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Knee Dislocations: Lessons Learned From 20-Year Follow-up.

Schenck RC, Richter DL, Wascher DC - Orthop J Sports Med (2014)

Bottom Line: Traumatic knee dislocation is becoming more prevalent because of improved recognition and increased exposure to high-energy trauma, but long-term results are lacking.Both patients had radiographic signs of arthritis, which lowered 1 subject's IKDC score to "C." Knee dislocations have rare long-term excellent results, and most intermediate-term studies show fair to good functional results.Hopefully, continued advances in the evaluation and treatment of knee dislocations will improve the long-term outcomes for these patients in the future.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.

ABSTRACT

Background: Traumatic knee dislocation is becoming more prevalent because of improved recognition and increased exposure to high-energy trauma, but long-term results are lacking.

Purpose: To present 2 cases with minimum 20-year follow-up and a review of the literature to illustrate some of the fundamental principles in the management of the dislocated knee.

Study design: Review and case reports.

Methods: Two patients with knee dislocations who underwent multiligamentous knee reconstruction were reviewed, with a minimum 20-year follow-up. These patients were brought back for a clinical evaluation using both subjective and objective measures. Subjective measures include the following scales: Lysholm, Tegner activity, visual analog scale (VAS), Short Form-36 (SF-36), International Knee Documentation Committee (IKDC), and a psychosocial questionnaire. Objective measures included ligamentous examination, radiographic evaluation (including Telos stress radiographs), and physical therapy assessment of function and stability.

Results: The mean follow-up was 22 years. One patient had a vascular injury requiring repair prior to ligament reconstruction. The average assessment scores were as follows: SF-36 physical health, 52; SF-36 mental health, 59; Lysholm, 92; IKDC, 86.5; VAS involved, 10.5 mm; and VAS uninvolved, 2.5 mm. Both patients had excellent stability and were functioning at high levels of activity for their age (eg, hiking, skydiving). Both patients had radiographic signs of arthritis, which lowered 1 subject's IKDC score to "C."

Conclusion: Knee dislocations have rare long-term excellent results, and most intermediate-term studies show fair to good functional results. By following fundamental principles in the management of a dislocated knee, patients can be given the opportunity to function at high levels. Hopefully, continued advances in the evaluation and treatment of knee dislocations will improve the long-term outcomes for these patients in the future.

No MeSH data available.


Related in: MedlinePlus

(A) Arthroscopic image of the medial compartment at 6 years after injury in patient 1. (B) Bilateral, standing, weightbearing images at 6 years after injury showing early medial compartment narrowing.
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fig3-2325967114534387: (A) Arthroscopic image of the medial compartment at 6 years after injury in patient 1. (B) Bilateral, standing, weightbearing images at 6 years after injury showing early medial compartment narrowing.

Mentions: The patient was injured in the spring of 1991 at the age of 22 years when he was hit by a tractor trailer while stranded on a back road in South Texas. The patient recalls being thrown 100 feet by the truck and feeling as if “the truck driver tried to hit me.” He suffered a closed KD III-MC injury (Figure 1 and Table 1), upper arm soft tissue and humeral fracture, closed head injury, and multiple rib fractures. One of the senior authors (R.C.S.) was consulted while the trauma service was performing a reverse saphenous vein graft reconstruction of the arterial injury suffered at the time of knee dislocation (Figure 2). After completion of the arterial reconstruction, a peel-off lesion of the posterior cruciate ligament (PCL) and a tibial avulsion of the medial collateral ligament (MCL) were reattached utilizing locking nonabsorbable Krackow sutures. A large tibiofemoral Steinman pin was placed with the knee in full extension from the proximal medial tibia through the notch, avoiding the PCL and MCL repair, and exiting the distal-lateral femur to provide additional skeletal stability and protection of the vascular reconstruction. The pin was removed at 10 days with manipulation under anesthesia. Six weeks after revascularization, the patient underwent an ipsilateral semitendinosus/gracilis reconstruction of his anterior cruciate ligament (ACL). Six years after injury, the patient underwent arthroscopic debridement secondary to pain and concern for meniscal injury but with continuing excellent stability. Diagnostic arthroscopy noted intact ligamentous structures but findings of early medial compartment osteoarthritis (Figure 3, A and B).


Knee Dislocations: Lessons Learned From 20-Year Follow-up.

Schenck RC, Richter DL, Wascher DC - Orthop J Sports Med (2014)

(A) Arthroscopic image of the medial compartment at 6 years after injury in patient 1. (B) Bilateral, standing, weightbearing images at 6 years after injury showing early medial compartment narrowing.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555540&req=5

fig3-2325967114534387: (A) Arthroscopic image of the medial compartment at 6 years after injury in patient 1. (B) Bilateral, standing, weightbearing images at 6 years after injury showing early medial compartment narrowing.
Mentions: The patient was injured in the spring of 1991 at the age of 22 years when he was hit by a tractor trailer while stranded on a back road in South Texas. The patient recalls being thrown 100 feet by the truck and feeling as if “the truck driver tried to hit me.” He suffered a closed KD III-MC injury (Figure 1 and Table 1), upper arm soft tissue and humeral fracture, closed head injury, and multiple rib fractures. One of the senior authors (R.C.S.) was consulted while the trauma service was performing a reverse saphenous vein graft reconstruction of the arterial injury suffered at the time of knee dislocation (Figure 2). After completion of the arterial reconstruction, a peel-off lesion of the posterior cruciate ligament (PCL) and a tibial avulsion of the medial collateral ligament (MCL) were reattached utilizing locking nonabsorbable Krackow sutures. A large tibiofemoral Steinman pin was placed with the knee in full extension from the proximal medial tibia through the notch, avoiding the PCL and MCL repair, and exiting the distal-lateral femur to provide additional skeletal stability and protection of the vascular reconstruction. The pin was removed at 10 days with manipulation under anesthesia. Six weeks after revascularization, the patient underwent an ipsilateral semitendinosus/gracilis reconstruction of his anterior cruciate ligament (ACL). Six years after injury, the patient underwent arthroscopic debridement secondary to pain and concern for meniscal injury but with continuing excellent stability. Diagnostic arthroscopy noted intact ligamentous structures but findings of early medial compartment osteoarthritis (Figure 3, A and B).

Bottom Line: Traumatic knee dislocation is becoming more prevalent because of improved recognition and increased exposure to high-energy trauma, but long-term results are lacking.Both patients had radiographic signs of arthritis, which lowered 1 subject's IKDC score to "C." Knee dislocations have rare long-term excellent results, and most intermediate-term studies show fair to good functional results.Hopefully, continued advances in the evaluation and treatment of knee dislocations will improve the long-term outcomes for these patients in the future.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.

ABSTRACT

Background: Traumatic knee dislocation is becoming more prevalent because of improved recognition and increased exposure to high-energy trauma, but long-term results are lacking.

Purpose: To present 2 cases with minimum 20-year follow-up and a review of the literature to illustrate some of the fundamental principles in the management of the dislocated knee.

Study design: Review and case reports.

Methods: Two patients with knee dislocations who underwent multiligamentous knee reconstruction were reviewed, with a minimum 20-year follow-up. These patients were brought back for a clinical evaluation using both subjective and objective measures. Subjective measures include the following scales: Lysholm, Tegner activity, visual analog scale (VAS), Short Form-36 (SF-36), International Knee Documentation Committee (IKDC), and a psychosocial questionnaire. Objective measures included ligamentous examination, radiographic evaluation (including Telos stress radiographs), and physical therapy assessment of function and stability.

Results: The mean follow-up was 22 years. One patient had a vascular injury requiring repair prior to ligament reconstruction. The average assessment scores were as follows: SF-36 physical health, 52; SF-36 mental health, 59; Lysholm, 92; IKDC, 86.5; VAS involved, 10.5 mm; and VAS uninvolved, 2.5 mm. Both patients had excellent stability and were functioning at high levels of activity for their age (eg, hiking, skydiving). Both patients had radiographic signs of arthritis, which lowered 1 subject's IKDC score to "C."

Conclusion: Knee dislocations have rare long-term excellent results, and most intermediate-term studies show fair to good functional results. By following fundamental principles in the management of a dislocated knee, patients can be given the opportunity to function at high levels. Hopefully, continued advances in the evaluation and treatment of knee dislocations will improve the long-term outcomes for these patients in the future.

No MeSH data available.


Related in: MedlinePlus