Chronic Knee Dislocation Research Articles

High Incidence of Osteoarthritis Observed in Patients at Short- to Midterm Follow-Up after Delayed Multiligament Knee Reconstruction.

The aim of this study was to evaluate the incidence of knee osteoarthritis, failure rate of reconstruction, and clinical outcomes of patients with chronic multiligament knee injuries subjected to surgical treatment. Sixty-two patients with chronic knee dislocation subjected to multiligament reconstruction between April 2008 and July 2016 were evaluated, with a minimum follow-up of 24 months. Anteroposterior and lateral radiographs were performed in the pre- and last postoperative evaluation; the progression of degenerative changes according to the Kellgren-Lawrence classification (KL) was assessed. The Schenck classification, Knee Injury and Osteoarthritis Outcome Score (KOOS), time between injury and surgery, type of postoperative rehabilitation protocol (brace vs. external fixator), and physical examination for ligament instability were also evaluated. Univariate and multivariate analysis were performed, p <0.05 was considered significant. Fifty-two (83.9%) patients were men and 16.1% (n = 10) were women, with a mean age of 38.8 ± 1.3 years. The time from injury to surgery was 31.1 ± 6.1 months, and the follow-up time was 6.1 ± 0.5 years. The mean final KOOS was 79.3 ± 10.4 and the overall reconstruction failure occurred in 25.8%. Of all patients, 64.5% (n = 40) presented a KL classification of ≥2 and were defined as having radiographic osteoarthritis (OA). As 11.7% (n = 7) also presented arthritis in the contralateral knee, in 53.2% (n = 33) the progression was most likely due to the initial injury. The failure of ligament reconstruction or residual instability was present in 15 (35.7%) of patients with OA, and only one patient (4.5%) without OA. In the multivariate analysis, only reconstruction failure was an independent predictor of OA (odds ratio = 13.2 [p = 0.028]). There is a high incidence of knee OA following ligament reconstruction for chronic multiligament knee injuries. Ligament reconstruction failure was the only independent predictor for the development of OA in our study.

Management of acute knee dislocation with vascular injury: the use of the external fixator. A systematic review.

Vascular injuries after traumatic knee dislocation pose a potential limb threat for the patient. The benefits of external fixation have been described by many authors. However, the usefulness of the external fixator during acute management of knee dislocations with vascular injuries is a controversial aspect that has no consensus in the literature. The purpose of the present study was to provide data from the current literature on the utility of the external fixator and to investigate the percentage of knee dislocations with vascular injuries treated with an external fixator, the timing between external fixator and vascular repair, and the total time of external fixator. The present systematic review was conducted according to the PRISMA checklist. MEDLINE (Pubmed), Web of Science, and SCOPUS databases were searched for articles from 1 January 2000 to 6 February 2019. Studies reporting outcomes of treatment of knee dislocations with vascular injuries were included. Exclusion criteria included studies investigating chronic knee dislocations, knee arthroplasties, editorials, case reports, and expert opinions. Two authors independently extracted data and appraised the quality of evidence and risk of bias using the Methodological quality and synthesis of case series and case reports. Descriptive statistics were used to report the outcomeofour findings. Seven studies related to the usefulness of the external fixator during acute management of knee dislocations with vascular injuries were included. The external fixator had been used in the majority of knee dislocations with vascular lesions (72%). Timing between external fixator and vascular repair was reported on four studies (57%), two studies performed external fixation before vascular repair, and two studies performed external fixation after vascular repair. Total time of external fixator was only reported on three studies, ranging from 3weeks to 3months. These studies reported acute management, without referring to long-term results and without comparative groups. External fixator was used in the majority of knee dislocations with vascular injuries but the justification for its use remained unclear. Larger studies are needed to fully understand the merit of the external fixator in knee dislocations with vascular injuries. Joint protocols between vascular surgeons and trauma surgeons are necessary to agree on the aspects related to the management of knee dislocations with vascular injuries. IV.

The Effect of Irreducible Dislocation on Functional Outcomes in Knees With Multiligament Injuries: A Matched-Cohort Analysis.

Background:Most cases of bicruciate knee dislocation (KD) with associated posteromedial disruption (KD-IIIM) are reducible, but some cannot be reduced by closed reduction because of soft tissue incarceration.Purpose:To compare the clinical characteristics and functional outcomes of KD-IIIM injuries in patients with or without incarceration of soft tissue requiring open or arthroscopic reduction.Study Design:Cohort study; Level of evidence, 3.Methods:This retrospective cohort study of patients with KD was conducted between January 2013 and December 2017 at a single large institution. We applied a 1:2 matching ratio between patients with irreducible KD-IIIM injuries (irreducible group; n = 14) and those with reducible KD-IIIM injuries (control group; n = 28). There were 13 patients in the irreducible group and 25 in the control group who completed follow-up (≥2 years) and were included in our analysis. The efficacy of treatment in patients with KD was evaluated based on range of motion, the Tegner score, the Lysholm score, and the International Knee Documentation Committee (IKDC) score.Results:At the end of follow-up, the mean Tegner score was 4.5 (range, 4-6), the mean Lysholm score was 79.2 (range, 60-95), and the mean IKDC score was 78.6 (range, 60.9-95.4) in the irreducible group. The respective results in the control group were 4.6 (range, 3-8), 83.1 (range, 39-100), and 80.6 (range, 42.5-96.6). These scores did not differ significantly between the 2 groups. Similarly, mean range of motion was similar between groups (irreducible, 118.1°; control, 124.8°). In the irreducible group, the acute subgroup showed significantly higher Lysholm and IKDC scores than the chronic subgroup, while the acute and chronic subgroups in the control group showed no significant differences in these respective outcome scores.Conclusion:In the present study, the treatment of irreducible KD led to similar functional outcomes compared with reducible KD. However, the treatment of chronic irreducible KD led to worse outcomes compared with acute irreducible KD, and therefore, urgent reduction is recommended in these patients.

Gradual Hexapodalic Correction of Chronic Knee Dislocation Using Ortho-SUV; A Case Series of 2 Patients

Chronic knee dislocation is rare and debilitating for patient. Treatment for chronic knee dislocation is still debatable. There are two opposing goals of treatment which are obtaining stability and obtaining range of motion. We presented 2 patients with good clinical outcome using a gradual hexapodalic correction with Ortho-SUV system.

External fixator for treatment of the sub-acute and chronic multi-ligament-injured knee.

To assess whether the use of an articulated external fixator provides improvements in the mobility, stability and subjective function of patients undergoing ligament reconstruction. Thirty-three patients with sub-acute and chronic knee dislocation were subjected to multi-ligament reconstruction surgery. These patients were randomly allocated to two groups for immobilization after reconstruction: group 0-control (18 patients), with rigid knee bracing, and group 1-articulated external fixator (15 patients). The stability of the reconstructed ligaments was assessed after at least 14months (26.6-month average) postoperatively by physical examination. Deficit of extension and flexion was measured in relation to the unaffected contralateral knee, and the Lysholm knee scoring scale questionnaire was applied. There was no difference in the assessment of joint stability between the groups. In group 1, patients showed less flexion deficit (4.8°±5.4° vs. 18.2°±14.8°, p<0.05), and the percentage of patients with a flexion deficit of 5° or less were higher compared with group 0 (64 vs. 18%, p<0.05). There was no difference between groups in relation to extension loss. Group 1 also presented better Lysholm scores, with 73% of patients rated as excellent or good compared with 35% in group 0 (p<0.05). Compared with the control rehabilitation protocol with rigid knee bracing in extension, the use of an articulated external fixator in the treatment of chronic multi-ligament-injured knees provided the same ligament stability, better final range of motion and improved Lysholm score. Patients presenting with chronic multi-ligament instability should be considered for articulated external fixation to supplement reconstruction procedures. Randomized controlled trial, Level I.

Chronic Knee Dislocation and Flexion Contracture Treated with Open Reduction and External Fixation-A Case Report

A 24 year old man presented 18 months after posterior knee dislocation, complaining of pain and inability to extend the knee or walk. An open reduction with posterior hamstring, gastrocnemius, and capsular release was performed and an anterior external fixator was placed to maintain the reduction for 3 weeks. A hinged external fixator was then placed for 4 weeks to maintain the reduction. No ligamentous reconstruction was performed. At one year after the initial operation, the patient had no pain, 5-120 degrees of motion, no clinical instability, and was able to walk. This case is an uncommon clinical scenario, the treatment was relatively straightforward and we were very happy with the result.

Chronic knee dislocation treated with arthroplasty

Chronic knee dislocation treated with arthroplasty

Semiconstrained Knee Arthroplasty in the Setting of a Chronic Knee Dislocation

We present the case of a 27-month chronic knee dislocation treated with a semiconstrained, stemmed total knee arthroplasty. The patient was neurovascularly intact preoperatively but had severe functional limitations caused by pain, stiffness, and instability. At 2-year follow-up, the patient remains pain-free with functional range of motion and the ability to ambulate without complication. This case report represents the longest-cited chronic knee dislocation treated with a reconstructive procedure.

Die Therapie der chronischen Kniegelenkluxation mit dem Bewegungsfixateur

Chronic knee dislocations are rare but represent a therapeutic challenge. A staged concept is necessary to correctly address the pathological components. This article uses a case study to provide an algorithm for the successful treatment of chronic knee dislocations.

Management of Chronic Posterior Tibial Subluxation in the Multiligament-Injured Knee

A chronic knee dislocation, although extremely rare, is a difficult problem that requires complex management. Achieving the two opposing goals of obtaining stability and range of motion can be difficult. Despite modern techniques with multiple ligamentous reconstructions using allograft tissues, recurrent knee laxity or stiffness can be problematic. To reduce the chronically dislocated knee, complete releases of scar tissue and capsule are required, placing increased stresses on the reconstruction. In an attempt to decrease the stress on the newly reconstructed ligaments and still allow knee motion, a skeletally fixed hinge system can be used. This provides a form of protection for the newly reconstructed ligaments, which still allows a functional range of motion. By using this method of hinge fixation it is possible to obtain a stable painless knee while maintaining a functional range of motion with allograft ligament reconstruction in the chronically dislocated knee.

Total knee arthroplasty for chronic posterior knee dislocation: Report of 2 cases with technical considerations

This article reports our experience in 2 patients with chronic knee dislocations treated with total knee arthroplasty, focusing on the technical difficulties in obtaining a well-balanced, well-aligned knee.