Facteurs de pronostic pour les résultats fonctionnels faibles dans les luxations du genou traitées par reconstruction ligamentaire

Abstract

Knee dislocation (KD) remains a therapeutic challenge. Current literature promotes multi ligament reconstructions (MLR) rather than repairs. However, little is known on their mid-term functional outcomes and especially their prognostic factors. The purpose of this study is to identify prognostic factors for Patient Reported Outcomes (PROMs), Return to Sport (RTS) and Return to Work (RTW) in knee dislocations treated by MLR. Patients with knee dislocations treated by MLR between 2013 and 2019 were identified in our registry. They all received a similar procedure: all complete ligament ruptures were reconstructed, starting with the PCL and extensor mechanism if involved. Postoperative functional outcomes were assessed with PROMs (IKDC, ACL-RSI, KOOS), Return To Sport (RTS) and Return To Work (RTW) questionnaires. We hypothesized the following factors as possible determinants of poor outcomes: KD severity according Schenck classification, postero medial (PMC) and lateral (PLC) corner injury, age, BMI, gender, OA changes, and ligament reconstruction failure confirmed under dynamic radiographs. Fifty-two consecutive patients were assessed at 3.6 ± 1.7 years following MLR. Demographics: sex ratio: 3, BMI: 25.7 ± 4.5 kg/m 2 , age: 35 ± 10.9 years. According Schenck, knee dislocations were classified KD I (40.4%), KD III (40.4%), KD IV (9.6%) and KD V (9.6%). 76.9% of these dislocations sustained either complete PMC ( n = 27) or PLC ( n = 13) injury. In Schenck classification, only KD V (intra articular fracture) was associated with lower IKDC (51.9; p = 0.007) and KOOS (49.7; p = 0.004) scores. In dislocation patterns involving PLC injury (encountered in KD I L and III L), we observed lower IKDC (63.0; p = 0.04) and ACL-RSI (43.2; p = 0.02), as well as more frequent need for professional reorientation (30.7%, p = 0.05). Early medial compartment OA led to lower ACL RSI (47.3; p = 0,04), IKDC (62.5; p = 0,03), total KOOS (67.1; p = 0,03). Failure to RTS increased with severity of dislocation (KD I: 28.6%, KD III: 47.6%; KD IV: 60%; KD V 80%) but differences did not reach significance ( p = 0.151) Simultaneous intra articular fracture, dislocation with PLC injuries and early medial compartment OA were identified as poor prognostic factors after knee dislocation treated by MLR.