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

Abstract

BackgroundThe purpose of our study was to analyze the clinical and radiological long-term outcomes of surgically treated traumatic knee dislocations and determine prognostic factors for outcome.MethodsRetrospective consecutive series of patients treated surgically for traumatic knee dislocation with reconstruction/refixation of the anterior (ACL) and posterior cruciate ligaments (PCL) and primary complete repair of collaterals and posteromedial and posteromedial corner structures. 68 patients were evaluated clinically (IKDC score, SF36 health survey, Lysholm score, Knee Society score, Tegner score, visual analogue scale - VAS pain and satisfaction, Cooper test) and radiologically (weight bearing and stress radiographs) with a mean follow up of 12 ± 8 years. Instrumented anterior-posterior translation was measured (Rolimeter, KT-1000). Pearson correlation and stepwise regression analysis was used.Results82% of patients (n = 56) returned to their previous work. At final follow-up 6 patients (9%) suffered from pain VAS > 3. The mean side-to-side difference of anterior/posterior translation (KT-1000, 134N) was 1.6 ± 1.6 mm and 2.6 ± 1.4 mm. Valgus and varus stress testing in 30° flexion was <3 mm (normal) in 57 patients (86%). The IKDC score was normal/nearly normal in 38 (58%) patients and the mean Lysholm score 83 ± 17 (intact 98 ± 7). The median Tegner score decreased from 7 preinjury (range 3-10) to 5 at follow-up (range 0-10). The mean Knee Society score was 187 ± 15 (out of maximum 200). In 7 patients (10%) a secondary ligament reconstruction was performed. Three patients (4%) underwent a high tibial osteotomy and four (6%) received a primary unconstrained total knee replacement. According to the Kellgren Lawrence osteoarthritis score only mild degenerative changes were present. The stress radiographs showed stable results for anteroposterior translation. Injury of the lateral collateral ligament, refixation of the ACL/PCL and delayed surgery >40 days were significantly associated with worse outcome (p < 0.05).ConclusionsEarly complete reconstruction can achieve good functional results and patient satisfaction with overall restoration of sports and working capacity. Negative predictive factors for outcome were injury pattern, type of surgical procedure and timing of surgery.

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

“…KT1000 TM was used assess stability in four of the five long-term case series of which we are aware (Table 1). Our results were comparable to other long-term studies with the exception of Hirschmann et al [12]. This cohort of 68 knee dislocations documented clinical stability in nearly 99% of their patients.…”

“…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]. With few studies focused on long-term followup, it was the purpose of this study to characterize the long-term recovery of the surgically treated patient with knee dislocation by focusing on four key issues: knee stability, return to preinjury level of function, development of radiographic signs of arthrosis, and ROM loss.…”

“…Use of the Lysholm and Tegner scales has been applied previously to the long-term assessment of the patient with knee dislocation [1, 5,12,27,28].…”

“…Furthermore, there is a paucity of data related to clinical and functional outcomes for the surgical treatment of knee dislocation injuries [19]. Few studies have shown successful results with up to 10 years of followup [1,5,9,12,27,28]. Even fewer studies include a substantial numbers of patients whose followup is into the second decade and beyond [12].…”

“…Few studies have shown successful results with up to 10 years of followup [1,5,9,12,27,28]. Even fewer studies include a substantial numbers of patients whose followup is into the second decade and beyond [12]. Of these studies, there is no consensus for the optimal evaluation methods in long-term followup.…”