Multi-ligament reconstructions as a risk factor for adverse outcomes in arthroscopic surgery

Justin Kyhos, Daniel Johnson, Bejan Alvandi, Michael Terry, Vehniah Tjong*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: Multi-ligament knee injuries are a serious consequence of knee dislocation with a poorly evaluated post-operative complication profile due to low incidence. The aim of this study is to assess the risk of adverse post-operative events associated with operative management of multi-ligament knee injuries. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients undergoing surgical procedures for multi-ligament knee injuries from 2006 to 2016 using Current Procedural Terminology codes. We evaluated data on patient demographics and used a propensity score algorithm to adjust for baseline differences in these patients and developed univariate and multivariate logistic regression models to assess effects on minor and severe 30-day post-operative complications. Results: We identified 444 patients in this database who underwent multi-ligament knee reconstructions between 2006 and 2016. After propensity matching, minor and major adverse post-operative events were more frequent in patients with multi-ligament knee injuries (1.4% vs 0.2%, p < 0.001 and 2.7% vs 1.1%, p = 0.002, respectively). Patients with multi-ligament knee injuries experienced a 55-fold increase risk of need for transfusion (p < 0.001) and a fivefold increased risk of pulmonary embolism (p = 0.025), with most occurring in bicruciate reconstructions (Schenck Classification KD-III and KD-IV injuries). Conclusion: The surgical management of multi-ligament knee injuries confers significant increased risk of 30-day post-operative minor or severe adverse event over arthroscopic ACL reconstruction. These patients are most at risk for post-operative blood transfusion requirement, and pulmonary embolism, with patient’s undergoing surgery for bicruciate ligament injuries at particularly high risk of complication. Level of evidence: IV.

Original languageEnglish (US)
Pages (from-to)1913-1919
Number of pages7
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Issue number6
StatePublished - Jun 2021


  • ACL reconstruction
  • Arthroscopy
  • Complications
  • Ligament reconstruction
  • Multiligament knee injuries
  • Outcomes

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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