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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

Bilateral, standing, weightbearing images with mild medial joint space narrowing in patient 2 at 22-year follow-up. The broken drill bit below the Gerdy tubercle and surgical staple in the tibia are from a previous failed attempt of posterolateral corner repair at an outside hospital. The anterior cruciate ligament was repaired using a bone–patellar tendon–bone allograft with interference screw fixation (femur and tibia) and back up sutures around a screw/washer on the tibia. The posterior cruciate ligament was repaired using Achilles allograft with press fit of the bone block on the femur and sutures around a screw/washer on the tibia. The soft tissue screw and spiked washer represents the biceps tenodesis for the posterolateral corner reconstruction.
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fig5-2325967114534387: Bilateral, standing, weightbearing images with mild medial joint space narrowing in patient 2 at 22-year follow-up. The broken drill bit below the Gerdy tubercle and surgical staple in the tibia are from a previous failed attempt of posterolateral corner repair at an outside hospital. The anterior cruciate ligament was repaired using a bone–patellar tendon–bone allograft with interference screw fixation (femur and tibia) and back up sutures around a screw/washer on the tibia. The posterior cruciate ligament was repaired using Achilles allograft with press fit of the bone block on the femur and sutures around a screw/washer on the tibia. The soft tissue screw and spiked washer represents the biceps tenodesis for the posterolateral corner reconstruction.

Mentions: This patient was also recently seen 22 years after injury (Table 2). He complained of mild knee pain with hiking. His VAS was 7 mm versus 5 mm on his uninjured knee. On physical examination, he had knee range of motion from 0° to 130°, equal to the other knee. Ligament examination showed a negative Lachman, 1+ posterior drawer, no valgus laxity, and 1+ varus laxity. KT-1000 arthrometer measurements showed a side-to-side difference of 1.34 mm at 20° and 1.49 mm at 70°. Stress radiographs performed with the Telos stress device at 90° showed approximately 8 mm of posterior displacement of the tibia on the femur compared with the uninjured knee. Radiographs revealed mild medial joint space narrowing (Figure 5). Average isokinetic strength testing performed at both 60 deg/s and 180 deg/s revealed quadriceps and hamstring strength 111% and 82% of the uninjured limb, respectively. A 6-m timed single-leg hop was 93.4% of the normal leg. Outcomes scores showed an SF-36 of 50.7, a Lysholm score of 90, and an IKDC score of B. At most recent follow-up, the patient was 72 years of age. He enjoyed recreational hiking and had recently completed a descent and ascent of the Grand Canyon (Figure 6).


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

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

Bilateral, standing, weightbearing images with mild medial joint space narrowing in patient 2 at 22-year follow-up. The broken drill bit below the Gerdy tubercle and surgical staple in the tibia are from a previous failed attempt of posterolateral corner repair at an outside hospital. The anterior cruciate ligament was repaired using a bone–patellar tendon–bone allograft with interference screw fixation (femur and tibia) and back up sutures around a screw/washer on the tibia. The posterior cruciate ligament was repaired using Achilles allograft with press fit of the bone block on the femur and sutures around a screw/washer on the tibia. The soft tissue screw and spiked washer represents the biceps tenodesis for the posterolateral corner reconstruction.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

fig5-2325967114534387: Bilateral, standing, weightbearing images with mild medial joint space narrowing in patient 2 at 22-year follow-up. The broken drill bit below the Gerdy tubercle and surgical staple in the tibia are from a previous failed attempt of posterolateral corner repair at an outside hospital. The anterior cruciate ligament was repaired using a bone–patellar tendon–bone allograft with interference screw fixation (femur and tibia) and back up sutures around a screw/washer on the tibia. The posterior cruciate ligament was repaired using Achilles allograft with press fit of the bone block on the femur and sutures around a screw/washer on the tibia. The soft tissue screw and spiked washer represents the biceps tenodesis for the posterolateral corner reconstruction.
Mentions: This patient was also recently seen 22 years after injury (Table 2). He complained of mild knee pain with hiking. His VAS was 7 mm versus 5 mm on his uninjured knee. On physical examination, he had knee range of motion from 0° to 130°, equal to the other knee. Ligament examination showed a negative Lachman, 1+ posterior drawer, no valgus laxity, and 1+ varus laxity. KT-1000 arthrometer measurements showed a side-to-side difference of 1.34 mm at 20° and 1.49 mm at 70°. Stress radiographs performed with the Telos stress device at 90° showed approximately 8 mm of posterior displacement of the tibia on the femur compared with the uninjured knee. Radiographs revealed mild medial joint space narrowing (Figure 5). Average isokinetic strength testing performed at both 60 deg/s and 180 deg/s revealed quadriceps and hamstring strength 111% and 82% of the uninjured limb, respectively. A 6-m timed single-leg hop was 93.4% of the normal leg. Outcomes scores showed an SF-36 of 50.7, a Lysholm score of 90, and an IKDC score of B. At most recent follow-up, the patient was 72 years of age. He enjoyed recreational hiking and had recently completed a descent and ascent of the Grand Canyon (Figure 6).

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