Varus mechanism is associated with high incidence of popliteal artery lesions in multiligament knee injuries

Sandoval

Journal of Clinical Orthopaedics and Trauma

2021

Schenck's knee dislocation (KD) I is a very uncommon pattern of KD, where the knee presents with clinical or radiographic evidence of a KD with one of the ligaments of the central pivot preserved. The correlation between imaging and physical examination is of the highest importance to correctly classify this injury. Recently, there have been reports in the literature with large numbers of Schenk's KD I, however this is due to classifying multiligament knee injuries as if they all were KDs rather to an increase of the pattern. In this report the case of an 18-year old patient that sustained a KD with a preserved posterior cruciate ligament is presented.

Section: Discussionmentioning

confidence: 87%

Schenck’s knee dislocation (KD) I injury: An uncommon pattern

Sandoval

Journal of Clinical Orthopaedics and Trauma

2021

Orthopaedic Journal of Sports Medicine

“…All studies were published over a 21-year period between 1999 and 2020, reporting on 2594 knee dislocations, multiligament knee injuries, or bicruciate knee injuries sustained by 2585 patients. Of the 31 publications, 5 of these 4 , 5 , 8 , 48 , 52 did not report the timing from injury to surgical repair/reconstruction of the cruciate ligaments. Based on each study’s stated mean time to surgery, 10 studies ∥ reported outcomes for acute surgical intervention, 8 studies 1 , 3 , 14 , 26 , 30 , 34 – 36 reported outcomes for delayed surgical intervention, and 8 studies 16 , 32 , 38 , 39 , 41 , 53 , 57 , 58 included outcomes on both.…”

Section: Resultsmentioning

confidence: 99%

“…Based on each study’s stated mean time to surgery, 10 studies ∥ reported outcomes for acute surgical intervention, 8 studies 1 , 3 , 14 , 26 , 30 , 34 – 36 reported outcomes for delayed surgical intervention, and 8 studies 16 , 32 , 38 , 39 , 41 , 53 , 57 , 58 included outcomes on both. According to sex distributions and male-to-female ratios, all but 2 studies 1 , 48 reported that men represented the majority in each cohort of patients. The mean age ranged from 25.1 to 65.3 years with a mean follow-up time ranging from 12 to 157.2 months.…”

Section: Resultsmentioning

confidence: 99%

Acute Versus Delayed Surgical Intervention in Multiligament Knee Injuries: A Systematic Review

Marder

Poonawala

Pincay

et al. 2021

Background: The optimal timing of surgical intervention for multiligament knee injuries remains controversial. Purpose: To review the clinical and functional outcomes after acute and delayed surgical intervention for multiligament knee injuries. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a search of the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to September 2020. Eligible studies reported on knee dislocations, multiligament knee injuries, or bicruciate ligament injuries in adult patients (age, ≥18 years). In addition to comparing outcomes between acute and delayed surgical intervention groups, we conducted 3 subgroup analyses for outcomes within isolated knee injuries, knee injuries with concomitant polytrauma/fractures, and high-level (level 2) studies. Results: Included in the analysis were 31 studies, designated as evidence level 2 (n = 3), level 3 (n = 8), and level 4 (n = 20). These studies reported on 2594 multiligament knee injuries sustained by 2585 patients (mean age, 25.1-65.3 years; mean follow-up, 12-157.2 months). At the latest follow-up timepoint, the mean Lysholm (n = 375), International Knee Documentation Committee (IKDC) (n = 286), and Tegner (n = 129) scores for the acute surgical intervention group were 73.60, 67.61, and 5.06, respectively. For the delayed surgical intervention group, the mean Lysholm (n = 196), IKDC (n = 172), and Tegner (n = 74) scores were 85.23, 72.32, and 4.85, respectively. The mean Lysholm (n = 323), IKDC (n = 236), and Tegner (n = 143) scores for our isolated subgroup were 83.7, 74.8, and 5.0, respectively. By comparison, the mean Lysholm (n = 270), IKDC (n = 236), and Tegner (n = 206) scores for the polytrauma/fractures subgroup were 83.3, 64.5, and 5.0, respectively. Conclusion: The results of our systematic review did not elucidate whether acute or delayed surgical intervention produced superior clinical and functional outcomes. Although previous evidence has supported acute surgical intervention, future prospective randomized controlled trials and matched cohort studies must be completed to confirm these findings.

“…Inclusion criteria were (1) radiographically documented KD; (2) PCL injury with associated injuries to the PMC, including the medial collateral ligament (MCL), and/or associated injuries to PLC, including the lateral collateral ligament (LCL); (3) bicruciate ligament injury and associated injury to at least one collateral ligament (KD-IIIM or KD-IIIL) [22]; and (4) injury to all four major ligaments (KD-IV). On the contrary, exclusion criteria were (1) chronic MLKIs or KDs, (2) no acute primary repair because of prolonged intensive care, (3) open knee dislocation, (4) knees with osteoarthritis, (5) patients with ACL injury and grade III MCL injury who underwent simultaneous ACL reconstruction and MCL repair, and (6) failure to complete the study questionnaire ( Fig. 1).…”

Section: Patientsmentioning

confidence: 99%

“…Knee dislocations (KDs) and multiligament knee injuries (MLKIs) are severe knee traumas which involve intra- and extraarticular ligament tears, often with concomitant vascular and nerve damage and a fracture around the knee. Because popliteal artery lesion is a limb-threatening injury, early revascularization should be prioritized to avoid limb amputation [ 1 , 2 ]. Concomitant other organ traumas, such as open fracture and head trauma, may similarly compromise the optimal timing of MLKI treatment.…”

Section: Introductionmentioning

confidence: 99%

Acute primary repair of extraarticular ligaments and staged surgery in multiple ligament knee injuries

et al. 2020

Background The purpose of this study is to compare the outcomes of acute primary repair of extraarticular ligaments with staged surgery for acute knee dislocations (KDs) and multiligament knee injuries (MLKIs). Materials and methods Between January 2005 and May 2018, 61 consecutive patients diagnosed with MLKI or KD were referred to or visited our institution. Of these, 31 patients who underwent acute repair of extraarticular ligaments within 3 weeks of injury were included in this study. These patients were retrospectively classified into two groups: those who underwent only primary repair (repair group) and those who underwent staged reconstructive surgery (staged group). Follow-up examination included range of motion (ROM), knee joint stability (Lachman test, posterior drawer test, and varus and valgus stress test), Lysholm knee score, Tegner activity scale, and Knee Injury and Osteoarthritis and Outcome Score (KOOS). Results Twelve of the 31 patients did not need or desire further surgery and were included in the repair group. No significant difference was observed in demographic data between the repair and staged groups. Although staged surgery decreased positive posterior drawer test results, no significant difference was observed between the two groups regarding ROM, other knee joint stability tests, Lysholm scores, Tegner scale, or KOOS. Conclusions In this series, all patients returned to their activities of daily living and preinjury occupation levels. Acute primary repair of extraarticular ligaments provides essential knee stability without varus/valgus instability and may reduce the need for subsequent cruciate ligament reconstruction. Level of evidence Level IV, retrospective observational study.