{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:00:59Z","timestamp":1790139659354,"version":"4.0.1"},"reference-count":29,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Multiligament knee injuries (MLKIs) are traumatic, limb-threatening injuries requiring surgical reconstruction, of which Schenck classification for knee dislocation (KD) 3 and 4 MLKIs are the most serious. Arthrofibrosis is a common complication of multiligament knee reconstruction (MLKR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>This study sought to identify risk factors for arthrofibrosis in Schenck KD 3 and 4 MLKI patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Case-control study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Patients with Schenck KD 3 or 4 MLKI who underwent MLKR with a single surgeon were identified retrospectively. Patient sociodemographics, injury characteristics, operative details, and postoperative courses were collected. Patients were divided into groups based on development of postoperative arthrofibrosis, defined as failure to reach a range of motion of 0\u00b0 to 90\u00b0 or extensor lag \u226510\u00b0 by 6 weeks or as undergoing manipulation under anesthesia with or without lysis of adhesions. Univariate and chi-square analyses were used to identify associations with arthrofibrosis, and logistic regression was used to confirm risk factors. Statistical significance was defined as\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 71 patients with a mean age of 31.5 \u00b1 10.6 and mean follow-up time of 25.1 months were included. Of this total, 23 (32.4%) developed arthrofibrosis postoperatively. Characteristics and variables associated with arthrofibrosis were younger age (28.0 \u00b1 10.4 vs 33.5 \u00b1 10.4 years;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .04), higher median household income by zip code ($107,066 \u00b1 $40,536 vs $83,911 \u00b1 $28,530;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .007), worse preoperative flexion (98.1\u00b0\u00b1 30.5\u00b0 vs 120.6\u00b0\u00b1 22.1\u00b0;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .002), quicker time from injury to surgery (81.6 \u00b1 74.2 days vs 232.5 \u00b1 307.3 days;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .03), and significantly longer time to return to weightbearing as tolerated (12.0 \u00b1 9.0 weeks vs 7.0 \u00b1 3.4 weeks;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .005). There were no differences in race, sex, body mass index, insurance type, preoperative extension, use of external fixation, mechanism of injury, or concomitant meniscal repair (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; .05).\u2009Logistic regression identified younger age, preoperative flexion, and time to weightbear as risk factors for arthrofibrosis (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .004, .014, .019, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>A third of MLKI KD 3 and 4 patients who underwent reconstruction developed arthrofibrosis. Younger patients, those with worse preoperative flexion, and those who take longer to return to weightbearing as tolerated are at risk of arthrofibrosis. Time to weightbearing and preoperative flexion may be modifiable by prehabilitation or manipulation under anesthesia at earlier stages.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671251383147","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T09:47:22Z","timestamp":1761126442000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk Factors for Arthrofibrosis in Schenck KD 3 and 4 Multiligament Knee Injury Patients"],"prefix":"10.1177","volume":"13","author":[{"given":"Cailan L.","family":"Feingold","sequence":"first","affiliation":[{"name":"Keck School of Medicine of USC, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric H.","family":"Lin","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of USC, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranit","family":"Kumaran","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of USC, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew B.","family":"Barcenas","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of USC, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Zheng","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of USC, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Mulakaluri","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of USC, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioanna K.","family":"Bolia","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of USC, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph N.","family":"Liu","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of USC, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth C.","family":"Gamradt","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of USC, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander E.","family":"Weber","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of USC, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"George F. 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