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Surgical Management of Knee Dislocations

¹ University of Pittsburgh Medical Center, Center for Sports Medicine, 3200 South Water Street, Pittsburgh, PA 15203. E-mail address for A. Chhabra: anikarchhabra{at}hotmail.com. E-mail address for C.D. Harner: harnercd{at}msx.upmc.edu
² Beacon Orthopaedics and Sports Medicine, 500 E-Business Way, Sharonville, OH 45241
³ Midwest Orthopaedics at Rush, 800 South Wells Street, Suite M30, Chicago, IL 60607
⁴ University of Maryland Medicine, 22 South Greene Street, Baltimore, MD 21201
⁵ East Suburban Orthopedic Associates, 2566 Haymaker Road, Suite 311, Monroeville, PA 15146

Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 86-A, pp. 262-273, February 2004

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The line drawings in this article are the work of Jennifer Fairman (jfairman{at}fairmanstudios.com).

The evaluation and management of knee dislocations remain variable and controversial. The purpose of this study was to describe our method of surgical treatment of knee dislocations with use of a standardized protocol and to report the clinical results.

METHODS:

Forty-seven consecutive patients presented with an occult (reduced) or grossly dislocated knee. Fourteen of these patients were not included in this series because of confounding variables: four had an open knee dislocation, five had vascular injury requiring repair, three were treated with external fixation, and two had associated injury. The remaining thirty-three patients underwent surgical treatment for the knee dislocation with our standard approach. Anatomical repair and/or replacement was performed with fresh-frozen allograft tissue. Thirty-one of the thirty-three patients returned for subjective and objective evaluation with use of four different knee-rating scales at a minimum of twenty-four months after the operation.

RESULTS:

Nineteen of the thirty-one patients were treated acutely (less than three weeks after the injury) and twelve, chronically. The mean Lysholm score was 91 points for the acutely reconstructed knees and 80 points for the chronically reconstructed knees. The Knee Outcome Survey Activities of Daily Living scores averaged 91 points for the acutely reconstructed knees and 84 points for the chronically reconstructed knees. The Knee Outcome Survey Sports Activity scores averaged 89 points for the acutely reconstructed knees and 69 points for the chronically reconstructed knees. According to the Meyers ratings, twenty-three patients had an excellent or good score and eight had a fair or poor score. Sixteen of the nineteen acutely reconstructed knees and seven of the twelve chronically reconstructed knees were given an excellent or good Meyers score. The average loss of extension was 1°, and the average loss of flexion was 12°. There was no difference in the range of motion between the acutely and chronically treated patients. Four acutely reconstructed knees required manipulation because of loss of flexion. Laxity tests demonstrated consistently improved stability in all patients, with more predictable results in the acutely treated patients.

CONCLUSIONS:

Surgical treatment of the knee dislocations in our series provided satisfactory subjective and objective outcomes at two to six years postoperatively. The patients who were treated acutely had higher subjective scores and better objective restoration of knee stability than did patients treated three weeks or more after the injury. Nearly all patients were able to perform daily activities with few problems. However, the ability of patients to return to high-demand sports and strenuous manual labor was less predictable.

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