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[Conservative treatment of congenital knee dislocation].
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[On a case of congenital knee dislocation].
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Popliteal artery injury associated with knee dislocation.
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[Arterial injuries complicating knee dislocations].
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Knee dislocation without anterior cruciate ligament disruption. A report of three cases.
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Knee dislocations with vascular injuries.
Any knee that is dislocated or that has both anterior and posterior cruciates and one collateral ligament torn should be carefully evaluated for neurologic and vascular injury. Reduction and immobilization should be performed. If the pulses are anything but normal, arrangements should be made to proceed to the operating room immediately. A one-shot arteriogram can be obtained in the operating room, but proceeding directly with popliteal artery exploration is reasonable if the pulses have not returned to normal. If the pulses have returned to normal, an arteriogram should be obtained. After the vascular repair has been done, a fasciotomy of the lower leg should be performed. In the young healthy active patient who does not have significant necrotic muscle or severe nerve injury, delayed reconstruction and early, very aggressive rehabilitation is recommended. Whether this treatment improves the results of this injury remains to be seen. Discussion with the vascular surgeon concerning the use of a tourniquet is recommended. If not functioning, the peroneal nerve is often severely stretched, and no treatment to date has been very encouraging. An ankle foot orthosis or tendon transfers to achieve dorsiflexion may be needed.
Open knee dislocation associated with vascular injury successfully salvaged by primary arthrodesis in an elderly patient: a case report.
Treatment by primary arthrodesis of the knee joint after temporary intraluminal shunt placement in a 70-year-old man with open knee dislocation involving the popliteal vessels is reported. After temporary shunting, the definitive vascular reconstruction of both the popliteal artery and vein was established by end-to-end anastomoses because of the shortening effect of the arthrodesis. Two skin coverage procedures were performed on day 0 and day 18. The patient recovered activity to a level near his pretrauma status. Primary arthrodesis for open knee dislocation associated with vascular injury in an elderly patient may be an efficacious procedure, depending on the patient's age, occupation, and level of activity.
[Diagnosis and therapy of vascular injuries in posterior knee dislocation].
AIM: We demonstrate the management and treatment of dislocation of the knee associated with vascular injury. The goal of the treatment is to avoid complications due to ischemia. The injured vessel can be repaired either by direct suture or by interposition of a saphenous vein graft. Capsule and ligaments should be reconstructed secondarily. PATIENTS AND METHODS: The charts of ten patients treated in the Division of Traumatology of the University of Zurich between 1979 and 1996 have been retrospectively checked. RESULTS: In eight of ten patients the injured vessel has been reconstructed with a saphenous vein graft, in one patient the artery has been repaired by direct suture. In one patient a flap of the intima has been refixed by endarterectomy. In five patients the knee has been stabilised with a transfixation (external fixation). In two patients the ligaments and the capsule were reconstructed at the time of vascular repair, in seven patients the reconstruction has been performed secondary. CONCLUSIONS: In case of a dislocation of the knee the examination of the vessels is mandatory. In case of a critical perfusion the "on table"--angiography is the procedure of choice. As an alternative method duplex sonography has been established. The vascular reconstruction is performed by saphenous vein graft interposition. We recommend to reconstruct ligamentous and capsular structures secondary.
Knee dislocation with ipsilateral femoral shaft fracture: a report of five cases.
We report the management and outcome of 4 patients with 5 knee dislocations associated with ipsilateral femoral shaft fractures. All patients were managed by immediate reduction of the knee dislocation, intramedullary nailing of the femur, and angiography, followed by postoperative immobilization of the knee (brace or external fixation) for a minimum of 6 weeks. Four of the 5 dislocations underwent a secondary ligament reconstruction. At the 2-year follow up, the mean Knee Society Score was 133 (range 99-170).
Isolated complete popliteal artery rupture associated with knee dislocation. Case reports.
Complete dislocation of the knee is a rare injury, and is frequently associated with injuries to other structures in the popliteal fossa. Prompt recognition of associated popliteal artery disruption and early revascularization is paramount for successful and functional results. The necessity for emergency vascular reconstruction markedly complicates an already difficult orthopaedic problem. Arteriography is recommended in all cases of complete dislocation of the knee.
Knee dislocation following anterior cruciate ligament disruption without any other ligament tears.
We report a rare case of complete knee dislocation following anterior cruciate ligament (ACL) disruption without any other ligament tears. The pathology of the knee joint was torn ACL, intact other ligaments, osteochondral fractures and bone bruise of the lateral femoral condyle, and torn lateral meniscus. In this case, osteochondral fracture resulting from the anteriorly sublaxiation of the tibia following ACL disruption was considered to prevent from spontaneous reduction. This case suggests that anterolateral knee dislocation and spontaneous reduction may occur in ACL injuries.
Peroneal nerve palsy following knee dislocation: pathoanatomy and implications for treatment.
Peroneal nerve palsy following knee dislocation is a serious problem, and neurolysis at the time of knee reconstruction does not always result in return of peroneal nerve function. We describe peroneal nerve pathoanatomy in three patients in whom late exploration of the peroneal nerve was performed because of ongoing absence of ankle dorsiflexion. We identified frank nerve rupture in two patients and a lengthy neuroma in continuity in one which extended far proximal to the fibular head and well above the previous surgical incision used for peroneal nerve neurolysis at the time of knee reconstruction. In light of the current state of microneural surgery and the potential to reconstruct nerve defects, we discuss how our findings impact on treatment, and provide recommendations which may improve recovery of peroneal nerve function in future cases.
Popliteal artery thrombosis associated with trampoline injuries and anterior knee dislocations in children.
Recent reports have emphasized the benign nature of trampoline-associated injuries. However, this study describes the limb-threatening problem of popliteal artery thrombosis occurring in association with anterior knee dislocation and trampoline injuries. Three children (ages 11, 13, and 17) were referred to the emergency room within the past 12 months with anterior dislocations of the knee, which occurred while jumping on trampolines. All patients had reduction of their dislocations at outside facilities and were referred within 6 to 12 hours after their injuries, with pulse, motor, and sensory deficits. All patients were taken directly to the operating room, where arteriography confirmed thrombosis of the popliteal artery below the knee. One patient had transection of the artery, whereas two patients had stretch injuries with intimal separation. Each patient required interposition grafting with reversed saphenous vein and underwent concomitant four-compartment fasciotomy. All patients had persistent sensory and motor deficits postoperatively, which were presumed to be a combination of ischemic injury and neuropraxia. All patients have functioning grafts with an average follow-up of 1 year (range, 9-15 months). One patient required a second interposition graft to treat an area of intimal hyperplasia, which developed at the proximal anastomosis, at 6 months postoperatively. Eighty per cent of trampoline injuries are associated with minor injuries with minimal long-term complications. However, dislocations of the knee may be associated with significant arterial injury and amputation rates of up to 30 per cent in many blunt trauma series. Based on our experience, physicians should recognize the possibility of significant arterial injuries occurring in children with anterior knee dislocations while jumping on trampolines.
Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts.
We reviewed the results in 13 patients who underwent simultaneous allograft reconstruction of both the anterior and posterior cruciate ligaments after a knee dislocation (nine acute and four chronic injuries). Seven patients sustained related medial collateral ligament injuries and six patients had posterolateral complex injuries. Ligament reconstructions were performed using fresh-frozen Achilles or patellar tendon allografts. At follow-up evaluation (mean of 38 months), only one patient described the reconstructed knee as normal. Six patients had returned to unrestricted sports activities and four had returned to modified sports. The average extension loss was 3 degrees (range, 0 degree to 10 degrees) and average flexion loss was 5 degrees (range, 0 degree to 15 degrees). The KT-1000 arthrometer measurements at 133 N anterior-posterior tibial load showed a mean side-to-side difference of 4.5 mm (range, 0 to 10) at 20 degrees and 5.0 mm (range, 0 to 9) at 70 degrees. The mean Lysholm score was 88 (range, 42 to 100). International Knee Documentation Committee ratings were six nearly normal, five abnormal, and one grossly abnormal. Two patients required manipulations for knee stiffness. This study demonstrates that reconstruction of both cruciate ligaments can restore stability sufficient to allow sports activity in most patients with knee dislocations, but "normal" results are difficult to achieve.
Congenital knee dislocation in a 49,XXXXY boy.
We report on a 12 year old mentally retarded boy who presented at birth with bilateral knee dislocations, dislocation of the right hip, and general joint laxity. Cytogenetic studies showed a 49,XXXXY karyotype. Hyperlaxity of joints is known to occur in 49,XXXXY patients, but congenital knee dislocation has not been reported. Rarely in 49,XXXXY and 49,XXXXX syndromes Larsen-like features may be seen. Patients with congenital joint dislocation or laxity, combined with other malformations, especially if psychomotor development is delayed, should be karyotyped to exclude chromosomal abnormalities.
An irreducible knee dislocation: a case report.
An 8-year-old man presented after sustaining an injury during a fall. A closed reduction attempt failed, and after several tests, an open reduction was performed. With posterolateral dislocation of the knee, there can be anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament disruption. At the 6-month (final) follow-up, the patient had no subjective pain or instability. With this type of injury, the approach can be conservative monitoring or repair of all of the ligaments. Because of the age and activity level of our patient, we opted for repair of the medial collateral ligament initially with the possibility of late anterior cruciate ligament and/or posterior cruciate ligament reconstruction.
Total knee arthroplasty for chronic posterior knee dislocation: report of 2 cases with technical considerations.
This article reports our experience in 2 patients with chronic knee dislocations treated with total knee arthroplasty, focusing on the technical difficulties in obtaining a well-balanced, well-aligned knee.