Irreducible Knee Dislocation Associated With a Tertiary Gastrocnemius Head

Price, Ryan C; Shultz, Christopher; Richter, Dustin L.; Veitch, Andrew; Schenck, Robert C.

doi:10.2106/jbjs.cc.18.00476

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…Irreducible knee dislocation (IKD) is a rare but serious type of knee injury ( Malik and Macdonald, 2019 ), constituting up to 4% of all knee dislocation (KD) ( Robertson et al, 2006 ; Schaefer et al, 2018 ). IKD is considered irreducible because of the soft tissue incarceration during closed reduction, for example, the capsuloretinacular structure, medial collateral ligament (MCL), vastus medialis muscle, or the gastrocnemius muscle are likely to trap in the medial compartment ( Chen et al, 2011 ; Price et al, 2019 ). The “pucker sign” or “dimple sign” is considered as the diagnostic characteristic of IKD, which is due to invagination of the soft tissue into joint space ( Jeevannavar and Shettar, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

The Efficacy and Outcome of a Two-Staged Operation for Irreducible Knee Dislocation: A Prospective Short-Term Follow-Up

Cui

Yang

Zhu

et al. 2022

Front. Bioeng. Biotechnol.

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Background: Irreducible knee dislocation (IKD) is a very rare but serious type of knee dislocation; it can lead to soft tissue necrosis due to incarceration of the medial structures and faces great difficulty in the postoperative rehabilitation, too. IKD needs careful pre-operative planning. There is no universal agreement about the appropriate surgical strategy for IKD. The purpose of this study was to investigate the clinical efficacy, safety, and outcome of the two-staged operation in treatment of IKD.Methods: IKD patients were included from June 1, 2016 to May 31, 2020. In the stage-1 surgery, acute reduction and extra-articular structure repair were performed. Following an intermediate rehabilitation, delayed cruciate ligament reconstructions were performed in stage-2. Physical examination, CT, MRI, and X-ray were performed during the pre-operative period. Knee function, joint stability, ligament laxity, knee range of motion (ROM), and alignment were accessed at follow-ups. The minimum and maximum follow-up times were 0.5 years and 1 year, respectively.Results: In total, 17 IKD patients were included. There were three subjects (17.65%) missing at the 1 year follow-up and the average follow-up was 11.18 ± 2.53 months. After stage-1, normal alignment and superior valgus/varus stability were restored in most subjects; however, a notable anterior–posterior instability still existed in most patients. The intermediate rehabilitation processed smoothly (6.94 ± 1.20 weeks), and all patients achieved knee ROM of 0–120° finally. At 0.5 years and 1 year follow-up after stage-2, all subjects had achieved normal knee stability, ROM, and satisfying joint function. No infection or DVT was observed.Conclusions: The two-staged operation for IKD has superior efficacy on knee stability and function, and it can facilitate the rehabilitation and achieve satisfactory short-term outcome.

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Section: Introductionmentioning

confidence: 99%

The Efficacy and Outcome of a Two-Staged Operation for Irreducible Knee Dislocation: A Prospective Short-Term Follow-Up

Cui

Yang

Zhu

et al. 2022

Front. Bioeng. Biotechnol.

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“…16 Various soft tissue structures, including capsuloretinacular structures, the medial collateral ligament (MCL), the vastus medialis muscle, and the gastrocnemius muscle, are trapped in the medial compartment, preventing closed reduction. 3,24 The specific "pucker sign" or "dimple sign" is considered a diagnostic feature showing that the skin and soft tissue are invaginated into the joint space. 17 In cases of delayed diagnosis and therapy, the functional prognosis of the knee joint and even the lower limb may be seriously compromised, primarily because of the inactivation or even necrosis of interposed structures.…”

mentioning

confidence: 99%

The Effect of Irreducible Dislocation on Functional Outcomes in Knees With Multiligament Injuries: A Matched-Cohort Analysis

Zhong

Zhang

Mao

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Most cases of bicruciate knee dislocation (KD) with associated posteromedial disruption (KD-IIIM) are reducible, but some cannot be reduced by closed reduction because of soft tissue incarceration. Purpose: To compare the clinical characteristics and functional outcomes of KD-IIIM injuries in patients with or without incarceration of soft tissue requiring open or arthroscopic reduction. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective cohort study of patients with KD was conducted between January 2013 and December 2017 at a single large institution. We applied a 1:2 matching ratio between patients with irreducible KD-IIIM injuries (irreducible group; n = 14) and those with reducible KD-IIIM injuries (control group; n = 28). There were 13 patients in the irreducible group and 25 in the control group who completed follow-up (≥2 years) and were included in our analysis. The efficacy of treatment in patients with KD was evaluated based on range of motion, the Tegner score, the Lysholm score, and the International Knee Documentation Committee (IKDC) score. Results: At the end of follow-up, the mean Tegner score was 4.5 (range, 4-6), the mean Lysholm score was 79.2 (range, 60-95), and the mean IKDC score was 78.6 (range, 60.9-95.4) in the irreducible group. The respective results in the control group were 4.6 (range, 3-8), 83.1 (range, 39-100), and 80.6 (range, 42.5-96.6). These scores did not differ significantly between the 2 groups. Similarly, mean range of motion was similar between groups (irreducible, 118.1°; control, 124.8°). In the irreducible group, the acute subgroup showed significantly higher Lysholm and IKDC scores than the chronic subgroup, while the acute and chronic subgroups in the control group showed no significant differences in these respective outcome scores. Conclusion: In the present study, the treatment of irreducible KD led to similar functional outcomes compared with reducible KD. However, the treatment of chronic irreducible KD led to worse outcomes compared with acute irreducible KD, and therefore, urgent reduction is recommended in these patients.

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“…When we generate this excitement, we know the result will be an impressive publication. For instance, one of our current residents and a graduate of the Air Force Academy, Ryan Price, wrote a case report for JBJS Case Connector regarding an active-duty military member who had an irreducible knee dislocation from snowboarding 2 . Ryan was passionate about this case and did an outstanding job taking the report from conception through publication.…”

Section: Investing Time Early In the Processmentioning

confidence: 99%