Abstract
PurposeThe aim of this study was to analyze the outcomes of anatomical repair and ligament bracing for Schenck III and IV knee dislocation (KD).MethodsThe results of 27 patients (15 and 12 cases of Schenck III and IV KD, respectively) after a mean follow-up of 18.1 ± 12.1 months (range 6–45 months) were retrospectively reviewed. Twenty-two patients suffered high-kinetic-energy accidents, whereas five patients suffered ultralow-velocity (ULV) trauma due to obesity. The outcome measures were the Lysholm score, Hospital for Special Surgery (HSS) knee score, Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Short Form 36 (SF-36) score. A kinematic 3D gait analysis with five walking trials was performed to compare the patients and healthy controls.ResultsThe mean KSS, HSS score, Lysholm score, and KOOS were 77.4 ± 14.4, 84.6 ± 11.2, 81.5 ± 10.4, and 67.3 ± 16.8, respectively. No intra- or postoperative complications occurred. The mean range of motion deficiency compared to the healthy side was 24.4 ± 18.5°. Ten patients had first-degree residual laxity of the anterior cruciate ligament; 12 and 2 patients had first- and second-degree residual laxity of the collateral ligament, respectively. Five patients underwent additional arthroscopic arthrolysis due to arthrofibrosis at an average of 6.2 ± 1.9 months (range 4–9 months) after the initial surgery. The 3D gait analysis showed no major differences in joint stability or movement between the patients and healthy controls. Only the ULV trauma patients had significantly lower outcome scores and showed larger kinematic deviations in joint movement during the gait analysis.ConclusionAnatomical repair with ligament bracing is a suitable surgical procedure in the treatment of KD and provides evidence in clinical practice with the benefit of early, definitive repair and preservation of the native ligaments. Patients reach acceptable subjective and objective functional outcomes, including mainly normalized gait patterns during short-term follow-up, with only minor changes in kinematics and spatial–temporal characteristics. Obese patients who suffered ULV trauma showed significantly inferior outcomes with larger deviations in joint kinematics.Level of evidenceLevel III.
Highlights
Knee dislocation (KD) with multiligament lesions is one of the most severe injuries of the knee joint, not least due to the high rate of accompanying injuries, such as peroneal nerve, vascular, chondral and meniscal lesions, injury to the posterolateral capsule and/or popliteus complex or disruption of the m. biceps femoris [3, 8, 10, 16, 17, 25, 37, 40, 51] and complications like the need for blood transfusion or pulmonary embolism [27]
Heitmann et al presented the first results of a multicenter study of anatomical repair and ligament bracing as a new treatment option for acute KD [16]
To the best of our knowledge, 3D gait analysis following the surgical repair of acute KD has not yet been performed
Summary
Knee dislocation (KD) with multiligament lesions is one of the most severe injuries of the knee joint, not least due to the high rate of accompanying injuries, such as peroneal nerve, vascular, chondral and meniscal lesions, injury to the posterolateral capsule and/or popliteus complex or disruption of the m. biceps femoris [3, 8, 10, 16, 17, 25, 37, 40, 51] and complications like the need for blood transfusion or pulmonary embolism [27]. Since nonsurgical therapy in the case of acute KD yields unsatisfactory results [14, 29, 35, 38], various surgical procedures have been developed These strategies range from early to late surgery [18] and repair to reconstruction and one- to two-stage procedures, with comparably satisfactory results [1, 4, 9, 15, 19, 24, 30, 34, 43, 54], even if most authors recommend a staged procedure for the repair of peripheral structures and reconstruction of cruciate ligaments [5, 14, 16, 22]. It was hypothesized that anatomical repair and ligament bracing yield good functional results, including widely restored physiological gait kinematics
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