Knee Dislocation Research Articles

Complications During the Hospital Stay, Length of Stay, and Cost of Care in Parkinson Patients Undergoing Total Knee Arthroplasty: A Propensity Matched Database Study.

Background:Patients with Parkinson disease (PD) undergoing total knee arthroplasty (TKA) can present with a unique subset of challenges during their hospital stay. The literature is limited to single-center studies with a small number of patients. This study was aimed to analyze the inpatient complications, length of stay (LOS), and cost of care (COC) associated after TKA with PD over 4 years (2016 to 2019).Methods:In this retrospective cohort study, we used National Inpatient Sample (NIS) database data from 2016 to 2019 and compared in-hospital complications, LOS, and COC among patients undergoing TKA with and without PD.Results:The National Inpatient Sample database is used to identify 558,371 patients (555,289 without PD and 3,082 with PD) who underwent TKA. After propensity-matching, there was an increased incidence of blood loss anemia (PD group 22.3%, control group 13.5%, P ≤ 0.01), periprosthetic dislocations (1.5% in PD group, 0.4% in control group, P < 0.001), and periprosthetic mechanical complications including but not limited to periprosthetic fractures, knee dislocations, patellar maltracking, and subluxations (1.1% in PD group, 0.6% in control group, P = 0.024) in the PD group. The other in-hospital complications including mortality, acute renal failure, myocardial infarction, pneumonia, pulmonary embolism, deep vein thrombosis, periprosthetic fracture, and wound dehiscence showed no notable differences. The average total incurred charges for the PD group were higher, with a mean of $67,581.58 (SD $44,554.64), than that in the control group, with a mean of $64,795.51 (SD $45,841.25) (P < 0.001). The average LOS was higher in the PD group with a mean of 2.7 days (SD = 1.93) compared with the control group (mean = 2.3, SD = 1.73 days, P < 0.001).Conclusions:An increased incidence of complications such as acute blood loss anemia, periprosthetic mechanical complications, and increased COC, but no difference in LOS was noted in patients undergoing TKA with PD. This information can be useful to make an informed decision regarding patient care and preferred healthcare setup for TKA in patients with PD.

Risk of Postoperative Stiffness Following Multiligamentous Knee Injury Surgery Is Not Affected by Obesity: A Multicenter Study

The purpose of this study was to examine the relationship between obesity and postoperative stiffness following surgical management of multiligamentous knee injuries (MLKIs) using a large two-center cohort, by both 1) using binary cutoffs at various body mass indexes (BMIs) and 2) a linear regression model. 190 consecutive patients who underwent surgical management of MLKIs between January 2001 and March 2020 were reviewed at two level 1 academic trauma centers. Patient demographics, surgical characteristics, and manipulation under anesthesia (MUA)/lysis of adhesions (LOA) were reviewed. Patients were stratified by obesity grades: grade 1 (BMI 30 to <35) grade 2 (BMI 35 to <40); grade 3 (BMI >40), and compared with a nonobese comparison group with BMI <30. Multivariate logistic regressions were performed, including the covariates of age, gender, BMI, acute versus chronic injury, external fixator, vascular injury, knee dislocation, and Schenck Classification. Fisher's exact test was used to compare rate of MUA between grades of obesity. Analyses were performed with R. Statistical significance was set at P < .05. The mean BMI of the cohort was 29.2 kg/m2. The mean overall follow-up was 27.2 ± 7.2 months (range: 14-142 months). There were 55 (29.1%) MUA procedures observed at a mean 3.77 ± 2.18 months (range: 1.8-9.7 months) after final MLKI surgery. No significant difference was found in BMI of patients who underwent a MUA compared to patients who did not (30.2 vs 28.8; P= .67). There was no significant difference in rate or time to MUA following MLKI surgery between groups, with logistic regression demonstrating no significance (P= .144). Use of external fixation at the index surgery (OR= 3.3 [95% CI: 2.2, 4.7; P < .0001]) and vascular injury (OR= 6.2 [95% CI: 1.8, 24.5; P= .005]) were found to be independent predictors for need for MUA. No difference in risk for postoperative stiffness requiring MUA following surgery for MLKI was found based on BMI. At all BMI levels, there were no significant increase in need for postoperative MUA, suggesting at minimum a neutralizing effect of obesity on postoperative stiffness. In addition, patients with external fixator use and vascular injury at index surgery were found to be at significantly higher risk for postoperative stiffness requiring MUA following surgery for MLKI. Surgeons should be aware of the risk factors for arthrofibrosis when proceeding with surgical repair or reconstruction of two or more ligaments of the knee. III, multicenter retrospective cohort study.

Irreducible lateral knee dislocation in an 88 year old female: A case report

We present the unique case of a 88-year-old female who suffered a lateral knee dislocation of the right knee following a fall on a wet bathroom floor. Attempts at realignment via manipulation under anaesthesia (MUA) were unsuccessful, so the patient underwent an open reduction and the application of an external fixator to stabilise the knee. Knee dislocations are characterised by a high rate of neurovascular injuries, therefore special emphasis should be made on the prompt diagnosis and treatment of such injuries. Informed consent was obtained from the patient and family for the publication of the case report and all the figures included.

Complex Repair and Cruciate Ligament Reconstruction in KDs III and IV Multiligamentous Knee Injuries-Results of Mid-Term Follow-up.

The purpose of the present study was to describe the longitudinal outcomes of acute repair of extra-articular structure and anatomical reconstruction of cruciate ligament for knee dislocations (KDs) III and IV multiligamentous knee injuries. Forty-seven patients with an acute KD III or IV were treated with one-stage management within 9.2 days. Forty-five KDs III and IV with a follow-up at a mean of 53.2 months were evaluated. The mean International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score were 81.5 ± 0.7, 89.6 ± 1.2, and 6.8 ± 0.5, respectively. Comparing preoperative data with those at the latest follow-up, significant improvements in IKDC score (p < 0.01), Lysholm score (p < 0.01), and Tegner score (p < 0.01) were noted in all groups. Comparing contralateral knee stability, no statistical differences were found including the varus/valgus (0 degree/30 degrees) and Telos stress radiography. So, acute repair of extra-articular structure and anatomical reconstruction of cruciate ligament resulted in satisfactory outcomes for KDs III and IV multiligamentous knee injuries.

Diagnostic accuracy of MRI in internal derangement of knee in comparison to arthroscopy MRI vs Arthroscopy in knee injury

Background: The knee joint (KJ) is one of the largest as well as most complicated joints in the human body. The knee is one of the most frequently injured joints, either as a separated injury or as a common portion in patients with multiple traumas. MRI has completely transformed the field of radio diagnosis because it provides superior soft tissue (ST) contrast. Also, it has appeared to be highly useful in muscle, brain, abdominal, and soft tissue imaging. The MRI is non-invasive which provides significantly better ST contrast, and requires less imaging time while having fewer artefacts. Aims &amp; Objectives: To compare the accuracy of diagnostic [True Positive (TP), True Negative (TN), False Positive (FP), as well as False Negative (FN)] of MRI &amp; arthroscopy in diagnosing internal derangement (ID) of the knee. To determine the function of MRI in selecting patients for arthroscopy. Material and Methods: This research is a cross-sectional investigation wherein patients who were thought to have an internal knee dislocation (IKD) were given an MRI and some were chosen for an arthroscopy. Most MRIs were done on a 1.5 tesla MRI scanner. The results of the MRI were written down.

Successful Management of a Case of Congenital Dislocation of Knee With Ipsilateral Developmental Dysplasia of Hip

Introduction Congenital dislocation of the knee (CDK) is a rare condition and includes a characteristic hyperextension deformity at the knee with varying degrees of anterior and lateral subluxation. Developmental dysplasia of the hip (DDH) is a common disorder and presents frequently to a pediatrician. DDH with CDK is common, but hip pathology usually remains unnoticed because of more obvious deformity at the knee. Through this case, we aim to highlight the association of CDK with DDH and discuss its management. Case Presentation A preterm, 31-week baby girl, appropriate for gestational age, delivered to a primigravida mother with early antenatal oligohydramnios. At birth, the baby had an externally rotated left lower limb and the knee in hyperextension. A clinical diagnosis of CDK with ipsilateral DDH was confirmed further with a radiological evaluation of the left hip and knee. Staged correction of deformities was done starting with the knee, followed by the hip joint. By the 12th week of life, the knee and hip dislocations were corrected satisfactorily, which remained stable till the last follow-up (6 months). Conclusion CDK can present with an ipsilateral DDH, and this possibility needs attention. Newborns having congenital knee dislocation should undergo hip screening for instability by clinical methods. Ultrasound screening of the hip can be done if clinical examination is inconclusive. Such cases can be managed successfully by staged knee and hip disorder correction.

Biological Bone Plate and Iliac Bone Autograft for Proximal Tibial Slope Changing Osteotomy in Genu Recurvatum

Genu recurvatum (GR) is defined as knee hyperextension greater than 5°, with the normal physiological accepted limits of up to 10 to 15° of extension. Physiological GR is commonly bilateral, symmetrical, and mostly asymptomatic. Pathologic GR is usually asymmetric, symptomatic, and can be congenital or acquired. Acquired GR can be classified according to the origin of the deformity into pure osseous, soft tissue, and combined types. Symptomatic GR can present with anterior knee pain and/or instability. Surgery is generally indicated in symptomatic (pain, instability), pathologic GR with an associated causative correctible deformity (bony, soft tissue, or a combination of both). Tibial slope–reversing osteotomy is indicated for the osseous or mixed types where there is inverted tibial slope. Varu-correcting osteotomy is indicated in the posttraumatic soft-tissue type (posterior and lateral soft-tissue injury as in knee dislocation), the aim of osteotomy is to protect the reconstructed ligaments. No role for osteotomy in the nontraumatic soft tissue type (gradual stretching of the posterior structures). In this article, we describe a technique to correct a unilateral genu recurvatum deformity with inverted tibial slope, mostly due to Osgood-Schlatter disease. Correction is done by performing an anterior open-wedge osteotomy of the proximal tibia and impaction of 2 wedges of autogenous iliac bone grafts within the osteotomy. The proximal portion of the tibia is cut in the coronal plan and is used as a biologic plate for fixation with no need for additional hardware (e.g., plate or staples) for fixation of the osteotomy.

Open knee dislocation, triple intra-articular fractures and patellar tendon rupture: case report of a knee disaster treated with aggressive irrigation/debridement, early anatomic reduction and internal fixation

BackgroundOpen knee fracture-dislocation is a rare orthopedic injury. However, the importance of its correct management could not be overstated. To the best of our knowledge, this is the fifth study reporting a case with simultaneous Hoffa fracture and knee dislocation and the 1st study describing a patient with open plateau fracture-dislocation accompanied with Hoffa fracture, patella fracture, and patellar tendon tear. In addition, this report is noticeable as our case had no gross ligament injury unlike frequent association of knee dislocation with knee collateral ligament damage.Case presentationIn this study, we describe a 34-year-old motorcyclist referred to our center following a motor car accident. Further work-up revealed an open irreducible posterolateral knee dislocation, type 5 Hohl and Moore plateau fracture, lateral femoral condyle Hoffa’s fracture, patellar fracture, and patellar tendon tear of his right knee. During an open reduction, it turned out that an entrapped lateral meniscus prevented the joint to be reduced by closed means. After applying a temporary external fixator, the patient was finally managed with open reduction and internal fixation.ConclusionIrreducible knee dislocation needs further work up to rule out any interposed soft tissue into the joint. Aggressive irrigation/ debridement, early anatomic reduction, and internal fixation may help reduce open fracture complications including infection, non-union, and stiffness.

Knee dislocations and multi-ligament knee injuries: A review

Acute knee dislocations are a relatively rare type of injury that can lead to serious neurovascular compromise and ligament instability. These injuries can be potentially limb threatening if not properly identified and managed. The following review discusses the relevant anatomy of the knee joint and different classification systems of dislocations in order to highlight the complications that could occur. Timely evaluation and management, including reduction, is paramount to ensure stability and determine the need for additional imaging or urgent consultation. Knee dislocations are also associated with the unique presentation of a multi-ligament injury. This text provides an overview of multi-ligament knee injuries and the various surgical modalities currently being used. Finally, considerations are given on the role of the osteopathic approach in restoring function of the knee in the context of a dislocation.

A Rare Closed Reduction of Posterolateral Dislocation with Medial Collateral Ligament (MCL) Injury : A Case Report

Introduction: Irreducible posterolateral dislocation of the knee is a rare condition. Due to limited reports available, it is a common dilemma whether closed reduction should be attempted at all or an open surgery is the only method. “Dimple Sign'' can be found in the presence of injured medial structure, including the medial collateral ligament rupture (MCL), failure to recognize this sign may lead to repeated attempts of close manual reduction where could lead to secondary soft tissue injuries. Case Report : In this study we present a 50 years old male with successful attempt of closed reduction in posterolateral knee dislocation combined with tendon repair for the MCL rupture. Conclusion: This study may add more perspective and be beneficial for similar cases where prompt open surgery is not possible and closed reduction is considered.

The Efficacy and Outcome of a Two-Staged Operation for Irreducible Knee Dislocation: A Prospective Short-Term Follow-Up.

Background: Irreducible knee dislocation (IKD) is a very rare but serious type of knee dislocation; it can lead to soft tissue necrosis due to incarceration of the medial structures and faces great difficulty in the postoperative rehabilitation, too. IKD needs careful pre-operative planning. There is no universal agreement about the appropriate surgical strategy for IKD. The purpose of this study was to investigate the clinical efficacy, safety, and outcome of the two-staged operation in treatment of IKD. Methods: IKD patients were included from June 1, 2016 to May 31, 2020. In the stage-1 surgery, acute reduction and extra-articular structure repair were performed. Following an intermediate rehabilitation, delayed cruciate ligament reconstructions were performed in stage-2. Physical examination, CT, MRI, and X-ray were performed during the pre-operative period. Knee function, joint stability, ligament laxity, knee range of motion (ROM), and alignment were accessed at follow-ups. The minimum and maximum follow-up times were 0.5 years and 1 year, respectively. Results: In total, 17 IKD patients were included. There were three subjects (17.65%) missing at the 1 year follow-up and the average follow-up was 11.18 ± 2.53 months. After stage-1, normal alignment and superior valgus/varus stability were restored in most subjects; however, a notable anterior–posterior instability still existed in most patients. The intermediate rehabilitation processed smoothly (6.94 ± 1.20 weeks), and all patients achieved knee ROM of 0–120° finally. At 0.5 years and 1 year follow-up after stage-2, all subjects had achieved normal knee stability, ROM, and satisfying joint function. No infection or DVT was observed. Conclusions: The two-staged operation for IKD has superior efficacy on knee stability and function, and it can facilitate the rehabilitation and achieve satisfactory short-term outcome.

Examining the Bone Bruise Patterns in Multiligament Knee Injuries With Peroneal Nerve Injury

Background: Tibiofemoral bone bruise patterns seen on magnetic resonance imaging (MRI) are associated with ligamentous injuries in the acutely injured knee. Bone bruise patterns in multiligament knee injuries (MLKIs) and particularly their association with common peroneal nerve (CPN) injuries are not well described. Purpose: To analyze the tibiofemoral bone bruise patterns in MLKIs with and without peroneal nerve injury. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively identified 123 patients treated for an acute MLKI at a level 1 trauma center between January 2001 and March 2021. Patients were grouped into injury subtypes using the Schenck classification. Within this cohort, patients with clinically documented complete (motor and sensory loss) and/or partial CPN palsies on physical examination were identified. Imaging criteria required an MRI scan on a 1.5 or 3 Tesla scanner within 30 days of the initial MLKI. Images were retrospectively interpreted for bone bruising patterns by 2 board-certified musculoskeletal radiologists. The location of the bone bruises was mapped on fat-suppressed T2-weighted coronal and sagittal images. Bruise patterns were compared among patients with and without CPN injury. Results: Of the 108 patients with a MLKI who met the a priori inclusion criteria, 26 (24.1%) were found to have a CPN injury (N = 20 complete; N = 6 partial) on physical examination. For CPN-injured patients, the most common mechanism of injury was high-energy trauma (N = 19 [73%]). The presence of a grade 3 posterolateral corner (PLC) injury (N = 25; odds ratio [OR], 23.81 [95% CI, 3.08-184.1]; P = .0024), anteromedial femoral condyle bone bruising (N = 24; OR, 21.9 [95% CI, 3.40-202.9]; P < .001), or a documented knee dislocation (N = 16; OR, 3.45 [95% CI, 1.38-8.62]; P = .007) was significantly associated with the presence of a CPN injury. Of the 26 patients with CPN injury, 24 (92.3%) had at least 1 anteromedial femoral condyle bone bruise. All 20 (100%) patients with complete CPN injury also had at least 1 anteromedial femoral condyle bone bruise on MRI. In our MLKI cohort, the presence of anteromedial femoral condyle bone bruising had a sensitivity of 92.3% and a specificity of 64.6% for the presence of CPN injury on physical examination. Conclusion: In our MLKI cohort, the presence of a grade 3 PLC injury had the greatest association with CPN injury. Additionally, anteromedial femoral condyle bone bruising on MRI was a highly sensitive finding that was significantly correlated with CPN injury on physical examination. The high prevalence of grade 3 PLC injuries and anteromedial tibiofemoral bone bruising suggests that these MLKIs with CPN injuries most commonly occurred from a hyperextension-varus mechanism caused by a high-energy blow to the anteromedial knee.

Congenital dislocation of the knee with bilateral absence of the fibula and suspected Apert syndrome – case report

Congenital dislocation of the knee is a rare deformity, with an unknown etiology. The treatment of this malformation depends on its extensiveness and applies both conservative approach and surgical procedures. The aim of this study is to evaluate treatment outcomes obtained in the patient with congenital dislocation of the right knee and other multiple abnormalities of the motor system as well as the suspicion of Apert syndrome. Between 2005 and 2019, patient with congenital knee dislocation was treated surgically in two medical centers. Authors performed a retrospective analysis of available data from medical archives. The patient first presented to the authors of this study at the age of nine months. Imaging diagnostics revealed complete luxation of the right knee, grade III according to Leveuf and club feet with no fibula bones in the lower legs. The objective of the multi-stage surgical treatment was to enable the patient to walk. Stage one involved a reposition of the congenital right knee dislocation following the Curtis and Fisher technique. The next stage involved a foot surgery – first the left one and then the right. At the age of 5, during the follow-up, the patient was very active: he kept walking, running and jumping and both his feet were in the right position. However, in the following year, a gradual increase of rotation disorders was observed in both lower legs. When the child was 6 years, he underwent derotation osteotomies in both tibia bones. Next, at the age of 12, he underwent anterior femoral hemiepiphysiodesis around right knee with two 8-plates. Plates were removed when he was 14. The last follow-up took place when the patient was 14. The patient is 100% able-bodied and can walk on his own. To sum up, patients with congenital knee dislocation make up a highly complex group that requires multidisciplinary care and frequently also multistage treatment.

Trends in Australian knee injury rates: An epidemiological analysis of 228,344 knee injuries over 20 years

SummaryBackgroundAcute knee injuries are a key predisposing risk factor for knee osteoarthritis. Public health interventions require in-depth epidemiological evidence to determine which knee injuries are problematic in critical age and sex demographics.MethodsDescriptive epidemiological analysis of longitudinal data on knee injuries (July 1998 – June 2018) from the National Hospital Morbidity Database in Australia were studied. The main outcomes where the population-related knee injury frequency, incidence per 100,000 and annual growth rate (%) over the 20-year observation period. Age-group and sex differences were also studied to determine demographic-specific trends.Findings228,344 knee injuries were diagnosed over the 20-year analysis period. Significantly rising annual incidences were observed for total knee injuries, anterior cruciate ligament (ACL) injuries and knee contusions in males and females. Posterior cruciate ligament (PCL) injuries and knee dislocations were also rising in females, but not males. Greater annual growth rates were observed for females compared to males for total knee injuries, knee contusions, PCL injuries and knee dislocations. Demographic analysis revealed that the highest annual growth rate in injury incidence (10.4%) was observed for ACL injuries in females aged 5–14 years old.InterpretationIncreasing annual incidence of knee injuries was observed over the 20-year period. Males have a higher incidence of knee injury per capita than females, but the gap appears to have narrowed over the 20-year analysis period. Younger Australians show a precipitous rise in the annual number of ACL injuries, particularly for females aged 5–14 years. These trends warrant urgent intervention.FundingNone.

Surgical Principles for Medial and Posteromedial Knee Injuries

Injuries to the medial side of the knee are among the most common knee ligament injuries. Treatment of these injuries require a thorough clinical workup and an intricate knowledge of the anatomy and biomechanics involving this region of the knee. Low grade injuries and isolated injuries to the medial collateral ligament (MCL) are treated nonoperatively with bracing and functional rehabilitation. Surgical treatment is recommended for high grade (Grade III) posteromedial corner injuries, distal MCL tears, including Stener lesions, knee dislocations and multiple ligament knee injuries involving the posterolateral corner (PLC) because of high risk of residual instability if treated non-operatively. When indicated, surgical treatment should be performed in the acute phase followed by early protected range of motion and functional rehabilitation. Preoperative planning should include stress radiographs and MRI. Important considerations for surgical technique include avoiding graft tunnel convergence in the setting of multiple ligament reconstruction and anatomic placement of the tunnels to recreate the native kinematics of the medial compartment. Postoperative rehabilitation focusing on quadriceps activation and protected range of motion is recommended beginning postoperative day one to minimize the risk of arthrofibrosis. Anatomic reconstruction of the superficial medial collateral ligament and posterior oblique ligament have been shown to produce good subjective and objective patient outcomes. Further level one studies are recommended to reinforce these findings.

Delayed treatment of neglected open knee dislocation; case report.

Introduction and importanceTraumatic open knee dislocation is a rare, severe injury characterized by severe ligamentous destruction and a high frequency of infection and neurovascular involvement. Delayed treatment of these injuries is complicated, necessitating the intervention of not only a skilled orthopedic surgeon but also a plastic surgeon. To the best of our knowledge, this is the first case of delayed open knee dislocation faced by a practicing surgeon in an underdeveloped country (Somalia) with a successful outcome.Case presentationA 60 years old diabetic man, presented to our emergency unit with an open wound of his left knee, due to a traffic accident three months ago. At the time, a bone healer reduced the dislocation and applied traditional medicine to cover the wound. We decided to treat the patient with vigorous debridement, gastrocnemius flap, and hybrid external fixation for arthrodesis. The patient was followed up for three months after the surgery with excellent clinical and radiological outcomes.ConclusionAlthough treating delayed open knee dislocation injuries is challenging, using a gastrocnemius muscle flap to cover the knee joint and arthrodesis to stabilize the joint will not only prevent limb amputation but will also result in satisfactory results.

Acute number one Repair of Extraarticular Ligaments and Staged Surgery in More than One Ligament Knee Injuries

Background: The motive of this observe is to compare the consequences of acute number one repair of extraarticular ligaments with staged surgical treatment for acute knee dislocations (KDs) and multiligament knee injuries (MLKIs). Materials and methods: The atudy has conducted in Department of Orthopedic, UHC sadar, Mymensingh. During the period of January 2013 and May 2021, 67 consecutive patients identified with MLKI or KD have been noted or visited our institution. Of these, 37 sufferers who underwent acute restore of extraarticular ligaments inside three weeks of damage had been included on this observe. These patients were retrospectively categorised into two corporations: people who underwent best primary repair (repair group) and people who underwent staged reconstructive surgical operation (staged group). Follow-up exam protected range of motion (ROM), knee joint balance (Lachman test, posterior drawer take a look at, and varus and valgus stress test), Lysholm knee score, Tegner interest scale, and Knee damage and Osteoarthritis and effect Score (KOOS). Results: Twelve of the 37 sufferers did not want or preference similarly surgical treatment and were protected inside the restore institution. No great distinction becomes determined in demographic facts among the restore and staged businesses. Although staged surgery decreased high-quality posterior drawer check results, no giant difference became located between the 2 businesses concerning ROM, different knee joint balance tests, Lysholm rankings, Tegner scale, or KOOS. Conclusions: all patients lower back to their activities of each day residing and preinjury career ranges. Acute primary restore of extraarticular ligaments gives critical knee stability without varus/valgus instability and may lessen the need for next cruciate ligament reconstruction.

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.

Review of Extensor Mechanism Injuries in the Dislocated Knee.

Knee dislocations, aka multiligamentous injuries, are uncommon but devastating injuries often following high-energy trauma. Tears of the major knee stabilizers are well documented; however, injuries of the knee extensor mechanism are less commonly reported. The extensor mechanism is comprised of the patella, patellar tendon, and quadriceps tendons. Magnetic resonance imaging (MRI) is the preferred imaging modality of internal derangements of the knee due to its excellent soft tissue contrast. In this article, we will discuss the normal imaging findings of the extensor mechanism and review abnormalities following knee dislocation.

Functional and Radiological Outcome of Revision Total Hip Arthroplasty in the Indonesian National Referral Hospital

Background: Revision total hip arthroplasty (rTHA) rate has increased until 12-20% in the past few decades, despite the 95% success rate of THA approach in 10 years and 80% in 20 years. The most common causes of rTHA are dislocation, periprosthetic fracture, aseptic loosening, and periprosthetic joint infection. This study is aimed to describe the outcome of rTHA in Indonesia where there are limited types of revision implant and funding. Material and Methods: An analytic cross-sectional study was conducted on 31 rTHA in the Indonesian national referral hospital from January 2014 to December 2019. Data on the causes of rTHA was extracted. All subjects met the criteria underwent examination for functional outcome (Harris hip score) and radiological outcome (Harris or Engh criteria). All complications and outcomes after rTHA were identified. Results: Sixteen subjects met the criteria with the mean age of 48.13 (18.74). The most common causes of rTHA were dislocation, aseptic loosening, and perirosthetic joint infection (five cases each, 31.25%). The Harris hip score after complete rTHA was 79.42 (SD 6.14, range 70.50 – 91) with the mean follow up of 29.50 (SD 16.88, range 7 – 70 months). Only one possible loosening was identified in hybrid prosthesis (femoral component) from radiological exam. Three complications were observed, i.e. drop foot, recurrent dislocation, and extension knee contracture. Conclusion: Revision THA produces fair to good results in terms of functional outcome and no loosening in radiological exam. Revision THA is still a reliable technique to manage complications of THA.