Patient Reported Clinical Outcomes Following PCL Suture Augmentation in Patients with Multiligamentous Knee Injury: A Retrospective Observational Study

Amir Fathi, Ashley A Thompson, Ioanna K Bolia, Cory K Mayfield, Shane S Korber, Avinash Iyer, George F Hatch III USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USACorrespondence: Ioanna K Bolia, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo St #2000, Los Angeles, CA, 90033, USA, Email [email protected]: To compare the patient-reported outcomes between patients with posterior cruciate ligament (PCL) reconstruction or repair alone versus PCL reconstruction or repair with internal bracing (IB) in the context of multi-ligament knee injuries (MLKI).Methods: All patients who underwent surgical management of MLKI at two institutions between 2006 and 2020 were retrospectively identified and offered participation in the study. Patient reported outcomes were measured via three instruments: Lysholm Knee score, Multiligament Quality of Life (ML-QOL), and the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT). The postoperative outcomes and reoperation rates were compared between the internal bracing and non-internal bracing groups.Results: Fifty-two patients were analyzed; 34 were included in the IB group (17.6% female; age 33.1 ± 1.60 years), and 18 were included in the non-IB group (11.1% female; age 34.1 ± 3.72 years). Mean follow-up time of the entire cohort was 1.44 ± 0.22 years (IB: 1.21 ± 0.18; non-IB: 2.1 ± 0.65). There were no significant differences between PROMIS CAT [PROMIS Pain (54.4 ± 1.78 vs 51.7 ± 1.70, p=0.319), Physical Function (44.3 ± 2.27 vs 47.9 ± 1.52, p=0.294), Mobility (44.0 ± 1.71 vs 46.1 ± 2.10, p=0.463)], ML-QOL [ML-QOL Physical Impairment (40.7 ± 4.21 vs 41.7± 5.10, p=0.884), Emotional Impairment (49.2 ± 4.88 vs 44.7± 5.87, p=0.579), Activity Limitation (43.5 ± 4.56 vs 31.5± 3.62, p=0.087), Societal Involvement (44.9 ± 4.96 vs 37.5 ± 5.30, p=0.345)] and Lysholm knee score (61.8 ± 4.55 vs 61.0 ± 4.95, p=0.916) postoperatively compared to the non-IB group.Conclusion: In this group of patients, function and patient-reported outcomes between patients treated with PCL reconstruction and repair without internal brace versus those with additional internal brace augmentation were not significantly different. Further research encompassing a larger patient sample is necessary to investigate the efficacy of the internal brace for PCL injury in the context of MLKI injuries.Keywords: knee, tissue augmentation, multiligament, suture augmentation, posterior cruciate ligament, internal brac