Surgical Management of Knee Dislocations

Harner, Christopher D.; Waltrip, Robert L.; Bennett, Craig; Francis, Kimberly; Cole, Brian J.; Irrgang, James J.

doi:10.2106/00004623-200402000-00008

Cited by 383 publications

(317 citation statements)

References 34 publications

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“…Peroneal nerve palsy is a frequent complication of knee dislocation with a reported frequency ranging from 14% to 40% [14]. The peroneal nerve is at risk because it is held tightly against the fibular head [11] and injury often is associated with proximal fibular fractures and posterolateral corner injuries [5,17]. Recovery of nerve injury is variable, reported as ranging from 31% to 75% [2,11,23,24,27].…”

Section: Introductionmentioning

confidence: 99%

“…The peroneal nerve is at risk because it is held tightly against the fibular head [11] and injury often is associated with proximal fibular fractures and posterolateral corner injuries [5,17]. Recovery of nerve injury is variable, reported as ranging from 31% to 75% [2,11,23,24,27]. However, morbidity associated with persistent nerve dysfunction and foot drop is considerable [3].…”

Section: Introductionmentioning

confidence: 99%

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Is Peroneal Nerve Injury Associated With Worse Function After Knee Dislocation?

Krych

Giuseffi

Kuzma

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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BackgroundPeroneal nerve palsy is a frequent and potentially disabling complication of multiligament knee dislocation, but little information exists on the degree to which patients recover motor or sensory function after this injury, and whether having this nerve injury-with or without complete recovery-is a predictor of inferior patient-reported outcome scores. Questions/purposes The purposes of this study were to (1) report on motor and sensory recovery as well as patientreported outcomes scores of patients with peroneal nerve injury from multiligament knee dislocation; (2) compare those endpoints between patients who had partial versus complete nerve injuries; and (3) compare patient-reported outcomes among patients who sustained peroneal nerve injuries after knee dislocation with a matched cohort of multiligament knee injuries without nerve injury. Methods Thirty-two patients were identified, but five did not have 2-year followup and are excluded (16% lost to followup). Twenty-seven patients (24 male, three female) with peroneal nerve injury underwent multiligament knee reconstruction and were followed for 6.3 years (range, 2-18 years). Motor grades were assessed by examination and outcomes by International Knee Documentation Committee (IKDC) and Lysholm scores. Retrospectively, patients were divided into complete (n = 9) and partial nerve palsy (n = 18). Treatment for complete nerve palsy included an ankle-foot orthosis for all patients, nonoperative (one), neurolysis (two), tendon transfer (three), nerve transfer (one), and combined nerve/tendon transfer (one). Treatment for partial nerve palsy included nonoperative (12), neurolysis (four), nerve transfer (one), and combined nerve/tendon transfer (one). Furthermore, patients without nerve injury were matched by Schenck classification, age, and sex. Data were analyzed using univariate and multivariate models. Results Overall, 18 patients (69%) regained antigravity ankle dorsiflexion after treatment (three complete nerve palsy [38%] versus 15 partial nerve palsy [83%]; p = 0.06). One patient with complete nerve palsy (13%) and 13 patients with partial nerve palsy (72%) regained antigravity extensor hallucis longus strength (p = 0.01). IKDC and Lysholm scores were similar between complete nerve palsy and partial nerve palsy groups. After controlling for confounding variables such as patient age, body mass index, injury interval to surgery, mechanism of injury, bicruciate injury, and popliteal artery injury status, there was no difference between patients with peroneal nerve injury and those without on Lysholm or IKDC scores.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is Peroneal Nerve Injury Associated With Worse Function After Knee Dislocation?

Krych

Giuseffi

Kuzma

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Some patients immediately eliminate patients with SPE nerve palsy from their ligament repair collective. Others emphasize the spontaneous and rapid recovery of paralysis (6,9,10) . Despite a significant rate of rupture or non-recovery, several authors do not report the impact of neurological sequelae on the final result (11,12,13) .…”

Section: Discussionmentioning

confidence: 99%

Trauma of the External Popliteal Sciatic Nerve (SPE) Following a Dislocation of the Knee: About a Case

Bensalah

Zadoug

Ouzaa

et al. 2017

IAM

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Knee dislocation is a translocation of the tibia with respect to the femur following a violent trauma. It can be complicated by serious vasculo-nervous lesions, of which the paralysis of the sciatic nerve poplite external remains infrequent. This is the case of our patient who presented six months ago a traumatic dislocation of the left knee reduced in urgency, And which was complicated by a complete neurological deficit of the SPE nerve, confirmed by electromyogram (EMG). Palliative surgery was indicated and was aimed at improving functional prognosis, using tendon transfer to resuscitate the dorsal flexion of the foot.

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“…The incidence of concomitant neurologic injury with knee dislocation is reported to be from 10% to 40%. 15,16 The indications for peroneal neurolysis and cable grafting in the setting of knee dislocations are controversial. Patients who are undergoing PLC repair or reconstruction and have a peroneal nerve injury should be treated with at least a peroneal neurolysis.…”

Section: Nerve and Vascular Injuriesmentioning

confidence: 99%

“…23,24 The few published studies offering direct comparison of surgical timing have typically shown greater improvements in functional and clinical outcomes with early treatment. 25,26 However, a recent systematic review of literature regarding timing of surgery in multiligament injured knees found residual anterior knee instability as well as more flexion deficits in acutely managed knees compared to delayed reconstructions. 27 Additional treatment for joint stiffness was also more likely in association with acute treatment.…”

Section: Management Of the Knee Dislocationmentioning

confidence: 99%