Early surgery of multiligament knee injuries may yield better results than delayed surgery: a systematic review
ImportanceMultiligament knee injuries are rare, but can lead to significant functional limitations. Surgery has been shown to improve outcomes, however, there remains considerable debate regarding the optimal timing of surgery.ObjectiveWe aimed to determine whether early surgery in the setting of a...
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| Veröffentlicht in: | Journal of ISAKOS 2019-01, Vol.4 (1), p.26-32 |
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| creator | Sheth, Ujash Sniderman, Jhase Whelan, Daniel B |
| description | ImportanceMultiligament knee injuries are rare, but can lead to significant functional limitations. Surgery has been shown to improve outcomes, however, there remains considerable debate regarding the optimal timing of surgery.ObjectiveWe aimed to determine whether early surgery in the setting of a multiligamentous knee injury was associated with superior functional outcomes when compared with surgery on a delayed basis.Evidence reviewA comprehensive literature search of the MEDLINE, EMBASE and PubMed databases was conducted up to March 2018. We identified studies with a sample size greater than 10 that included subjects with an injury to at least two of the four major knee ligaments and compared outcomes between early and delayed surgery. We assessed the methodological quality of each included study using the Newstead-Ottawa Scale.FindingsWe identified 11 eligible studies, including a total of 320 patients (195 early and 125 delayed). The mean time to surgery among patients treated early was 11.2 days in comparison to 294.8 days for the delayed group. Early surgery was found to have a statistically significantly higher Lysholm score (p |
| doi_str_mv | 10.1136/jisakos-2015-000021 |
| format | Article |
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Surgery has been shown to improve outcomes, however, there remains considerable debate regarding the optimal timing of surgery.ObjectiveWe aimed to determine whether early surgery in the setting of a multiligamentous knee injury was associated with superior functional outcomes when compared with surgery on a delayed basis.Evidence reviewA comprehensive literature search of the MEDLINE, EMBASE and PubMed databases was conducted up to March 2018. We identified studies with a sample size greater than 10 that included subjects with an injury to at least two of the four major knee ligaments and compared outcomes between early and delayed surgery. We assessed the methodological quality of each included study using the Newstead-Ottawa Scale.FindingsWe identified 11 eligible studies, including a total of 320 patients (195 early and 125 delayed). The mean time to surgery among patients treated early was 11.2 days in comparison to 294.8 days for the delayed group. Early surgery was found to have a statistically significantly higher Lysholm score (p<0.0001) and Meyers rating (p=0.02) when compared with delayed surgery. No statistically significant differences in International Knee Documentation Committee, Tegner Activity Scale, total arc of motion, loss of extension or loss of flexion were demonstrated between early and delayed surgery. Early surgery was noted to have a statistically significantly higher odds of requiring a manipulation under anaesthesia or arthrolysis (p=0.04), however, subsequent subgroup analysis showed no difference between early and delayed surgery when only studies employing an early range of motion protocol were pooled.Conclusions and relevanceBased on the current body of literature, which primarily consists of level IV evidence, early surgery in the setting of multiligament knee injury may provide better functional outcomes without compromising range of motion when using early postoperative mobilisation protocols. Further studies of higher quality are required to corroborate these findings.Level of evidenceLevel IV, systematic review.</description><identifier>ISSN: 2059-7754</identifier><identifier>EISSN: 2059-7762</identifier><identifier>DOI: 10.1136/jisakos-2015-000021</identifier><language>eng</language><publisher>London: Elsevier Limited</publisher><subject>Clinical trials ; Intervention ; Joint and ligament injuries ; Knee ; Medical Subject Headings-MeSH ; Quality of life ; Questionnaires ; Rates of return ; Rotator cuff ; Surgery ; Systematic review</subject><ispartof>Journal of ISAKOS, 2019-01, Vol.4 (1), p.26-32</ispartof><rights>International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2019 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b361t-e31f0d0df8325fd1eaecab1526e4f36bfad32775d6cc88f2277c504968f8e7683</citedby><cites>FETCH-LOGICAL-b361t-e31f0d0df8325fd1eaecab1526e4f36bfad32775d6cc88f2277c504968f8e7683</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids></links><search><creatorcontrib>Sheth, Ujash</creatorcontrib><creatorcontrib>Sniderman, Jhase</creatorcontrib><creatorcontrib>Whelan, Daniel B</creatorcontrib><title>Early surgery of multiligament knee injuries may yield better results than delayed surgery: a systematic review</title><title>Journal of ISAKOS</title><description>ImportanceMultiligament knee injuries are rare, but can lead to significant functional limitations. Surgery has been shown to improve outcomes, however, there remains considerable debate regarding the optimal timing of surgery.ObjectiveWe aimed to determine whether early surgery in the setting of a multiligamentous knee injury was associated with superior functional outcomes when compared with surgery on a delayed basis.Evidence reviewA comprehensive literature search of the MEDLINE, EMBASE and PubMed databases was conducted up to March 2018. We identified studies with a sample size greater than 10 that included subjects with an injury to at least two of the four major knee ligaments and compared outcomes between early and delayed surgery. We assessed the methodological quality of each included study using the Newstead-Ottawa Scale.FindingsWe identified 11 eligible studies, including a total of 320 patients (195 early and 125 delayed). The mean time to surgery among patients treated early was 11.2 days in comparison to 294.8 days for the delayed group. Early surgery was found to have a statistically significantly higher Lysholm score (p<0.0001) and Meyers rating (p=0.02) when compared with delayed surgery. No statistically significant differences in International Knee Documentation Committee, Tegner Activity Scale, total arc of motion, loss of extension or loss of flexion were demonstrated between early and delayed surgery. Early surgery was noted to have a statistically significantly higher odds of requiring a manipulation under anaesthesia or arthrolysis (p=0.04), however, subsequent subgroup analysis showed no difference between early and delayed surgery when only studies employing an early range of motion protocol were pooled.Conclusions and relevanceBased on the current body of literature, which primarily consists of level IV evidence, early surgery in the setting of multiligament knee injury may provide better functional outcomes without compromising range of motion when using early postoperative mobilisation protocols. Further studies of higher quality are required to corroborate these findings.Level of evidenceLevel IV, systematic review.</description><subject>Clinical trials</subject><subject>Intervention</subject><subject>Joint and ligament injuries</subject><subject>Knee</subject><subject>Medical Subject Headings-MeSH</subject><subject>Quality of life</subject><subject>Questionnaires</subject><subject>Rates of return</subject><subject>Rotator cuff</subject><subject>Surgery</subject><subject>Systematic review</subject><issn>2059-7754</issn><issn>2059-7762</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNqNkEtPwzAQhC0EElXpL-BiiXOKH7GTckNVeUiVuMDZcuJ1cZpHsR1Q_j1GLZzZy87hm1ntIHRNyZJSLm8bF_R-CBkjVGQkDaNnaMaIWGVFIdn5nxb5JVqE4CoiSMF5IegMDRvt2wmH0e_AT3iwuBvb6Fq30x30Ee97AOz6ZvQOAu70hCcHrcEVxAgeewgJDzi-6x4baPUE5jfsDmscphCh09HVCf108HWFLqxuAyxOe47eHjav66ds-_L4vL7fZhWXNGbAqSWGGFtyJqyhoKHWFRVMQm65rKw2nKWPjKzrsrQs6VqQfCVLW0IhSz5HN8fcgx8-RghRNcPo-3RSMVrSguSlFIniR6r2QwgerDp412k_KUrUT7nqVK76KVcdy02u5dFVdc2_DN-SL4AB</recordid><startdate>201901</startdate><enddate>201901</enddate><creator>Sheth, Ujash</creator><creator>Sniderman, Jhase</creator><creator>Whelan, Daniel B</creator><general>Elsevier Limited</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope></search><sort><creationdate>201901</creationdate><title>Early surgery of multiligament knee injuries may yield better results than delayed surgery: a systematic review</title><author>Sheth, Ujash ; Sniderman, Jhase ; Whelan, Daniel B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b361t-e31f0d0df8325fd1eaecab1526e4f36bfad32775d6cc88f2277c504968f8e7683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Clinical trials</topic><topic>Intervention</topic><topic>Joint and ligament injuries</topic><topic>Knee</topic><topic>Medical Subject Headings-MeSH</topic><topic>Quality of life</topic><topic>Questionnaires</topic><topic>Rates of return</topic><topic>Rotator cuff</topic><topic>Surgery</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sheth, Ujash</creatorcontrib><creatorcontrib>Sniderman, Jhase</creatorcontrib><creatorcontrib>Whelan, Daniel B</creatorcontrib><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><jtitle>Journal of ISAKOS</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sheth, Ujash</au><au>Sniderman, Jhase</au><au>Whelan, Daniel B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early surgery of multiligament knee injuries may yield better results than delayed surgery: a systematic review</atitle><jtitle>Journal of ISAKOS</jtitle><date>2019-01</date><risdate>2019</risdate><volume>4</volume><issue>1</issue><spage>26</spage><epage>32</epage><pages>26-32</pages><issn>2059-7754</issn><eissn>2059-7762</eissn><abstract>ImportanceMultiligament knee injuries are rare, but can lead to significant functional limitations. Surgery has been shown to improve outcomes, however, there remains considerable debate regarding the optimal timing of surgery.ObjectiveWe aimed to determine whether early surgery in the setting of a multiligamentous knee injury was associated with superior functional outcomes when compared with surgery on a delayed basis.Evidence reviewA comprehensive literature search of the MEDLINE, EMBASE and PubMed databases was conducted up to March 2018. We identified studies with a sample size greater than 10 that included subjects with an injury to at least two of the four major knee ligaments and compared outcomes between early and delayed surgery. We assessed the methodological quality of each included study using the Newstead-Ottawa Scale.FindingsWe identified 11 eligible studies, including a total of 320 patients (195 early and 125 delayed). The mean time to surgery among patients treated early was 11.2 days in comparison to 294.8 days for the delayed group. Early surgery was found to have a statistically significantly higher Lysholm score (p<0.0001) and Meyers rating (p=0.02) when compared with delayed surgery. No statistically significant differences in International Knee Documentation Committee, Tegner Activity Scale, total arc of motion, loss of extension or loss of flexion were demonstrated between early and delayed surgery. Early surgery was noted to have a statistically significantly higher odds of requiring a manipulation under anaesthesia or arthrolysis (p=0.04), however, subsequent subgroup analysis showed no difference between early and delayed surgery when only studies employing an early range of motion protocol were pooled.Conclusions and relevanceBased on the current body of literature, which primarily consists of level IV evidence, early surgery in the setting of multiligament knee injury may provide better functional outcomes without compromising range of motion when using early postoperative mobilisation protocols. Further studies of higher quality are required to corroborate these findings.Level of evidenceLevel IV, systematic review.</abstract><cop>London</cop><pub>Elsevier Limited</pub><doi>10.1136/jisakos-2015-000021</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Clinical trials Intervention Joint and ligament injuries Knee Medical Subject Headings-MeSH Quality of life Questionnaires Rates of return Rotator cuff Surgery Systematic review |
| title | Early surgery of multiligament knee injuries may yield better results than delayed surgery: a systematic review |
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