Comparison of adverse events and postoperative mobilization following knee extensor mechanism rupture repair: A systematic review and network meta-analysis

Extensor mechanism rupture (EMR) of the knee is a rare but potentially debilitating injury that often occurs due to trauma. While a wide variety of surgical treatments have been reported, there is currently no consensus on the most successful treatment method. The timing of post-operative joint mobilization is also critical for successful recovery after EMR repair. Despite the traditional method of complete immobilization for 6 weeks, there is an increasing trend towards early post-operative knee mobilization. The purpose of this network meta-analysis was to compare adverse event rates and function outcomes between repair methods and between post-operative mobilization protocols. MEDLINE, EMBASE, Web of Science, and Cochrane Central electronic databases were searched in August 2016 for observational studies involving repair of acute, traumatic EMRs. Data extraction included functional outcomes, adverse events, and additional surgeries. Cohort studies that were used in functional outcome analysis were assessed for risk of bias by the Newcastle-Ottawa Quality Assessment Scale (NOS). Twenty-three studies (709 patients) were included for adverse event analysis. There were no significant differences in adverse event or additional surgery rates between EMR repair methods However, early mobilization produced significantly higher adverse event rates (p=0.02) and total event rates (p