Classification Of Knee Dislocations Research Articles

Inclusion of open injuries in an updated Schenck classification of knee dislocations based on a global Delphi consensus study

ObjectivesKnee dislocations (KDs) are complex injuries defined as incongruity of the tibiofemoral joint, which leads to tears of two or more of the main stabilising knee ligaments, and they are often associated with damage to surrounding soft tissue or neurovascular structures. A classification system for these injuries should be simple and reproducible and allow communication among surgeons for surgical planning and outcome prediction. The aim of this study was to formulate a list of factors, prioritised by high-volume knee surgeons, that should be included in a KD classification system. MethodsA global panel of orthopaedic knee surgery specialists participated in a Delphi process. The first survey employed 91 orthopaedic surgeons to generate a list of patient- and system-specific factors that should be included in a KD classification system that may affect surgical planning and outcomes. This list was subsequently prioritised by 27 identified experts (mean 15.3 years of experience) from Brazil (n = 9), USA (n = 6), South Africa (n = 4), India (n = 4), China (n = 2), and the United Kingdom (n = 2). The items were analysed to find factors that had at least 70% consensus for inclusion in a classification system. ResultsOf the 12 factors identified, four (33%) achieved at least 70% consensus for inclusion in a classification system. The factors deemed critical for inclusion in a classification system included vascular injuries (89%), common peroneal nerve injuries (78%), number of torn ligaments (78%), and open injuries (70%). ConclusionConsensus for inclusion of various factors in a KD classification system was not easily achieved. The wide geographic distribution of participants provides diverse insight and makes the results of the study globally applicable. The most important factors to include in a classification system as determined by the Delphi technique were vascular injuries, common peroneal nerve injuries, number of torn ligaments, and open injuries. To date, the Schenck anatomic classification system most accurately identifies these patient variables with the addition of open injury classification. The authors propose to update the Schenck classification system with the inclusion of open injuries as an additional modifier, although this is only a small step in updating the classification, and further studies should evaluate the inclusion of more advanced imaging modalities. Future research should focus on integrating these factors into useful existing classification systems that are predictive of surgical treatment and patient outcomes.

Novel classification for multi-ligament knee injury including both tibiofemoral joint factor and patellofemoral joint factor (193)

Novel classification for multi-ligament knee injury including both tibiofemoral joint factor and patellofemoral joint factor (193)

The Knee Dislocation Classification System Is Simple, Reproducible, and Allows Communication among Surgeons.

The Knee Dislocation Classification System Is Simple, Reproducible, and Allows Communication among Surgeons.

Initial Evaluation and Classification of Knee Dislocations.

The traumatic knee dislocation (KD) is a complex condition resulting in injury to >1 ligament or ligament complexes about the knee, termed multiligament knee injuries. Typically, KDs result in injury to both cruciate ligaments with variable injury to collateral ligament complexes. Very rarely, KD may occur with single cruciate injuries combined with collateral involvement but it is important to understand that not all multiligament knee injuries are KDs. Patients can present in a wide spectrum of severity; from frank dislocation of the tibiofemoral joint to a spontaneously reduced KD, either with or without neurovascular injury. The initial evaluation of these injuries should include a thorough patient history and physical examination, with particularly close attention to vascular status which has the most immediate treatment implications. Multiple classification systems have been developed for KDs, with the anatomic classification having the most practical application.

Multiple Ligament Knee Injuries: Does the Knee Dislocation Classification Predict the Type of Surgical Management?

This study aims to evaluate relationships among multiple ligament knee injury (MLKI) patterns as classified according to the knee dislocation (KD) classification and the types of surgical management pursued. We hypothesized that the KD classification would not be predictive of the types of surgical management, and that categorizing injuries according to additional injury features such as structure, chronicity, grade, and topographic location would be predictive of the types of surgical management. This is a Retrospective cohort study. This study was conducted at a level I trauma center with a 150-mile coverage radius. Query of our billing database was performed using combinations of 43 billing codes (International Classification of Diseases [ICD] 9, ICD-10, and Current Procedural Terminology) to identify patients from 2011 to 2015 who underwent operative management for MLKIs. There were operative or nonoperative treatment for individual ligamentous injuries, repair, or reconstruction of individual ligamentous injuries, and staging or nonstaging or nonstaging of each surgical procedure. The main outcome was the nature and timing of clinical management for specific ligamentous injury patterns. In total, 287 patients were included in this study; there were 199 males (69.3%), the mean age was 30.2 years (SD: 14.0), and the mean BMI was 28.8 kg/m2 (SD: 7.4). There were 212 injuries (73.9%) categorized as either KD-I or KD-V. The KD classification alone was not predictive of surgery timing, staging, or any type of intervention for any injured ligament (p > 0.05). Recategorization of injury patterns according to structure, chronicity, grade, and location revealed the following: partial non-ACL injuries were more frequently repaired primarily (p < 0.001), distal medial-sided injuries were more frequently treated operatively than proximal medial-sided injuries (odds ratio [OR] = 24.7; p <0.0001), and staging was more frequent for combined PCL-lateral injuries (OR = 1.3; p = 0.003) and nonavulsive fractures (OR = 1.2; p = 0.0009). The KD classification in isolation was not predictive of any surgical management strategy. Surgical management was predictable when specifying the grade and topographic location of each ligamentous injury. This is a Level IV, retrospective cohort study.

Classifications in Brief: The Schenck Classification of Knee Dislocations.

Classifications in Brief: The Schenck Classification of Knee Dislocations.

Demographics and Injuries Associated With Knee Dislocation: A Prospective Review of 303 Patients.

Background:Information on the incidence, injury mechanisms, ligament injury patterns, and associated injuries of knee dislocations is lacking in the literature. There is a need to characterize ligament injury patterns and associated injuries in knee dislocations to avoid missing common associated diagnoses and to plan surgical treatment.Purpose:To evaluate patient demographics, ligament injury patterns and associated injury patterns, and associated injuries in patients with knee dislocation.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 303 patients with knee dislocations treated at a single level 1 trauma center were followed prospectively. Injury mechanism; ligament injury patterns; associated neurovascular, meniscal, and cartilage injuries; and surgical complications were recorded. The Schenck knee dislocation classification was used to classify the ligament injury patterns.Results:The mean age at injury was 37.8 ± 15.3 years. Of the 303 patients included, 65% were male and 35% were female. There was an equal distribution of high-energy and low-energy injuries. Injury to 3 major ligaments was the most common, with Schenck classification type KD III-M constituting 52.4% of the injuries and KD III-L comprising 28.1%. Meniscal injuries and cartilage injuries occurred in 37.3% and 28.3% of patients, respectively. Patients with acute injuries had significantly lower odds of a cartilage injury than those with chronic injuries (odds ratio [OR], 0.28; 95% CI, 0.15-0.50; P < .001). Peroneal nerve injuries were recorded in 19.2% of patients (10.9% partial and 8.3% complete deficit), while vascular injuries were recorded in 5%. The odds of having a common peroneal nerve injury were 42 times greater (P < .001) among those with posterolateral corner injury (KD III-L) than those without. The odds for popliteal artery injury were 9 times greater (P = .001) among those with KD III-L injuries than other ligament injury types.Conclusion:Medial-sided bicruciate injuries were the most common injury pattern in knee dislocations. Cartilage injuries were common in chronically treated patients. There was a significant risk of peroneal nerve injury with lateral-sided injuries.

Medial Patellofemoral Ligament Tears in the Setting of Multiligament Knee Injuries Rarely Cause Patellar Instability

Background: Multiligament knee injuries (MLKIs) can also involve the medial patellofemoral ligament (MPFL), but there is a paucity of information regarding prevalence and relevance of MPFL involvement in this setting. Purpose: (1) To identify the prevalence of MPFL injury in MLKIs, (2) to determine whether an MPFL tear results in symptomatic patellar instability, and (3) to report clinical and functional outcomes of patients with and without MPFL tears after MLKI surgical reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: The records of all patients who underwent surgical reconstruction of MLKI (defined as a grade 3 injury of ≥2 ligaments) at a single institution from 2007 to 2010 were reviewed. Age, sex, knee dislocation classification (according to Schenck), and MRI findings were documented. All preoperative MRI scans were reviewed by an experienced musculoskeletal radiologist to determine the presence or absence of MPFL involvement. If an MPFL tear was present, its anatomic location and severity as well as the presence of patellar or lateral femoral condyle bone bruises were documented. Inclusion criteria included (1) MLKI treated at a single institution, (2) presence of MPFL tear on preoperative MRI, and (3) minimum 2-year clinical follow-up. Patellar instability symptoms were assessed with the Kujala Knee Questionnaire. Functional outcomes were measured using the International Knee Documentation Committee (IKDC) score. IKDC scores were compared between patients who sustained MLKIs with and without MPFL tears. There were 21 patients in each group. Results: Over the 4-year study period, 30 of 51 patients (59%) treated surgically for a MLKI had MRI evidence of an MPFL tear. Nine were lost to follow-up, leaving 21 patients for review. There were 13 complete (62%), 5 high-grade partial (24%), and 3 partial (14%) MPFL tears. Sixteen of 21 tears (76%) occurred at the proximal third, with the remainder exhibiting diffuse signal abnormality consistent with tearing throughout the length of the MPFL. The superficial medial collateral ligament was involved in all patients. In no case was the MPFL repaired or reconstructed. At mean follow-up of 3.6 years (range, 2.0-5.7 years), only 1 of 21 patients (5%) complained of patellofemoral instability symptoms whereas 20 of 21 patients (95%) did not experience patellar subluxation or dislocation. No significant difference was found when IKDC scores were compared between patients with and without an MPFL tear (mean ± SD, 65.5 ± 22.9 vs 79.4 ± 16.1; P = .07). Conclusion: MPFL tears occur frequently in patients with MLKI but rarely cause instability. In the majority of cases, MPFL tears do not need to be addressed at the time of surgery.

Classification of knee dislocations

Knee dislocations are uncommon injuries with a wide variety of presentations and treatment options. Havingexperience in the treatment of multiple injured ligaments about the knee is often rare in a general sports practice and usually requires exposure to Level I trauma patients. Furthermore, ones orthopaedic surgical subspecialization frequently dictates the initial approach to the dislocated knee. In my experience, orthopaedic trauma surgeons frequently perform primary ligamentous repairs for dislocations, whereas orthopaedic sports surgeons usually see patients with a knee dislocation on a delayed basis and recommend ligamentous reconstructions. Nonetheless, it is useful to classify dislocations in an effort to more consistently communicate between physicians and, most importantly, to reproducibly dictate treatment. The knee dislocation can be classified by different parameters and usually involves one of the following options: 1) energy level; 2) joint position; and, more recently, 3) the anatomic classification system. Energy level of injury is extremely important and gives information concerning soft-tissue injury, risk of arterial injury, and as will be seen below, the overall surgical approach. Classification by position is useful for reduction maneuvers, and historically has been the most commonly used system. However, in most instances, the position system cannot be utilized due to the frequency of a spontaneously reduced knee dislocation. Classifying by what ligaments are torn (based on a functional examination) is very useful in determining the ligamentous approach for reconstruction (basically, “fix what is broke”). Classifying dislocations by what is torn is a useful concept, and has advantages over the position system because it more clearly identifies the ligamentous injury and can be applied to any knee dislocation. In my experience, both the anatomic and energy classification systems should be used in tandem. As will be described below, the level of energy of injury usually increases with each progressive anatomic classification stage, and can be used to predict associated injuries.