Outcomes of Operatively Treated Acute Knee Dislocations

Abstract

Knee dislocation is a complex and rare injury often presenting in the context of high velocity trauma. The aim of this study is to establish the subjective outcomes of surgically treated knee dislocations. A total of 20 knees dislocations treated by open repair were reviewed. Their progress and outcomes were assessed by using a modified Lysholm score questionnaire. Data was obtained on patient demographics, details of injury, investigation, treatment, rehabilitation, 24 months objective outcome and subjective outcomes. Six patients had a vascular deficit and six had neurological deficits. The median range of motion was 0°-100°. Patients with an initially lower pre-injury level of function were able to return an activity level comparable to their pre-injury status. 22% of competitive athletes retuned to competitive sports. 38% of patients undertaking heavy activity returned to comparable pre-injury level of activity and 67% of patients undertaking moderate level of activity before injury returned to a comparable level after repair. 68% regularly had problems running, 70% problem squatting, 40% swelling and 42% problem with stairs. Most patients however did not have locking of the knee or problems with knees giving way. Patients pain scores decreased over time to an acceptable level. Despite the severity of the injury, majority of patients achieved a satisfactory outcome, although none of the patients reached the same level of function as before the injury. 80% of the patients were satisfied with their outcome. All dissatisfied patients suffered postoperative complications.

The Changing Demographics of Knee Dislocation: A Retrospective Database Review

“…Our data demonstrated that male patients were more likely to sustain a knee dislocation than female patients. This increased risk of dislocations in males has been previously reported, with most case studies exhibiting a male-to-female patient ratio of 4:1 or higher [6,23,27]. However, while our data demonstrated a statistically significant increase in knee dislocations in males, this increase was slight and we found a male-to-female patient ratio of nearly 1:1.…”

“…Owing to the highenergy nature of knee dislocation injuries, they occur more frequently in younger and more active patient populations. The mean age of patients with knee dislocations typically reported in other studies ranges between 29 and 37 years [6,23,27]. We found a mean patient age of 35 years and a statistically significant inverse correlation between patient age and risk for dislocation.…”

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

“…Specific treatment depends on the exact nature of the injury, systemic status of the patient, and presence of concomitant injuries [15]. It is difficult to draw definitive conclusions in regards to outcomes following knee dislocations because of the relative rarity of the injury and the variability of the specific injury pattern, operative technique, graft selection, and rehabilitation protocol [20]. Patients who sustain a knee dislocation have decreased range of motion, increased instability, greater pain, and lower functional outcome scores compared with uninjured agematched controls.…”

Radiologic Review of Knee Dislocation: From Diagnosis to Repair

“…Until recently, there was debate as to whether operative management was superior to nonoperative management, and there remains debate relating to early versus delayed surgery, a single versus multistage procedure, and ligament repair versus reconstruction, to name a few [5,[51][52][53][54][55]. Regardless of the treatment, the goal is to restore knee function by providing the patient with a pain free stable joint and full range of motion.…”

“…Likely due to rarity, incidence data are scarce and dated, with most accounts from large academic institutions citing a rate ranging from 0.28 to 5.3 knee dislocations per year and an overall incidence of 0.02-0.2% of all orthopedic injuries [1, 3,4]. Complicating the diagnosis is that knee dislocations frequently reduce spontaneously or are reduced by paramedical personnel in the field before being evaluated by a physician [5,6]. Further compounding this problem is either a missed or delayed diagnosis in the setting of polytrauma, in which a dedicated knee ligament examination may be overlooked because attention is focused on other life-threatening injuries [7].…”