A systematic review on management and outcome of irreducible knee dislocations

Malik, Shahbaz S.; Osan, Jess K; Aujla, Randeep; Aslam, Nadim; D’Alessandro, Peter; MacDonald, Peter B.

doi:10.1016/j.otsr.2022.103415

Cited by 4 publications

(21 citation statements)

References 55 publications

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“…The most important finding of this SR is that IKDs require a prompt surgical reduction, either open or arthroscopically performed, since closed maneuvers cannot disengage the medial entrapped structures, and they potentially lead to an increased risk of soft tissues and neurovascular damage. This observation perfectly aligns with the most recent algorithm proposed by Malik et al [ 8 ]. Furthermore, this SR provides the attending orthopedics with the various surgical options concerning ligament repair/reconstruction following knee reduction, and it reports improved functional outcome scores after them.…”

Section: Discussionsupporting

confidence: 92%

“…IKDs represent a unique, rare rotatory subcategory of KDs [ 1 – 4 , 7 , 8 , 10 , 28 ]. As described by Malik et al [ 8 ], most of them occurred through a posterolateral displacement, and according to the Schenck classification, they start from KD IIIM as a grade of severity [ 12 , 14 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Malik et al, in 2022, proposed the most recently updated algorithm for the management of IKDs [ 8 ]. They suggested that following the mandatory surgical reduction, an assessment of the cruciate and collateral ligaments should be done, with the reconstruction or repair of MCL along with the capsule and the retinaculum at the initial surgery [ 8 ]. The other structures are managed in a one- or a double-staged procedure [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…They suggested that following the mandatory surgical reduction, an assessment of the cruciate and collateral ligaments should be done, with the reconstruction or repair of MCL along with the capsule and the retinaculum at the initial surgery [ 8 ]. The other structures are managed in a one- or a double-staged procedure [ 8 ]. Despite this, several authors described their strategies and ligament management experience.…”

Section: Introductionmentioning

confidence: 99%

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Irreducible knee dislocation: improved clinical outcomes of open and arthroscopic surgical treatment. A systematic review of the literature

Giustra,

Bosco,

Masoni

et al. 2023

Eur J Orthop Surg Traumatol

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Purpose Irreducible knee dislocations (IKDs) are a rare rotatory category of knee dislocations (KDs) characterized by medial soft tissue entrapment that requires early surgical treatment. This systematic review underlines the need for prompt surgical reduction of IKDs, either open or arthroscopically. It describes the various surgical options for ligament management following knee reduction, and it investigates their respective functional outcome scores to assist orthopedic surgeons in adequately managing this rare but harmful KD. Methods A comprehensive search in four databases, PubMed, Scopus, Embase, and MEDLINE, was performed, and following the PRISMA guidelines, a systematic review was conducted. Strict inclusion and exclusion criteria were applied. Studies with LoE 5 were excluded, and the risk of bias was analyzed according to the ROBINS-I tool system. This systematic review was registered on PROSPERO. Descriptive statistical analysis was performed for all data extracted. Results Four studies were included in the qualitative analysis for a total of 49 patients enrolled. The dimple sign was present in most cases. The surgical reduction, either open or arthroscopically performed, appeared to be the only way to disengage the entrapped medial structures. After the reduction, torn ligaments were addressed in a single acute or a double-staged procedure with improved functional outcome scores and ROM. Conclusions This systematic review underlines the importance of promptly reducing IKDs through a surgical procedure, either open or arthroscopically. Moreover, torn ligaments should be handled with either a single acute or a double-staged procedure, leading to improved outcomes. Level of evidence IV.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Irreducible knee dislocation: improved clinical outcomes of open and arthroscopic surgical treatment. A systematic review of the literature

Giustra,

Bosco,

Masoni

et al. 2023

Eur J Orthop Surg Traumatol

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“…Despite new treatment strategies and surgical techniques, the severe soft-tissue damage caused by knee dislocation results in a high rate of knee disability [30]. Only 40% of patients reported normal knee function after knee dislocation, while the majority reported abnormal and severely abnormal function [6,17,26,34]. Significant stiffness of the knee joint with limitations in ROM has been described in up to 21% of the patients in the literature, with surgical intervention required by 14% [8].…”

Section: Limitation In Everyday Lifementioning

confidence: 99%

No effect of dislocation status at arrival in emergency department on outcome of knee joint dislocations

Szymski,

Huber,

Riedl

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeKnee dislocation is a rare but severe injury of the lower extremities. The aim of this study was to report on the epidemiology, diagnostics and treatment of such injuries and to identify negative predictors of clinical outcomes.MethodsThis retrospective analysis included all knee dislocations treated at a Level I Trauma Centre in Germany between 2009 and 2021. Medical records were categorised, collected and analysed in a standardised manner. A follow‐up visit 1 year after the injury focused on limitations in knee mobility.ResultsA total of 120 knee dislocations were included in the study. 29.3% of patients presented to the emergency department with a dislocated joint, and 17.5% (n = 21) had a neurovascular lesion. At follow‐up 12 months after the injury, 65.8% of the patients reported limitations in the range of motion, and 11.7% (n = 14) reported severe limitations in daily activities. Site infections due to surgery occurred in 3.3% of patients. Increased body weight (r = 0.294; p < 0.001 and r = 0.259; p = 0.004), an increased body mass index above 25 kg/m2 (body mass index, r = 0.296; p < 0.001 and r = 0.264; p = 0.004) and deficits in peripheral perfusion as well as sensory and motor function (r = 0.231; p = 0.040 and r = −0.192; p = 0.036) were found to be negative predictive factors for clinical outcome. For posttraumatic neurovascular injury, lack of peripheral perfusion, insufficient sensory and motor function (r = −0.683; p < 0.0001), as well as a higher Schenck grade (r = 0.320; p = 0.037), were identified as independent risk factors. The status of dislocation at the site of the accident and on arrival at the emergency department had no impact on the outcome or neurovascular injury.ConclusionKnee dislocation is a rare injury with a high rate of severe complications such as neurovascular lesions. In particular, the initial status of neurovascular structures and injury classification showed a relevant negative correlation with the posttraumatic status of nerves and vessels. In particular, patients with these characteristics need close monitoring to prevent negative long‐term consequences.Level of EvidenceLevel III.

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