Predictors of Mid- to Long-Term Outcomes in Patients Experiencing a Knee Dislocation: A Systematic Review of Clinical Studies

Smith, Jacob; Belk, John W.; Friedman, Jamie L.; Dragoo, Jason L.; Frank, Rachel M.; Bravman, Jonathan T.; Wolcott, Michelle; McCarty, Eric C.

doi:10.1055/s-0041-1723762

Cited by 7 publications

(3 citation statements)

References 56 publications

(117 reference statements)

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“…Many studies and systematic reviews advocate that acute surgery yields overall better results [22,28,44,50,79] and delayed surgery (after 2-3 weeks) decreases the risk of AF [14,50], whereas others found that acute surgery was not associated with stiffness [21].…”

Section: Timing Of Surgerymentioning

confidence: 99%

Arthrofibrosis is a common but poorly defined complication in multiligament knee injuries: a systematic review

Fahlbusch

Krivec

Müller

et al. 2022

Arch Orthop Trauma Surg

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Purpose The purpose of this study is to systematically review multiligament knee injury (MLKI) outcome studies to determine definitions of arthrofibrosis (AF) and provide information about incidence, management as well as potential risk factors. Methods A systematic literature search was performed (PubMed and Cochrane library) following the PRISMA guidelines of operatively treated MLKI (Schenck II–IV) studies reporting the incidence of AF. Twenty-five studies met the inclusion criteria. Injury pattern, timing of surgery, surgical technique, treatment of AF, rehabilitation programs and PROMS were inquired. Risk of bias and quality of evidence were assessed using the Coleman methodological score. Results Twenty-five studies with a total of 709 patients with a mean age of 33.6 ± 4.8 years were included and followed 47.2 ± 32.0 months. The majority of studies (22/25) used imprecise and subjective definitions of AF. A total of 86 patients were treated for AF, resulting in an overall prevalence of 12.1% (range 2.8–57.1). Higher-grade injuries (Schenck III–IV), acute treatment and ROM (range of motion) limiting rehabilitation programs were potential risk factors for AF. The time from index surgery to manipulation anesthesia (MUA) and arthroscopic lysis of adhesions (LOA) averaged at 14.3 ± 8.8 and 27.7 ± 12.8 weeks. Prior to MUA and LOA, the ROM was 51.7° ± 23.5 and 80.2° ± 17.0, resulting in a total ROM gain after intervention of 65.0° ± 19.7 and 48.0° ± 10.6, respectively; with no reports of any complication within the follow-up. The overall methodological quality of the studies was poor as measured by the Coleman score with average 56.3 ± 12.5 (range 31–84) points. Conclusions AF is a common but poorly defined complication particularly in high-grade MLKI. Early postoperative and intensified physiotherapy is important to reduce the risk of AF. MUA and LOA are very effective treatment options and result in good clinical outcome. Prospective studies with bigger study population are needed to optimize treatment algorithms of further patients after MLKI. The protocol of this systematic review has been prospectively registered with PROSPERO (CRD42021229187, January 4th, 2021).

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Section: Timing Of Surgerymentioning

confidence: 99%

Arthrofibrosis is a common but poorly defined complication in multiligament knee injuries: a systematic review

Fahlbusch

Krivec

Müller

et al. 2022

Arch Orthop Trauma Surg

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“…Traumatic knee dislocation (TKD) is mostly caused by high‐energy trauma, leading to serious damage to the tissues around the knee. It used to be a rare injury accounting for 0.02%–0.2% of all orthopaedic injuries 1,2 . However, the incidence might have been underestimated because of misdiagnoses and spontaneous knee reduction 3 .…”

Section: Introductionmentioning

confidence: 99%

“…It used to be a rare injury accounting for 0.02%–0.2% of all orthopaedic injuries. 1 , 2 However, the incidence might have been underestimated because of misdiagnoses and spontaneous knee reduction. 3 Additionally, morbidity may rise with the increase in high‐energy trauma, low‐velocity injuries (contact sports), or ultralow‐velocity injuries among obese populations.…”

Section: Introductionmentioning

confidence: 99%

One‐Stage Arthroscopic Multiple Ligament Reconstruction for Schenck IV Knee Dislocation

Liu

Zheng³

et al. 2022

Orthopaedic Surgery

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Purpose Schenck IV knee dislocation patients have dissatisfactory knee function and return‐to‐sport rate with the existing treatment methods. The purpose of this study was to illustrate a one‐stage arthroscopic multiple ligament reconstruction method for treating Schenck IV knee dislocations. Methods A retrospective case series study was performed. All patients with a history of Schenck IV knee dislocation who underwent one‐stage arthroscopic multi‐ligament reconstruction from 2010 to 2018 were followed for 24 months. The outcomes, including general patient data, Lysholm scores, International Knee Documentation Committee (IKDC) scores, visual analog scale (VAS) pain scores, knee active range of motion, and complications, were reviewed. The data was analyzed with paired‐samples t‐test. Results A total of 12 patients, comprising nine males and three females, were followed up and reviewed. The mean age at the time of the surgical procedure was 40.3 ± 9.0 (22–57) years. The mean body mass index (BMI) was 24.6 ± 4.9 (15.2–32.5) kg/m2. The mean IKDC score and Lysholm score before surgery were 30.4 ± 6.1 (21–42) and 28.2 ± 6.2 (22–39), respectively. The average operation time was 121.8 minutes. The mean IKDC score and Lysholm score at the 24‐month follow‐up were 80.6 ± 6.5 (68–92) and 82.0 ± 7.5 (72–95), respectively. There were significant differences in the IKDC and Lysholm scores between the preoperative and 24‐month postoperative time points (p < 0.01). The mean knee range of motion was 124.6° ± 6.6° (115°–135°) at the 24‐month follow‐up. No major complications occurred. Conclusions The results of this retrospective study suggest that the new arthroscopic one‐stage multi‐ligament reconstruction technique is an effective way to treat Schenck IV knee dislocation with satisfactory postoperative knee function.

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Knee joint dislocations—Current epidemiology and treatment in Germany

Weber,

Szymski,

Huber

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeKnee joint dislocations, though rare, present significant challenges due to potential complications like vascular and nerve damage, and are known to be often linked to sports injuries, accidents and obesity. This study aims to analyse the epidemiology, incidence and treatment approaches for knee dislocations in Germany from 2019 to 2022.MethodsThis retrospective cohort study utilized data from the German Institute for the Hospital Remuneration System to examine knee dislocation cases across German medical institutions. Patient data coded under International Statistical Classification of Diseases and Related Health Problems 10 for ‘knee dislocation’ enabled detailed analysis by age, sex and surgical procedures categorized by operation and procedure codes. The Patient Clinical Complexity Level (PCCL) assessed complication severity.ResultsAnalysis of 1643 knee dislocation cases revealed an incidence rate of 0.44–0.54 per 100,000 inhabitants annually. During the years 2020 and 2021, there were fewer cases of knee dislocations. Male patients comprised 50%–56% of cases, with an average hospital stay of 11 days. Most cases were PCCL 0 (62%–72%) and predominantly affected patients aged 18–29 years. Anterior tibial dislocations were common among classified cases. Injuries included ligament ruptures, meniscus lesions and grade I soft‐tissue injuries. Patients with pre‐existing knee prostheses constituted 0%–16% annually. Treatment involved closed reduction, external fixation and surgeries like capsuloligamentous reconstructions and arthroscopic procedures. Revision knee arthroplasty was required in 2%–9% of cases, with obesity rates up to 7%.ConclusionsThis study provides valuable insights into the epidemiology, incidence and treatment of knee dislocations in Germany, with a focus on demographic risk factors, treatment complexities and the impact of obesity and knee prostheses. The findings emphasize the importance of specialized care in larger hospitals, comprehensive management of concomitant injuries and the need for improved coding accuracy. Future research should aim to refine treatment protocols.Level of EvidenceLevel III.

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Predictors of Mid- to Long-Term Outcomes in Patients Experiencing a Knee Dislocation: A Systematic Review of Clinical Studies

Cited by 7 publications

References 56 publications

Arthrofibrosis is a common but poorly defined complication in multiligament knee injuries: a systematic review

Arthrofibrosis is a common but poorly defined complication in multiligament knee injuries: a systematic review

One‐Stage Arthroscopic Multiple Ligament Reconstruction for Schenck IV Knee Dislocation

Knee joint dislocations—Current epidemiology and treatment in Germany

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