Prioritised challenges in the management of acute knee dislocations are stiffness, obesity, treatment delays and associated limb-threatening injuries: a global consensus study

Abstract

ObjectivesHeterogeneous patient factors and injury mechanisms result in a great variety of injury patterns encountered in knee dislocations (KD). Attempts to improve outcome can focus on a wide range of challenges. The aim of this study was to establish and prioritise a list of challenges encountered when treating patients with acute KD.MethodsA modified Delphi consensus study was conducted with international knee specialists who generated a prioritised list of challenges. Selected priorities were limited to half of the possible items. Agreement of more than 70% was defined as consensus on each of these items a priori.ResultsNinety-one international surgeons participated in the first round. The majority worked in public hospitals and treated patients from low-income and middle-income households. Their propositions were prioritised by 27 knee surgeons from Europe, Africa, Asia, as well as North and South America, with a mean of 15.3 years of experience in knee surgery (SD 17.8). Consensus was reached for postoperative stiffness, obesity, delay to presentation and associated common peroneal nerve injuries. Challenges such as vascular injuries, ipsilateral fractures, open injuries as well as residual laxity were also rated high. Most of these topics with high priority are key during the initial management of a patient with KD, at presentation. Topics with lower priority were postsurgical challenges, such as patient insight, expectations and compliance, rehabilitation programme, and pain management.ConclusionThis consensus study has a wide geographical footprint of experts around the world practising in various settings. These participants prioritised stiffness, obesity, treatment delays and associated limb-threatening injuries as the most important challenges when managing a patient with acute KD. This list calls for applicable and feasible solutions for these challenges in a global setting. It should be used to prioritise research efforts and discuss treatment guidelines.Level of evidenceV.

Catalysing global surgery: a meta-research study on factors affecting surgical research collaborations with Africa

“…A clear structure with terms of reference, a central management team, multidisciplinary groups, a division into smaller teams with experienced leaders, and goal and target setting could facilitate these collaborations [ 39 , 48 , 50 , 63 , 64 , 69 , 75 , 79 , 81 ]. Problems included poor recruitment of local investigators, especially in LMICs and Africa, dropout of investigators across multiple rounds of the same study, power imbalances between HIC and LMIC authors, a skewed data representation of the identified regions, variations in the local and regional context, and difficulties in achieving consensus [ 27 , 30 , 31 , 33 , 35 , 36 , 39 , 40 , 43 , 49 , 63 , 67 , 75 , 80 ].…”

“…Information and communication included maximizing the initial recruitment of collaborators into the study using multiple channels such as social media, videos, personal emails, and promotions. Online communication tools, electronic data capture, and information systems greatly facilitated the proliferation of collaboratives [ 27 , 28 , 30 , 32 , 33 , 35 – 43 , 48 , 50 , 55 , 56 , 58 , 59 , 67 , 69 , 81 ]. These were shown to be more successful when augmented with physical and offline modes of communication, such as face-to-face meetings.…”

“…HICs had higher access to these resources and utilized this advantage to partner with collaborators in Africa and other LMICs [ 28 , 39 , 43 , 49 , 69 , 75 , 81 ]. However, African researchers had lower access to financial resources, limited research support from their home institutions and countries, and a limited number of experts and specialists [ 27 , 28 , 31 , 33 , 45 , 49 , 65 , 78 , 80 ].…”