Knee Dislocations: Where Are the Lesions?

Twaddle, Bruce; Bidwell, Terri; Chapman, Jens R.

doi:10.1097/00005131-200303000-00008

Cited by 147 publications

(53 citation statements)

References 15 publications

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“…Other studies with smaller cohorts reported a mean age of 28 to 32 years. 1,10,33 Meniscal injuries were found in 37.3% of patients in the current study, and cartilage injuries were found in 28.3%. Richter et al 26 reported a lower incidence (15%) of meniscal injuries in association with knee dislocation, while Krych et al 17 reported higher rates of meniscal and chondral lesions associated with knee dislocation in 121 patients (122 knees), with 76% of patients having a meniscal or chondral injury (55% with meniscal tears, 48% with chondral injury).…”

Section: Discussionmentioning

confidence: 43%

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Demographics and Injuries Associated With Knee Dislocation: A Prospective Review of 303 Patients

Moatshe

Dornan

Løken

et al. 2017

Orthopaedic Journal of Sports Medicine

140

113

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Background:Information on the incidence, injury mechanisms, ligament injury patterns, and associated injuries of knee dislocations is lacking in the literature. There is a need to characterize ligament injury patterns and associated injuries in knee dislocations to avoid missing common associated diagnoses and to plan surgical treatment.Purpose:To evaluate patient demographics, ligament injury patterns and associated injury patterns, and associated injuries in patients with knee dislocation.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 303 patients with knee dislocations treated at a single level 1 trauma center were followed prospectively. Injury mechanism; ligament injury patterns; associated neurovascular, meniscal, and cartilage injuries; and surgical complications were recorded. The Schenck knee dislocation classification was used to classify the ligament injury patterns.Results:The mean age at injury was 37.8 ± 15.3 years. Of the 303 patients included, 65% were male and 35% were female. There was an equal distribution of high-energy and low-energy injuries. Injury to 3 major ligaments was the most common, with Schenck classification type KD III-M constituting 52.4% of the injuries and KD III-L comprising 28.1%. Meniscal injuries and cartilage injuries occurred in 37.3% and 28.3% of patients, respectively. Patients with acute injuries had significantly lower odds of a cartilage injury than those with chronic injuries (odds ratio [OR], 0.28; 95% CI, 0.15-0.50; P < .001). Peroneal nerve injuries were recorded in 19.2% of patients (10.9% partial and 8.3% complete deficit), while vascular injuries were recorded in 5%. The odds of having a common peroneal nerve injury were 42 times greater (P < .001) among those with posterolateral corner injury (KD III-L) than those without. The odds for popliteal artery injury were 9 times greater (P = .001) among those with KD III-L injuries than other ligament injury types.Conclusion:Medial-sided bicruciate injuries were the most common injury pattern in knee dislocations. Cartilage injuries were common in chronically treated patients. There was a significant risk of peroneal nerve injury with lateral-sided injuries.

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Section: Discussionmentioning

confidence: 43%

“…3,4,28,29,33 Most studies are retrospective in nature, and few patients are included. The incidence of these injuries is reported to be between 0.02% and 0.2% of all orthopaedic injuries.…”

mentioning

confidence: 99%

Demographics and Injuries Associated With Knee Dislocation: A Prospective Review of 303 Patients

Moatshe

Dornan

Løken

et al. 2017

Orthopaedic Journal of Sports Medicine

140

113

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“…Neurological compromise associated with KD occurs most commonly to the common peroneal nerve [26] and has a reported incidence of between 10-40% [27-29]. One study by Peskun et al performed univarate and multivariate regression analysis to suggest that the risk of peroneal nerve injury is increased in those patients with a higher BMI (p = 0.0206), associated fibular head fracture (p = 0.009) or associated vascular injury (p = 0.035) [26].…”

Section: Acute Managementmentioning

confidence: 99%

Current Concepts in Acute Knee Dislocation: The Missed Diagnosis?

McKee¹,

Ibrahim²,

Lawrence³

et al. 2014

TOORTHJ

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Traumatic knee dislocation is a serious and potentially limb threatening injury that can be easily missed if meticulous history and examination have not been employed. Neurovascular injuries are common in this condition, and due diligence should be given to their thorough evaluation at time of secondary survey so as to avoid complications such as ischaemia, compartment syndrome and eventual amputation. There is growing evidence in the literature that morbid obesity is associated with low energy knee dislocation, therefore this should be considered when assessing this cohort of patients presenting with an acute knee injury. Early operative intervention especially with multi ligaments involvement is the preferable strategy in the management of this acute injury. Controversy exists whether to reconstruct or repair damaged structures, and whether to adopt a one stage or two stage reconstruction of the cruciate ligaments. Early rehabilitation is important and essential to achieve satisfactory outcomes. This article is an evidence-based overview of this rare but devastating injury.

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“…Traumatic dislocation of the tibiofemoral joint is considered to be rare in Europe and western civilized countries[1,2], but when present it often has dramatic social and economic consequences for the patient[3-9]. Spontaneous reduction makes the true frequency of knee dislocation unclear.…”

Section: Introductionmentioning

confidence: 99%

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

Hirschmann

Zimmermann

Rychen

et al. 2010

BMC Musculoskelet Disord

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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.

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Knee Dislocations: Where Are the Lesions?

Cited by 147 publications

References 15 publications

Demographics and Injuries Associated With Knee Dislocation: A Prospective Review of 303 Patients

Demographics and Injuries Associated With Knee Dislocation: A Prospective Review of 303 Patients

Current Concepts in Acute Knee Dislocation: The Missed Diagnosis?

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

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