Heterotopic Ossification Linked to Knee Fixation and CNS Trauma
Publication Title: Heterotopic Ossification After Multiligament Knee Injury Is Associated With Knee-Spanning External Fixation and Central Nervous System Trauma
Summary
- Question
- This study aimed to identify the frequency and risk factors for heterotopic ossification (HO) following multiligament knee injuries (MLKIs). HO is an abnormal growth of bone in soft tissues, which can cause pain and limit joint movement. The researchers hypothesized that certain factors, such as knee-spanning external fixation (KSEF) and central nervous system (CNS) trauma, might increase the risk of developing HO after MLKIs.
- Why it Matters
- HO can significantly impair recovery and function in patients with MLKIs by limiting joint movement and causing pain. Understanding the factors that increase the risk of HO is critical for healthcare providers to identify at-risk patients and implement strategies to prevent or manage this complication. The findings have practical implications for surgical decision-making, rehabilitation, and improving long-term outcomes for individuals with severe knee injuries.
- Methods
- The study reviewed medical records of 128 patients treated for MLKIs by a single surgeon at a Level 1 trauma center between 2001 and 2023. After excluding 28 patients with insufficient follow-up, the final cohort included 100 patients with radiographic evaluations at injury and at least six months post-treatment. Risk factors, such as KSEF and CNS trauma, were assessed using statistical analyses.
- Key Findings
- HO developed in 35% of the patients in this study. The analysis showed that KSEF, a device used to stabilize the knee externally after injury, increased the likelihood of HO by over eight times. CNS trauma, such as brain or spinal cord injury, was also a strong predictor, raising the risk by more than six times. Factors like the severity of ligament injuries or the mechanism of injury did not independently predict HO.
- Implications
- The study highlights the need for close monitoring and preventive strategies, such as HO prophylaxis, in patients with MLKIs who undergo KSEF or experience CNS trauma. These findings can guide surgeons and rehabilitation specialists in tailoring treatment plans to minimize the risk of HO and improve recovery outcomes.
- Next Steps
- The authors recommend future research to explore the safety and effectiveness of HO prevention strategies, particularly in patients with CNS trauma where standard treatments may pose risks. Larger, multi-center studies could also investigate additional risk factors and refine approaches to managing MLKIs.
- Funding Information
- This research was not supported by any external funding sources, as explicitly stated in the paper. Yale University also provided funding and support for this research.
Full Citation
Ayhan E, Levitt S, Nair M, Park N, Moran J, Katz L, Wang A, Li F, Song Z, Islam W, Medvecky M. Heterotopic Ossification After Multiligament Knee Injury Is Associated With Knee-Spanning External Fixation and Central Nervous System Trauma. Orthopaedic Journal Of Sports Medicine 2026, 14: 23259671261416523. PMID: 41727788, PMCID: PMC12921146, DOI: 10.1177/23259671261416523.
This AI-assisted summary has been reviewed and approved by at least one of the study's authors to ensure it accurately reflects the research.
Authors
Ekrem M. Ayhan
First AuthorMichael Medvecky, MD
Last AuthorProfessor of Orthopaedics and Rehabilitation