Knee dislocations?a retrospective study comparing operative versus closed immobilization treatment outcomes

Abstract

Controversies over operative versus closed immobilization of traumatic complex multiple ligamentous knee injury are still debated. The aim of our study is to evaluate the outcome of reconstructive vs non-reconstructive (closed immobilization) treatment outcomes. This is a retrospective review of cases seen at our institution. All cases admitted with a diagnosis of knee dislocation, defined as patients with multidirectional knee instability in the setting of trauma, were reviewed. Twenty-nine consecutive patients from January of 1996 to June of 2002 were reviewed. Twenty-six patients (89.7%) were successfully recalled and their functional outcome analyzed. Comparing the operated group (n=15, 57.7%) with closed immobilized patients (n=11, 42.3%), there was no statistical difference in the range of motion (mean difference 8.55 degrees , p=0.202). While the operated group had more flexion contracture (mean difference 3.9 degrees , p=0.002), they had better stability and better overall knee function as measured by the International Knee Documentation Committee (IKDC) score (the mean difference of IKDC score was 12.13, p=0.005). In the operated group of 15 patients, we compared partial repair (n=7) with complete repair of all torn ligaments (n=8). Superior results were noted in the group with complete repair of all structures, with comparable range of motion (mean difference 0.6 degrees , p=0.861) and flexion contractures (mean difference 1.0 degrees , p=0.795) but better stability and IKDC score (mean difference of IKDC score 13.6, p=0.003). Our conclusion is that operative treatment with complete repair of all torn structures produces the best overall knee function with better knee stability and patient satisfaction.

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

“…Our findings are comparable to those obtained by Mariani et al, who found that patients treated by direct repair had less favorable results in terms of laxity and range of motion than reconstructed patients [22]. Wong et al found that surgical treatment involving the complete repair of all injured structures was superior in terms of IKDC score and antero-posterior laxity when compared to partial repair (unicruciate ligament reconstruction)[33]. …”

Is Peroneal Nerve Injury Associated With Worse Function After Knee Dislocation?

“…Existing knee dislocation studies focus on surgical treatment of the ligamentous injuries [1,8,[17][18][19]30], but the impact of associated injuries such as those to the popliteal artery or peroneal nerve can be just as vital. In this study, we evaluated motor and sensory recovery as well as patient-reported outcomes scores in patients with peroneal nerve injury after knee dislocation, compared recovery between partial and complete palsies, and established the impact of peroneal nerve injury by contrasting results with a cohort of patients without nerve injury.…”

Evaluation of reconstructive surgery using artificial ligaments in 71 acute knee dislocations

“…Nonoperative treatment, which was once deemed acceptable [1], is now reserved for very-low-demand patients. The introduction of surgical treatment was later shown to be more effective than conservative treatment [2,3]. It began with the primary repair of the injured ligaments [4][5][6], then evolved into the era of reconstruction [7][8][9][10][11][12][13][14][15][16][17][18].…”