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PubMed2000

Outcomes of the operatively treated knee dislocation.

Despite being a serious injury with early complications associated with a high degree of morbidity, the outcomes of knee dislocations have improved dramatically since the days of Sir Astley Cooper. Currently, most authors favor early surgical reconstruction of the injured ligamentous structures. With modern surgical techniques and rehabilitation protocols, most patients are able to achieve functional range of motion and stability necessary for everyday life. Despite improvements in treatment, stiffness and pain, rather than instability, can be a problem. Patients continue to have difficulty returning to pre-injury levels of athletic competition and manual labor, although a significant number of patients have achieved these goals. As physicians, we must be knowledgeable in the current surgical techniques and rehabilitation protocols used in the treatment of knee dislocations, and the typical prognosis of the injury. By informing our patients of hurdles that they will be forced to overcome, in their path to recovery, before initiating treatment, patients will better understand the seriousness of the injury, which, it is hoped, will lead to compliance with their rehabilitation and thus better outcomes.

Activities of Daily Living↗
PubMed1985

Complete knee dislocation. A follow-up study of operative treatment.

Twenty knee dislocations in 19 patients (one bilateral) occurred over a period of 20 years. The age range was 21 to 65 years, with an average age of 40.8 years. There were two popliteal artery and eight peroneal nerve injuries in the group. All patients were managed by early closed reduction at the scene of the accident or at the admitting hospital. Treatment consisted of 13 acute arthrotomies with complete ligamentous repair, one partial ligament repair, two delayed repairs, and four cast applications. Both anterior and posterior cruciate ligaments were torn in each knee surgically examined. In contrast to cruciate injuries in nondislocated knees, avulsion of bone of the PCL was present in 14 of 16 and of the ACL in ten of 16. Complete follow-up study including examination and radiographic evaluation was obtained on 18 knees in 17 patients. Special investigations of 13 with acute complete ligament repair, followed from 12 months to 48 months (average of 24 months), showed loss of joint motion following this injury. Clinical instability was generally not a problem, but chronic pain and discomfort were present in 46%. The average knee diagnostic score was 43. Seventy-seven percent of the patients returned to vigorous sports activities. Early operative repair followed by cast bracing and manipulation at three months (if flexion was less than 90 degrees) is recommended in young, active patients.

Adult↗
PubMed1996

MRI in acute knee dislocation. A prospective study of clinical, MRI, and surgical findings.

We treated 17 knees in 15 patients with severe ligament derangement and dislocation by open repair and reconstruction. We assessed the competence of all structures thought to be important for stability by clinical examination, MRI interpretation, and surgery. Our findings showed that in these polytrauma patients clinical examination was not an accurate predictor of the extent or site of soft-tissue injury (53% to 82% correct) due mainly to the limitations of associated injuries. MRI was more accurate (85% to 100% correct) except for a negative result for the lateral collateral ligament and posterolateral capsule. The detail and reliability of MRI are invaluable in the preoperative planning of the surgical repair and reconstruction of dislocated knees.

Acute Disease↗
PubMed1999

[Knee dislocation. Long-term results after operative treatment].

INTRODUCTION: Traumatic dislocation is the most severe ligamentous injury of the knee. The indications for operative and conservative treatment are still controversial. METHODS AND RESULTS: From 1974 to 1994, 38 patients with documented knee dislocation were treated operatively in our department. Thirty-four of these patients were followed up for 3-16 years (mean: 8.6 years). In 29 cases of the follow-up group, reconstruction of both cruciate ligaments was performed. In the remaining cases the cruciate ligaments were left alone. At the time of follow-up, 90 % of the patients showed good knee stability, but 90 % had lack of motion as well. Post-traumatic osteoarthritis was mostly mild to moderate. Thirty-five percent of the patients achieved excellent to good results in the Lysholm Score. CONCLUSIONS: Positive prognostic factors were an age less than 40 years at the time of the accident, a low-energy trauma, e. g., a sports-related injury, early reconstruction of both cruciate ligaments, and initial postoperative functional treatment.

Adolescent↗
PubMed2003

Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases.

OBJECTIVE: To evaluate soft-tissue injury patterns in a large series of patients with knee dislocations to identify frequency and associations that may aid in surgical planning. DESIGN: Prospective clinical study. SETTING: Two institutions, both level I trauma centers. PATIENTS: Sixty patients with 63 dislocatable knees. RESULTS: Cause of injury was motor vehicle injury in 34 patients, sports in 23 patients, and falls in 3 patients; 71% of knees studied had bicruciate injuries. Eight knees had associated major intraarticular fractures. Vascular disruption occurred in 14% of knees. Peroneal nerve palsies occurred in 14% of knees. All injured knees with complete peroneal nerve palsies had anterior cruciate ligament, posterior cruciate ligament, and lateral collateral ligament disruptions. The incidence of vascular injury was the same for patients injured in sports as for those injured in road trauma. Reattachable ligamentous avulsions occurred in 19% for anterior cruciate ligament, 51% for posterior cruciate ligament, 64% for medial collateral ligament, and 84% for lateral collateral ligament injuries. Certain injury patterns also had a high association of tendon and capsule avulsions. Proximal lateral collateral ligament injuries were commonly associated with popliteus tendon avulsions and seldom with distal biceps avulsions. Distal lateral collateral ligament injuries were commonly associated with distal biceps avulsions and seldom with popliteus tendon avulsions. Reattachable meniscal capsular avulsions off the tibia occurred predominantly when the collateral ligament injury was a distal avulsion. CONCLUSIONS: This study showed a wide variety of injury patterns. Knees had to have at least two ligaments injured to be dislocatable but not necessarily both cruciate ligaments. Sports injuries have the same pattern of injury as motor vehicle accidents, suggesting similar forces of injury. The study demonstrates a high incidence of reattachable avulsion injuries to ligaments and soft tissues in dislocatable knees. These may not be as easily dealt with if surgery is delayed beyond 3-4 weeks.

Adolescent↗
PubMed1995

Orthopedic management of knee dislocations. Comparison of surgical reconstruction and immobilization.

Thirty-nine patients with 43 complete knee dislocations managed between 1973 and 1990 were reviewed retrospectively to compare the results of surgical reconstruction to nonreconstructive treatment of these injuries. The average patient age was 34 years and the average follow-up was 5 years (range: 1 to 18 years). Patients were evaluated by physical examination and the Lysholm knee scoring scale. Fourteen knees (33%) sustained popliteal vessel injury and five (9%) required amputation. Peroneal and tibial nerve injuries involved 13 knees (30%). Twenty-five of 39 patients (64%) sustained other associated fractures. Three patients sustained associated paraplegia and nine were lost to follow-up, leaving 25 knees available for follow-up examination. Thirteen knees were managed by surgical reconstruction of their ligamentous injuries and 12 were managed by nonreconstructive means. The surgically treated group had an average Lysholm knee score of 80 compared with the nonreconstructive group with an average score of 66. Average range of motion of was 106 degrees for the surgical group and 95 degrees for the nonreconstructive group. Despite the severity of the initial injury and the potential presence of vascular/nerve injuries, surgical reconstruction provides superior results to immobilization alone in the management of these injuries.

Adolescent↗
PubMed2003

Results after treatment of traumatic knee dislocations: a report of 26 cases.

BACKGROUND: A retrospective study was carried out with all the cases of traumatic dislocation of the knee joint treated in our institution between 1988 and 1998. METHODS: In most cases (81%), the dislocation was reduced under general anesthesia and early surgical repair of damaged structures was performed as each case required. In five cases, the treatment was conservative because of associated skeletal and visceral injuries that made immediate surgery inadvisable. RESULTS: Peroneal nerve palsy (23%) and popliteal artery disruption (7.5%) were the most frequent early complications. The most common sequelae were instability (85%) and limp (50%). Early operative repair of all damaged structures was associated with the best functional result (55%). Nonoperative treatment was associated with 100% unsatisfactory results, and these patients are waiting for a second operation to treat the sequelae. CONCLUSION: Operative treatment makes possible the recovery of structures that provide enough stability to perform day-to-day activities in the majority of cases.

Adolescent↗
PubMed1979

Vascular and orthopedic complications of knee dislocation.

Experience with complete dislocation of the knee in 22 consecutive patients during a six year period was analyzed. Major vascular complications occurred in nine of 13 extremities with anterior dislocation, one of seven extremities with posterior dislocation and none of two extremities with lateral dislocation. Liberal use of trans-femoral ateriography for diagnosis disclosed significant arterial injuries in four of 15 limbs, despite postreduction pedal pulses which were apparently normal. Limb salvage was accomplished in 20 of 21 survivors and in eight of nine with associated vascular complications. All patients demonstrated severe instability of the ligamentous structures of the knee consistent with the type of dislocation. Posterior instability was severe in all patients, an indication of disruption of the posterior cruciate ligament in every instance. Adequate follow-up information was available on 12 knees that had primary ligamentous repair, ten of which were stable to stress testing. Postoperative immobilization was accomplished by external skeletal fixation, skeletal traction or long leg posterior plaster splint.

Adolescent↗
PubMed1995

[Treatment of posterior cruciate ligament rupture and recent knee dislocations by olecranisation of the patella without surgical repair].

Olecranisation of the patella was described and first used by Grammont (1984) to maintain reduction of the knee joint after posterior cruciate repair and reconstruction. Since 1985 we used this technique in 18 acute posterior ruptures and knee dislocations which did not undergo surgery. Knee laxity is assessed under general anaesthesia with radiographic control. A 4 or 5 mm. Steinmann pin is introduced medially at the top of the patella and drilled vertically through the bone to continue behind the patella tendon. After reduction of the posterior drawer, the pin is passed into the anterior part of the tibia. Full mobility between 0 degrees and 90 degrees is maintained. Physiotherapy started immediately and early weight bearing is allowed with a posterior splint. Olecranisation prevents posterior subluxation of the tibia and gives an anterior tibial subluxation force which is minor in flexion but major in extension. We followed up our patients for 1 to 8 years. The latest testing with radiographs demonstrate posterior drawer but all patients report good results. Early physiotherapy avoids stiffness, amyotrophy, and reflex sympathetic dystrophy. Olecranisation appears to give similar results more quickly and with fewer complications than P. C. L. surgery.

Acute Disease↗
PubMed1997

Knee dislocations and their management. A report of 16 cases.

We retrospectively studied the outcome of 16 knee dislocations. 11 patients had surgical treatment, 4 were managed nonoperatively and 1 patient died. In the elderly the outcome was poor, regardless of the type of treatment. Only 3 adolescents obtained excellent results and 2 young adults had good results after surgical repair of the knee. Concurrent arterial and nerve damage increased the morbidity.

Adolescent↗
PubMed1995

Noncontact knee dislocation in a female basketball player: a case report.

Knee ligamentous injuries occur during sport, and when there is extensive injury, they can be associated with subluxation or dislocation. We present the case of a female basketball player who sustained a knee dislocation during noncontact play. An immediate angiogram confirmed vascular integrity, and surgical treatment with ligamentous reconstruction was performed. Peroneal nerve injury was present but resolved in 42 weeks. A review of the literature discussing knee dislocation is presented.

Adult↗
PubMedDate not supplied

Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Use of early protected postoperative motion to decrease arthrofibrosis.

We report a critical rating of results for 11 patients with bicruciate ligament reconstructions and immediate protected knee motion after knee dislocations (seven acute and four chronic). Six patients had concurrent repair or reconstruction of medial ligamentous structures, and six had reconstruction of the lateral and posterolateral ligaments. All patients returned for followup at a mean of 4.8 years postoperatively. Follow-up arthrometric testing at 20 degrees of flexion showed 10 knees had less than 3 mm of increased total anterior-posterior displacement and 1 knee had 7 mm of increase. At 70 degrees of flexion, 9 knees had less than 3 mm of increased displacement and 2 knees had more than 6 mm of increase. The failure rates were as follows: 18% of posterior cruciate ligament reconstructions (2 of 11), 9% of anterior cruciate ligament reconstructions (1 of 11), 17% of lateral and posterolateral procedures, and 0% of medial collateral ligament procedures. At followup, five of the seven patients with acute injuries had no limitations with daily or sports activities. Three of the four patients with chronic ruptures were asymptomatic with daily activities, but only one was asymptomatic with light sports. Five patients (all acute injuries) required treatment for knee motion limitations. Nine patients had full range of motion at followup. We concluded that simultaneous bicruciate ligament reconstructions, performed with associated medial or lateral procedures, are warranted to restore function to all ligament structures. Even though immediate motion was used, several patients required early manipulation or arthroscopic debridement, which restored full motion and prevented permanent arthrofibrosis.

Activities of Daily Living↗
PubMed2000

Knee dislocation. Complications of nonoperative and operative management.

Because of the nature and extreme severity of the injury, complications will continue to be a common denominator in traumatic knee dislocations. The major complications that cause significant morbidity, including amputation and death, are now relatively infrequent. Prompt recognition and treatment of these complications are of utmost importance to assure functional viability of the extremity. These complications must continue to be addressed preoperatively and postoperatively. Minor complications will persist after significant knee surgery. New complications will evolve as newer techniques, instrumentation, and procedures are introduced. Ligament reconstructive surgery is relatively new and technically demanding. The surgeon must continue to use meticulous technique and attention to detail. Orthopedic surgeons must continue to closely evaluate the procedures they perform, making sure they are as technically correct as possible. Each surgeon must observe and determine what technique will be of true benefit to the patient. Most complications that do occur can be corrected or at least improved if they are handled early and with a true understanding of the problem.

Bone Screws↗