Limits...
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) Prone extension of the affected knee with 2° of flexion contracture compared with normal side in patient 1 at 22-year follow-up. (B) Supine knee flexion with 10° of flexion loss compared with normal. (C) Bilateral, standing, weightbearing images with tricompartmental degenerative changes. (D) Magnetic resonance image of anterior cruciate ligament graft demonstrating some graft attenuation.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

fig4-2325967114534387: (A) Prone extension of the affected knee with 2° of flexion contracture compared with normal side in patient 1 at 22-year follow-up. (B) Supine knee flexion with 10° of flexion loss compared with normal. (C) Bilateral, standing, weightbearing images with tricompartmental degenerative changes. (D) Magnetic resonance image of anterior cruciate ligament graft demonstrating some graft attenuation.

Mentions: Otherwise, the patient noted continued excellent stability and continued to enjoy sporting activities such as skydiving. Knee range of motion was –2° to 130° on examination. Ligament examination showed a negative Lachman, negative posterior drawer, 1+ valgus laxity, and no varus laxity. KT-1000 measurements showed a side-to-side difference of 0.33 mm at both 20° and 70°. Stress radiographs performed with the Telos stress device (Telos, Marburg, Germany) at 90° showed similar findings.50 Radiographs revealed moderate tricompartmental arthritic changes (Figure 4, A-D). Average isokinetic strength testing performed at both 60 deg/s and 180 deg/s revealed quadriceps and hamstring strength 78.8% and 97.6% of the uninjured limb, respectively. A 6-m timed single-leg hop was 93.4% of the normal leg (average of 3 measurements). Outcomes scores showed a Short Form–36 (SF-36) score of 60.6, a Lysholm score of 94, and an International Knee Documentation Committee (IKDC) score of C (downgraded primarily because of radiographic changes).


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

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

(A) Prone extension of the affected knee with 2° of flexion contracture compared with normal side in patient 1 at 22-year follow-up. (B) Supine knee flexion with 10° of flexion loss compared with normal. (C) Bilateral, standing, weightbearing images with tricompartmental degenerative changes. (D) Magnetic resonance image of anterior cruciate ligament graft demonstrating some graft attenuation.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

fig4-2325967114534387: (A) Prone extension of the affected knee with 2° of flexion contracture compared with normal side in patient 1 at 22-year follow-up. (B) Supine knee flexion with 10° of flexion loss compared with normal. (C) Bilateral, standing, weightbearing images with tricompartmental degenerative changes. (D) Magnetic resonance image of anterior cruciate ligament graft demonstrating some graft attenuation.
Mentions: Otherwise, the patient noted continued excellent stability and continued to enjoy sporting activities such as skydiving. Knee range of motion was –2° to 130° on examination. Ligament examination showed a negative Lachman, negative posterior drawer, 1+ valgus laxity, and no varus laxity. KT-1000 measurements showed a side-to-side difference of 0.33 mm at both 20° and 70°. Stress radiographs performed with the Telos stress device (Telos, Marburg, Germany) at 90° showed similar findings.50 Radiographs revealed moderate tricompartmental arthritic changes (Figure 4, A-D). Average isokinetic strength testing performed at both 60 deg/s and 180 deg/s revealed quadriceps and hamstring strength 78.8% and 97.6% of the uninjured limb, respectively. A 6-m timed single-leg hop was 93.4% of the normal leg (average of 3 measurements). Outcomes scores showed a Short Form–36 (SF-36) score of 60.6, a Lysholm score of 94, and an International Knee Documentation Committee (IKDC) score of C (downgraded primarily because of radiographic changes).

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