Treatment of Knee Dislocation With Primary Repair and Suture Augmentation: A Viable Solution

Abstract

Background: Different surgical techniques have been described for the treatment of knee dislocation (KD). Nonoperative approaches are frequently combined with surgical reconstruction using auto- or allograft. Purpose: To evaluate the midterm results of primary surgical repair and suture augmentation to treat KD. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 patients (5 women, 17 men; mean age, 45 ± 15 years) with KD were evaluated at a mean of 49 ± 16 months after surgical treatment that included primary repair and suture augmentation. Magnetic resonance imaging, stress radiographs, and outcome scores were obtained at the follow-up. Clinical examination including hop tests and force measurements for flexion and extension was performed. Results: The mean difference in pre- to postinjury Tegner scores was –2 ± 1. The outcome scores showed mean values of 84 ± 15 (Lysholm), 73 ± 15 (International Knee Documentation Committee) and 65 ± 25 (Anterior Cruciate Ligament–Return to Sport after Injury scale). Compared with the uninjured knee, the range of motion of the injured knee was reduced by 21° ± 12°. Twelve patients felt fit enough to perform hop tests and showed a mean deficit of 7% ± 17%° compared with the uninjured leg. The mean force deficit was 19% ± 18% for extension and 8% ± 16% for flexion. Stress radiographs revealed an 11 ± 7–mm higher anteroposterior translation on the injured side. Four patients had secondary ligament reconstructions due to persistent instability and 7 underwent arthroscopic arthrolysis due to stiffness. A significant increase of osteoarthritis was found for the medial, lateral, and patellofemoral compartments ( P = .007, .004, and .006, respectively). Conclusion: Primary repair and suture augmentation of KD led to satisfactory clinical midterm results despite persistent radiological instability and a significant increase in osteoarthritis. This technique allows the return to activities of daily living without subjective instability in most nonathletic patients. Secondary ligament reconstructions should be performed if relevant instability persists to decrease the risk of secondary meniscal and cartilage damage.

Irreducible knee dislocation: improved clinical outcomes of open and arthroscopic surgical treatment. A systematic review of the literature

“…As described by Malik et al [ 8 ], most of them occurred through a posterolateral displacement, and according to the Schenck classification, they start from KD IIIM as a grade of severity [ 12 , 14 , 28 ]. With KD type III reported as the most common type in the entire KD literature, this systematic review agrees since KD III was the major injury pattern described [ 4 , 12 , 14 , 28 ].…”

“…IKDs represent a unique, rare rotatory subcategory of KDs [ 1 – 4 , 7 , 8 , 10 , 28 ]. As described by Malik et al [ 8 ], most of them occurred through a posterolateral displacement, and according to the Schenck classification, they start from KD IIIM as a grade of severity [ 12 , 14 , 28 ].…”

“…Two-thirds of the patients were males, and the mean age of the population investigated corresponds to the mean age reported by Malik et al [ 8 ]. In the literature, two main mechanisms of injury are described at the base of KDs as either low or high-energy trauma [ 1 – 4 , 10 ]. It is well known that KDs overall are most commonly due to high-energy trauma, such as road traffic accidents [ 1 – 4 ], and this is consistent with the IKDs group by Xu et al, whose patients were admitted after high-energy trauma, especially motor accidents [ 12 ].…”

“…Knee dislocations (KDs) are rare events with an incidence of up to 0.20% among all orthopedic trauma, and they are assumed to be underestimated because, in most cases, they undergo a spontaneous reduction [ 1 – 4 ].…”

No effect of dislocation status at arrival in emergency department on outcome of knee joint dislocations

“…While conservative treatment showed inferior results, primary stabilisation of highly unstable knee joints with an external fixator or primary ligament bracing showed significantly better results [9,12,15,24]. A meta-analysis published by Frosch et al comparing ligament bracing and reconstruction of the ACL and/or PCL showed comparable results, including dislocation of Schenck II and higher dislocations [4].…”