Outcomes of Operative and Nonoperative Treatment of Multiligament Knee Injuries

Abstract

Knee dislocation is an uncommon orthopedic diagnosis with a high rate of neurovascular complications. The goal of definitive management is to provide a pain free and functional knee through restoration of ligamentous stability and range of motion. Operative management has been suggested to be superior to nonoperative management for knee dislocations largely in part owing to a meta-analysis on the topic published a decade ago. The purpose of this study was to summarize the results of operative and nonoperative treatment of knee dislocations over the past 10 year period. There were a total of 855 patients from 31 studies managed operatively and 61 patients from 4 studies managed nonoperatively. The overall methodological quality of the studies was poor as measured by the Newstead-Ottawa scale. Data regarding functional outcome, instability, contracture, and return to activity were all in favor of operative management. Significant differences were found for return to employment (P<0.001) and return to sport (P=0.001). The results of this study provide further evidence for the superiority of operative management, compared with nonoperative management, for knee dislocations across several clinical and functional domains. There is a need for higher level studies to assist the treating surgeon in the management of these challenging injuries.

Long-term Followup of Surgically Treated Knee Dislocations: Stability Restored, but Arthritis Is Common

“…Furthermore, most studies are small retrospective cohorts that contain considerable variability in terms of surgical treatment, injury patterns, and mechanism of injury [26]. A review of the literature for long-term outcomes returned only five peer-reviewed articles documenting average outcomes greater than 5 years postoperatively [1, 5,12,27,28].…”

“…There is now a general consensus that surgical treatment of these injuries provides better results than nonsurgical treatment [4, 10, 11, 13, 15-18, 21-26, 29, 30, 32]. Although some progress has been made, a review of the literature still contains numerous accounts of surgical techniques and small patient cohorts [26]. Furthermore, there is a paucity of data related to clinical and functional outcomes for the surgical treatment of knee dislocation injuries [19].…”

Behandlung der akuten Kniegelenksluxation

“…So sind Patientenzufriedenheit, Funktionsscore, verbleibende Instabilität, Kontrakturen, erfolgreiche Wiedereingliederung in den Beruf und Rückkehr zum Sport signifikant besser nach operativem Vorgehen [11,21]. Das nichtoperative Vorgehen kann bei schwer polytraumatisierten Patienten, Patienten mit schweren Komorbiditäten und/oder bei nur geringen Instabilitätsgraden in Erwägung gezogen werden.…”

Initial Treatment of Knee Dislocation at Yopougon Teaching Hospital/Abidjan, Ivory Coast

“…Its rarity and the variety of injuries that result from it mean that there is no adequate management that is universally accepted; non-operative or surgical repair in emergency [4]- [10]. Despite the boom in arthroscopy for knee surgeries, there is still controversy regarding the surgical schedule, graft selection, reconstruction of medial and lateral structures and postoperative rehabilitation [7] [8] [9] [10]. The aim of this study was to evaluate our emergency care strategy for these injuries.…”