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Delayed Surgery May Be Better for Some Knee Injuries

Study suggests acute management does not always lead to best outcomes

MONDAY, Dec. 14 (HealthDay News) -- Delaying surgery to treat multiple-ligament knee injuries may yield similar stability outcomes as acute surgery, while staged surgery yields better subjective results, according to a study in the Dec. 1 issue of the Journal of Bone & Joint Surgery.

William R. Mook, M.D., and colleagues at the University of Virginia Health System in Charlottesville, conducted a literature review of 24 retrospective studies comprising 396 knees, to compare the results of early, delayed and staged procedures.

Patients who were treated acutely had more flexion deficits than those treated chronically, and also had more residual anterior knee instability and joint stiffness, the researchers found. The highest proportion of excellent and good subjective outcomes was achieved with staged management, but these patients also had more stiffness.

"Delayed reconstructions of severe multiple-ligament knee injuries could potentially yield equivalent outcomes in terms of stability when compared with acute surgery," the authors write. "However, in the acutely managed patient, early mobility is associated with better outcomes in comparison with immobilization. Acute surgery is highly associated with range-of-motion deficits. Staged procedures may produce better subjective outcomes and a lower number of range-of-motion deficits but are still likely to require additional treatment for joint stiffness."

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