knee injury (MLKI). Methods: A retrospective cohort analysis of patients with MLKI from 2007 to 2019 was conducted. Patients who underwent a reconstructive surgical procedure with ≥12 months of postoperative follow-up were included. Patients were stratified into early reconstruction ( 0.05). Patients in the early reconstruction group had higher odds of requiring MUA compared with the delayed reconstruction group (24 32% compared with 8 14%; IPTW-adjusted odds ratio OR, 3.85 95% confidence interval (CI), 2.04 to 7.69; p < 0.001) and had less knee flexion at the most recent follow-up (β, 6.34° 95% CI, 0.91° to 11.77°; p = 0.023). Patients undergoing early reconstruction had lower KL osteoarthritis grades compared with patients in the delayed reconstruction group (OR, 0.46 95% CI, 0.29 to 0.72; p < 0.001). There were no differences in clinical laxity between groups. Conclusions: Early reconstruction of MLKIs likely increases the likelihood of postoperative arthrofibrosis compared with delayed reconstruction, but it may be protective against the development of osteoarthritis. When considering the timing of MLKI reconstruction, surgeons should consider the benefit that early reconstruction may convey on long-term outcomes but should caution patients regarding the possibility of requiring an MUA. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.