Knee Dislocations

Abstract

Background:Traumatic knee dislocation is becoming more prevalent because of improved recognition and increased exposure to high-energy trauma, but long-term results are lacking.Purpose:To present 2 cases with minimum 20-year follow-up and a review of the literature to illustrate some of the fundamental principles in the management of the dislocated knee.Study Design:Review and case reports.Methods:Two patients with knee dislocations who underwent multiligamentous knee reconstruction were reviewed, with a minimum 20-year follow-up. These patients were brought back for a clinical evaluation using both subjective and objective measures. Subjective measures include the following scales: Lysholm, Tegner activity, visual analog scale (VAS), Short Form–36 (SF-36), International Knee Documentation Committee (IKDC), and a psychosocial questionnaire. Objective measures included ligamentous examination, radiographic evaluation (including Telos stress radiographs), and physical therapy assessment of function and stability.Results:The mean follow-up was 22 years. One patient had a vascular injury requiring repair prior to ligament reconstruction. The average assessment scores were as follows: SF-36 physical health, 52; SF-36 mental health, 59; Lysholm, 92; IKDC, 86.5; VAS involved, 10.5 mm; and VAS uninvolved, 2.5 mm. Both patients had excellent stability and were functioning at high levels of activity for their age (eg, hiking, skydiving). Both patients had radiographic signs of arthritis, which lowered 1 subject’s IKDC score to “C.”Conclusion:Knee dislocations have rare long-term excellent results, and most intermediate-term studies show fair to good functional results. By following fundamental principles in the management of a dislocated knee, patients can be given the opportunity to function at high levels. Hopefully, continued advances in the evaluation and treatment of knee dislocations will improve the long-term outcomes for these patients in the future.

Knee Dislocation: A Case Report, Diagnostic Vascular Work-Up, and Literature Review

“…Knee dislocations can be simply defined “as ligamentous disruptions with loss of continuity of tibiofemoral articulation” [1]. However, a broader definition encompassing the entity of spontaneously reduced knee dislocations includes “those with plain radiographic tibiofemoral alignment but” with “multiple injured ligaments and gross instability on stress testing” [1].…”

“…However, a broader definition encompassing the entity of spontaneously reduced knee dislocations includes “those with plain radiographic tibiofemoral alignment but” with “multiple injured ligaments and gross instability on stress testing” [1]. This broader definition is important because neurovascular injury patterns are likely similar, if not identical, between acutely dislocated and spontaneously reduced but recently dislocated knees.…”

“…Oddly, the ultra-low-velocity trauma group seems to have an equal or even higher incidence of neurovascular injury when compared to high-energy dislocations [3]. The current state-of-the-art classification system is anatomic, based on the five major injury patterns that occur about the dislocated knee [1]. A full discussion of the anatomic classification is beyond the limits of this brief review but can be easily found in the medical literature [1, 4].…”

“…Keenly aware of the delicate risk/benefit ratio inherent in the care of the patient with a knee dislocation, many modern authors have researched various aspects of the vascular evaluation of these patients [1, 4, 9–13]. Out of these studies the so-called selective angiography approach has emerged.…”

Which Risk Factors Predict Knee Ligament Injuries in Severely Injured Patients?—Results from an International Multicenter Analysis

“…However, recent publications also reported knee dislocations as a result of low-energy mechanisms, including ground level falls in obese individuals [8][9][10]. The prompt identification, dedicated evaluation, and a comprehensive management of knee injuries have a high impact on long-term functional outcomes [11][12][13][14].…”