Irreducible knee dislocation treated by arthroscopic debridement

Dubberley, James; Burnell, Colin; Longstaffe, Albert; MacDonald, Peter B.

doi:10.1053/jars.2001.22357

Cited by 25 publications

(29 citation statements)

References 12 publications

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“…With regard to the method to repair this kind of impaction, there have been different suggestions. One report indicated that arthroscopic surgery was effective, but other reports suggested that it was difficult to repair the impaction with arthroscopic surgery [6][7][8]. In either case, it is considered that this dislocation is not reducible without open repair of the impaction of the medial femoral condyle.…”

Section: Discussionmentioning

confidence: 99%

Knee Joint Dislocation Complicated by Tabes Dorsalis Requiring Open Reduction: A Case Report

Shimura

Iwase²,

Sawa³

et al. 2014

Osteopor Phys

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herein report a case of knee dislocation with an unusual clinical course in which closed reduction was difficult due to the patient's past illness. Case ReportA 78-year-old man was injured in a fall while wheeling his bicycle on a snowy road. Although his right knee joint was deformed, he left it untreated for seven days, but finally attended the outpatient department of our hospital at the suggestion of his family on day 8 after the injury. At the first examination, his right knee joint was swollen and contracted in a slight flexion/varus/lateral rotation position. The femur protruded as a result of the deformation, and the skin of the proximomedial region of the knee showed ischemic change due to compression (Figures 1 and 2). The right dorsalis pedis pulse was weak but palpable. Plain X-ray films showed that the patella was outwardly displaced, and the tibia was displaced posterolaterally to the femur. Based on these findings, we made a diagnosis of traumatic knee joint dislocation (Figures 3 and 4).He had a history of quaternary neurosyphilis and had been treated with high doses of penicillin prior to the current visit, with sequelae of tabes dorsalis and dementia. Before the injury, imperception and gait disturbance due to spinal ataxia had been observed in the patient.Under fluoroscopic guidance, we tried several closed reduction methods such as anterior tibial drawer in the knee flexed position, lower limb traction and application of anterior pressure to the patella, but failed to reposition the knee. Subsequently, we tried to perform closed reduction under general anesthesia. During repositioning, the skin with ischemic change was lacerated and the articular surface of the medial femoral condyle was exposed, creating an open wound on the knee (Figure 5). Consequently, we changed the procedure to open reduction. AbstractA 78-year-old man sustained right knee dislocation in a fall. His pain was diminished on account of his past history of tabes dorsalis due to neurosyphilis, resulting in delayed hospital attendance for a week. The injury was posterolateral rotatory dislocation of the knee. Since closed reduction was not possible, open reduction was performed. Most cases of knee joint dislocation are easy to reduce. However, it is difficult to conduct closed reduction in this type of dislocation, because the joint capsule and medial collateral ligaments are torn by the medial femoral condyle. It is important to recognize that some types of dislocation of the knee are difficult to reduce.

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Section: Discussionmentioning

confidence: 99%

Knee Joint Dislocation Complicated by Tabes Dorsalis Requiring Open Reduction: A Case Report

Shimura

Iwase²,

Sawa³

et al. 2014

Osteopor Phys

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“…18,19 Once an irreducible posterolateral dislocation is recognized, it must be urgently reduced in order to preserve knee function. 2,4,[6][7][8][9][10]12,13,15,20 In our case, the delay in recognition ultimately affected the available treatment options and potentially the eventual outcome. 21 If a posterolateral dislocation is addressed immediately, an arthroscopic 9,6,22 and an open approach for reduction have been described.…”

Section: Discussionmentioning

confidence: 99%

“…2,4,[6][7][8][9][10]12,13,15,20 In our case, the delay in recognition ultimately affected the available treatment options and potentially the eventual outcome. 21 If a posterolateral dislocation is addressed immediately, an arthroscopic 9,6,22 and an open approach for reduction have been described. With an open reduction, primary repair of damaged structures may be feasible if they are in the operative field 21,23 ; however, further dissection or incisions should be avoided until the soft tissues become more amenable to intervention.…”

Section: Discussionmentioning

confidence: 99%

“…This requires either an urgent open or an arthroscopic reduction. [4][5][6][7][8][9][10][11][12][13][14][15] However, an unrecognized or unreduced dislocation can lead to a significant increase in the complexity of definitive operative management with extensive scar tissue and decreased mobility of injured structures. Patient disability may also be severely influenced through permanently limited range of motion.…”

Section: Introductionmentioning

confidence: 99%

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A Chronic Posterolateral Knee and Patella Dislocation: Case Report

Thiel¹,

Baker²,

Bush‐Joseph³

2009

Journal of Orthopaedic Trauma

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Knee dislocations are uncommon as isolated orthopaedic injuries, but their prevalence is increased in the setting of high-energy multiple trauma. In these circumstances, it is important for the orthopaedic clinician to recognize and appropriately treat the knee dislocation in parallel with other significant injuries. We report the case of an 18-year-old woman who was involved in a motor vehicle collision and sustained multiple injuries in addition to a posterolateral knee dislocation. An attempt at reduction was made in the initial trauma setting, and the patient was medically stabilized. She was discharged from the hospital in a splint with orthopaedic follow-up and presented 3 months after injury with an unreduced posterolateral dislocation. A single-stage operation was performed with reduction and stabilization of the knee. Postoperatively, the patient has done well and regained significant range of motion.

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“…Recently, reduction by arthroscopic debridement of irreducible knee dislocations has been reported [11]. Gu et al analyzed nine cases of posterolateral knee joint dislocation, five of them being fresh and four of them old injuries.…”

Section: Discussionmentioning

confidence: 99%

Delayed Reduction of Irreducible Chronic Posterolateral Dislocation of the Knee with Buttonholing of the Medial Femoral Condyle

et al. 2005

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European Journal of Trauma Ab stractTraumatic knee dislocations are relatively rare and almost always respond to closed reduction; however, a small percentage of knee dislocations are irreducible and in these cases open reduction is frequently required. A 65-year-old man with an unreduced posterolateral knee dislocation with laterally dislocated patella was seen 3 weeks after a motor vehicle accident. Medial femoral condyle was found buttonholed through the medial capsule together with the medial collateral ligament and lying in the medial joint space that allowed posterior rotary dislocation of the joint. Both cruciate ligaments and medial meniscus were torn. There was no evidence of any vascular or nerve injury. Reduction was accomplished by removal of the capsuloligamentous structures which were incarcerated in the trochlea and intercondylar notch and by excision of meniscal tear. Following posterior cruciate ligament reconstruction with patellar tendon autograft, lateral patellar release, vastus medialis advancement, and gracilis transfer were done. Case StudyA 65-year-old man, when walking in the street, was involved in a motor vehicle accident 3 weeks previously. He described a valgus and internal rotation force to his right knee. After falling to the ground, he was unable to weight bear on his right knee. Initially, the patient was seen at the state hospital in another city and according to medical records his right knee remained dislocated despite reduction attempts by closed means. The patient was admitted to our hospital with a 21-day delay. The right knee was noted to have a gross S-shaped deformity with the tibia dislocated posterior to the femoral condyles. The right medial femoral condyle was prominent under the skin, and a dimple sign, an invagination of medial tissues located anteriorly between the medial femoral condyle and medial tibial plateau, was seen on the ecchymotic skin (Figures 1a and 1b). The patella was dislocated laterally. Ligamentous stability could not be assessed, since the knee was locked in 30° flexion. The right dorsalis pedis and posterior tibial arteries were pulsatile. Sensation and motor function of the right leg and foot were intact. Radiographs of right knee showed marked medial joint space widening with posterolateral translation of the proximal tibia and patella dislocation laterally (Figures 2a to 2c). Despite difficulties obtaining appropriate and sufficient views because of discomfort of patient, MRI showed incarceration of the medial collateral ligament (MCL) and rupture of both cruciate ligament ( Figure 3). Angiography of his right lower extremity was normal (Figure 4). He had ipsilateral both rami pubis fractures and a contralateral minimally displaced transverse distal third tibia fracture. A long-leg cast had been applied before. In his systemic examination, he had partial visual impairment and headache. CT examination revealed a minimal subdural hematoma which did not require surgical intervention by the consultant neurosurgeon. After clinical and radiologic e...

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Irreducible knee dislocation treated by arthroscopic debridement

Cited by 25 publications

References 12 publications

Knee Joint Dislocation Complicated by Tabes Dorsalis Requiring Open Reduction: A Case Report

Knee Joint Dislocation Complicated by Tabes Dorsalis Requiring Open Reduction: A Case Report

A Chronic Posterolateral Knee and Patella Dislocation: Case Report

Delayed Reduction of Irreducible Chronic Posterolateral Dislocation of the Knee with Buttonholing of the Medial Femoral Condyle

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