Abstract
Background: The purpose of this study was to investigate the prevalence of preoperative osteoarthritis in patients requiring surgical management for multiligament knee injury at a single institution. We additionally sought to determine whether injury patterns were different in patients with and without osteoarthritis. We hypothesized that radiographic osteoarthritis would be more common among older patients and those with greater body mass index (BMI), and that these patients would demonstrate lower-grade ligamentous injury patterns.
Methods: A consecutive cohort of patients surgically treated for multiligament knee injury between June 2008 and June 2026 was identified. Demographic and injury characteristics, and preoperative imaging were reviewed within the electronic medical record. Preoperative radiographs were evaluated for presence of osteoarthritis using the Kellgren-Lawrence (KL) grading system. Multiligament knee injuries were additionally defined using the Schenck classification system. Patients were separated into “Healthy” (KL 0-1) and “Osteoarthritis” (KL ≥ 2) groups for initial analysis. Secondary analysis was performed by individual KL grade (0-4). Categorical variables were compared using chi-square and Fisher exact tests, and continuous variables were compared using Mann-Whitney U and Kruskal-Wallis testing with significance defined as p < 0.05.
Results: Radiographic osteoarthritis was found in 27 of the 230 included patients (11.7%). Patients in the Osteoarthritis group were significantly older than those in the healthy group (49.2 [39.63 - 52.75] vs. 24.8 [18.4 - 35.85], p < 0.001). Body mass index (BMI) was also higher in the Osteoarthritis group than in the Healthy group (30.25 [27.95 - 34.8] vs. 26.6 [23.25 - 32.1], p = 0.002). Sex distribution and injury-to-surgery interval were not significantly different between groups. Ligamentous injury patterns and Schenck classification were not significantly associated with the presence of osteoarthritis. These findings were corroborated by KL grade-specific analyses, with increasing age and BMI associated with greater osteoarthritis severity.
Conclusion: Preoperative radiographic osteoarthritis was present in 11.7% of patients surgically treated for multiligament knee injury within the study period at a single center. Patients with osteoarthritis were significantly older and had higher BMI values, while ligamentous injury patterns and Schenck classification were not associated with osteoarthritis presence or severity.