Comparison of Surgical Repair or Reconstruction of the Cruciate Ligaments versus Nonsurgical Treatment in Patients with Traumatic Knee Dislocations

Abstract

Surgical repair or reconstruction of the cruciate ligaments was superior to nonsurgical treatment. Functional rehabilitation was the most important positive prognostic factor. Surgical repair or reconstruction of the cruciate ligaments is mandatory to achieve sufficient stability for functional rehabilitation. In cases of cruciate ligament avulsion, repair with transosseous fixation is a reasonable alternative to reconstruction, provided that it is performed within 2 weeks of trauma.

Clinical and radiological outcomes after management of traumatic knee dislocation by open single stage complete reconstruction/repair

“…This was also reflected by our joint space measurements. This is in accordance with Richter et al[17] who reported mostly mild and moderate osteoarthritic changes after a similar follow-up time. Interestingly, more degenerative changes were found in the non-surgically treated group of patients, which may be attributed to abnormal joint kinematics due to ligamentous instability.…”

“…Richter et al reported on a series of patients and compared the outcomes of surgically and non-surgically treated patients. They found inferior results in terms of the IKDC and Lysholm and Tegner scores, which may be explained by the high number of polytraumatized patients in their series[17]. As a referral center for severe knee ligament injuries we often see trauma patients after primary stabilization and care in another hospital, which partly explains the low rate of neurovascular injuries in our series.…”

“…Most authors agree that non-surgical treatment with cast immobilization produces inferior results compared to surgical treatment regimens [5,17,29,43]. A variety of surgical procedures both open[8,21,27,29,31,44] and arthroscopy-assisted[19,21] have been reported.…”

“…In fact, traumatic knee dislocation typically leads to injuries of both cruciate ligaments[12], but there have been a few reports of patients with a documented knee dislocation and injury to only one cruciate ligament[13-16]. A tear of both cruciate ligaments with injury to the medial or lateral corner is considered to be a reliable indicator of sustained but spontaneously reduced traumatic knee dislocation[17]. …”

“…There are a few, predominantly retrospective studies that include a small number of cases, which often address epidemiology, diagnosis and treatment strategy for traumatic knee dislocations in a heterogenous group of patients[8,9,17-34]. Very little knowledge is available on the clinical and radiological long-term outcomes after treatment of these severe ligament injuries.…”