Management of acute knee dislocations: anatomic repair and ligament bracing as a new treatment option—results of a multicentre study

Abstract

Purpose The literature shows no consensus regarding the best method and timing for the treatment of acute knee dislocations. Studies indicate that a one‐stage procedure performed in the early stages of injury can lead to superior results. The aim of this study was to evaluate the results after performing early surgical repair with additional suture augmentation (ligament bracing) of all torn ligaments in acute knee dislocations. Methods In this prospective multicentre study, 73 patients with an acute type III or IV knee dislocation were treated with one‐stage ligament bracing within 10 days. Twenty‐six patients sustained a type III medial dislocation, thirty‐nine patients sustained a type III lateral dislocation, and eight patients presented a type IV dislocation. Four patients were lost to follow‐up. Within the follow‐up evaluation, various scores were collected (International Knee Documentation Committee IKDC Score, Tegner Score and Lysholm Score). Additional stress radiography was performed (Telos™) postoperatively. Results Sixty‐nine knee dislocations (Schenck III and IV) with a follow‐up at a mean of 14 ± 1.6 months were evaluated. The average IKDC score was 75.5 ± 14.5, the average Lysholm score was 81.0 ± 15.5, and the median loss of activity in the Tegner score was 1 (range 0–3) point. Stress radiographs showed side‐to‐side differences at a mean of 3.2 ± 1.3 mm for the anterior cruciate ligament (ACL) and of 2.9 ± 2.1 mm for the posterior cruciate ligament (PCL). The operative revision rate (early and late) was 17.4%. In the early stage, one wound infection and one case of transient common peroneal nerve (CPN) paresis were successfully revised. In the later stage, four patients with knee stiffness and six cases with symptomatic knee instability needed reoperation. Patients without ultra‐low velocity (ULV) dislocations or CPN showed good or excellent results in 87.5% according to the Lysholm score. Conclusion In cases of acute knee dislocation, primary ACL and PCL transosseous sutures with additional suture augmentation predominantly lead to good and excellent clinical results. Obese patients sustaining ultra‐low velocity (ULV) dislocations and patients following injury to the CPN show inferior outcomes. In patients without ULV and CPN intraoperative and postoperative complications occurred in 10.1%. The obtained results and revision rates show that early primary suture repair is a promising option. Level of evidence Prospective multicentre study, II.

The multiple ligament-injured knee: When is primary repair an option?

“…When looking at the incidence of neurological injuries in this cohort, Niall et al showed that the majority (41%) occurred in patients with KD-IIIL injuries which is slightly less frequent than found in the present study [43], which may be explained due to our small sample size of patients with KD-IIIL injuries (n = 7). In general, neurovascular injuries are associated with KD-IIIL and KD-IV dislocations, which is consistent with the results found in the present study [46].…”

“…When reviewing recent repair studies, Hua et al performed open single-stage repair in all injured ligaments in 17 MLIKs and reported no knee laxity during final follow-up (mean 4.8 years) [20]. Given Heitmann et al supported these results by reporting that 91.3% of cases had clinical stable knees following primary repair with additional suture augmentation of all injured ligaments in 69 MLIKs (KD-III and IV) at a mean follow-up of 14 months [46]. In their study, secondary ACL reconstruction was performed in four patients (seven percent), while two underwent multiligamentous reconstruction (three percent) following instability.…”

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

“…27 Similarly, the mean IKDC score (78.6 points) in this study was within the range of previous reports, from 74.5 to 83.8. 11,27,40 Because of the small number of patients in the irreducible group, the absence of significant differences between the 2 groups could potentially be attributed to a lack of power.…”

Multiligamentäre Kniegelenkverletzungen – Therapieempfehlungen für die Frührehabilitation

“…Die Technik des "Bracings" soll hierbei eine frühe Gelenkmobilisierung mit Schutz der in Konsolidierung begriffenen Bandstrukturen ermöglichen [20]. Die Techniken I-III sollten in den ersten 2 Wochen nach der Verletzung erfolgen; in der chronischen Situation steht nahezu ausnahmslos die Ligament-Rekonstruktion zur Verfügung [2] [7].…”