Clinical and radiological outcomes after management of traumatic knee dislocation by open single stage complete reconstruction/repair (original) (raw)
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Surgical Management of Traumatic Knee Dislocation
Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2008
Purpose: The purpose of this study was to evaluate our method of surgical treatment of traumatic knee dislocation, by use of a standardized protocol, and to report our clinical results. Methods: Thirty-six consecutive patients presented with a grossly dislocated or reduced knee. Ten of these patients were not included in this series. Five had vascular or neurovascular injury. Three had open fracture dislocation, and two had associated severe injury. The remaining 26 patients were treated by primary arthroscopic reconstruction with autologous grafting of the anterior cruciate ligament, posterior cruciate ligament, and collateral ligaments. The anterior cruciate ligament and posterior cruciate ligament were reconstructed via the gracilis and semitendinosus tendons of the uninjured and injured limbs. The collateral ligaments were reconstructed via artificial ligaments (LARS Ligament; J. K. Orthomedic, Dollard-des-Ormeaux, Quebec, Canada). Of the 26 patients, 20 returned for subjective and objective evaluation at a minimum of 24 months after the operation. Early mobilization via a continuous passive motion machine and active exercise were started on the fourth day postoperatively. Results: At a mean follow-up of 43 months, the mean Lysholm score was 91 points, the mean score on the survey of daily activities was 90 points, and the sports activities score on the Knee Outcome Survey averaged 86 points. On the basis of the rating of Meyers et al., the results were excellent in 5 patients, good in 12, fair in 2, and poor in 1. The final International Knee Documentation Committee rating was not normal in any knee, nearly normal in 9, abnormal in 9, and severely abnormal in 2. The mean loss of extension was 0° to 2°, and the mean loss of flexion was 10° to 15°. Conclusions: By use of the described method of arthroscopic-assisted reconstruction of the cruciate ligaments and repair or reconstruction of the collateral ligament and other injured structures, 45% of the patients had good subjective results and functional stability and 45% had satisfactory subjective and functional stability within 2 to 3 weeks after surgery. According to the International Knee Documentation Committee scale, 45% of knees were nearly normal, 45% were abnormal, and 10% were severely abnormal. No patient's rating returned to normal. Level of Evidence: Level IV, therapeutic case series.
Primary repair of the cruciate and collateral ligaments after traumatic dislocation of the knee
The Journal of Bone and Joint Surgery, 1999
The management of traumatic dislocation of the knee in 40 patients (41 knees) with a mean age of 26.3 years is described. They were treated by primary repair and reconstruction with autologous grafting of the anterior (ACL) and posterior cruciate ligaments (PCL) and repair injuries to the collateral ligament and soft-tissue. The ACL and PCL were reconstructed using the patellar tendon and the gracilis and semitendinosus tendons, respectively. Early mobilisation using a continuous-passive-movement machine and active exercises was started on the second day after operation. At a mean follow-up of 39 months no patient reported 'giving way' and all except one had good range of movement. Of the 41 knees, 21 were rated as excellent, 15 good, four fair and one poor. Early reconstruction of the cruciate ligaments and primary repair of the collateral ligaments followed by an aggressive rehabilitation programme are recommended for these young, active patients.
Medial injury in knee dislocations: what are the common injury patterns and surgical outcomes?
Clinical orthopaedics and related research, 2014
When associated with a knee dislocation, management of the medial ligamentous injury is challenging, with little literature available to guide treatment. We (1) compared MRI findings of medial ligament injuries between Schenck KDIIIM and KDIV injuries, (2) compared clinical outcomes and health-related quality of life as determined by Lysholm and Veterans Rand 36-Item Health Survey (VR-36) scores, respectively, of reconstructed KDIIIM and KDIV injured knees, and (3) determined reoperation rates of reconstructed KDIIIM and KDIV injured knees. Over a 12-year period, we treated 65 patients with knee dislocations involving bicruciate ligament injury and concomitant medial ligament injuries, without or with posterolateral corner injuries (Schenck KDIIIM and KDIV, respectively); 57% were available for followup at a mean of 6.2 years (range, 1.1-11.6 years). These patients were contacted, and prospectively measured clinical outcomes scores (Lysholm and VR-36) were obtained and compared betw...
Anatomic medial knee reconstruction restores stability and function at minimum 2 years follow-up
Knee Surgery, Sports Traumatology, Arthroscopy, 2021
Chronic grade 3 tears of the medial collateral ligament and posterior oblique ligament may result in valgus laxity and anteromedial rotational instability after an isolated or multiligament injury. The purpose of this study was to prospectively analyze the restoration of physiologic medial laxity as assessed on stress radiography and patient reported subjective functional outcomes in patients who undergo an anatomic medial knee reconstruction. This was a prospective study which included patients with chronic (> 6 weeks old) posteromedial corner injury with or without other ligament and meniscus lesions. Pre- and post-operative valgus stress radiographs were performed in 20° knee flexion and functional outcome was recorded as per the International Knee Documentation Committee (IKDC) and Lysholm scores. All patients underwent anatomic medial reconstruction with two femoral and two tibial sockets using ipsilateral hamstring tendon autograft. Simultaneous ligament and meniscus surger...
Surgical Management of Traumatic Knee Dislocation With Posterolateral Corner Injury
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013
To evaluate the results of our method of surgical treatment of traumatic knee dislocation with injury to the posterolateral corner by use of a standardized protocol. Twenty-five consecutive patients presented with a grossly dislocated or reduced knee. Five of these patients were not included in this series. The remaining 20 patients were treated by primary arthroscopic reconstruction. The anterior cruciate ligament (ACL) was reconstructed using gracilis tendon reinforced with artificial ligament (Ligament Augmentation and Reconstruction System [LARS] ligament); the posterior cruciate ligament (PCL) was reconstructed with semitendinosus tendon and reinforced with LARS ligament; and the posterolateral corner was treated using the gracilis and semitendinosus tendons from the uninjured knee. Twenty patients returned for subjective and objective evaluation at a minimum of 24 months after surgery. Early mobilization through continuous and active exercise was started on the fourth day postoperatively. At a mean follow-up of 44 months, the mean Lysholm score was 90 points, the mean score on the survey of daily activities was 90 points, and the sports activities score on the knee outcome survey averaged 80 points. By the rating of Meyers et al. the results were excellent in 6 patients, good in 10 patients, fair in 3 patients, and poor in one patient. The final International Knee Documentation Committee (IKDC) rating was not normal in any knee. The mean loss of extension was 2° (range, 0° to 3°) and loss of flexion was 12° (range, 10° to 15°). By using the described method of arthroscopically assisted reconstruction of the cruciate ligaments and the posterolateral corner, 80% of the patients had good subjective results and functional stability, and according to the IKDC scale, 45% of knees were nearly normal, 45% were abnormal, and 10% were severely abnormal. No patient's rating returned to normal. Level IV, therapeutic case series.
Orthopaedic Journal of Sports Medicine, 2021
Background: In cases of multiple ligaments or medial collateral ligament (MCL) reconstruction, restoring the native anatomy of the posterior oblique ligament (POL) to address chronic valgus instability has been attracting increased attention. Purpose: To review the current literature on postoperative outcomes, complications, and return to sports after superficial MCL-POL (sMCL-POL) reconstruction to restore medial knee integrity. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two independent reviewers searched the PubMed, Scopus, Embase, and Cochrane Library databases using the terms "posterior oblique ligament," "posteromedial corner of the knee," and "reconstruction." Included were studies that reported postoperative clinical and functional outcomes in patients who had undergone a combined sMCL-POL reconstruction for medial knee instability. The authors evaluated surgical technique, rehabilitation protocol, postoperative outcomes (Lysholm, International Knee Documentation Committee [IKDC], and Tegner scores and valgus stress radiograph), and return to sports and complication rates across the included studies. Results: A total of 6 studies were reviewed. The cohort consisted of 199 patients (121 men and 78 women), with a mean age of 32.7 ± 3.9 years (range, 27.4-36.6 years). The Lysholm and IKDC scores improved from pre-to postoperatively (Lysholm, from 67.2 ± 20.4 to 89.4 ± 3; IKDC, from 45.8 ± 2.1 to 84.8 ± 7.5). The Tegner score produced satisfactory results, from a preoperative mean of 3.3 ± 2.4 to 6.3 ± 0.9 postoperatively. The medial joint opening on valgus stress radiographs ranged from 7.5 ± 1.1 mm preoperatively to 3 ± 3.1 mm postoperatively. After passing activity-specific functional and clinical tests, 88% to 91.3% of the patients were reported to have returned to recreational sports within 6 to 12 months postoperatively, whereas 10% of the patients developed postoperative complications. Conclusion: Satisfactory clinical and functional outcomes, a high rate of return to recreational sports, and a low rate of postoperative complications were reported after an sMCL-POL reconstruction to restore medial knee integrity.
International Journal of Orthopaedics Sciences, 2016
Introduction: Total Knee Arthroplasty (TKA) is now a proven and reliable treatment for severe osteoarthritis of knee joint with the incidence of the same increasing day by day. Material and Methods: 60 patients with primary osteoarthritis knee were included in the study between February 2013 and June 2015 at a tertiary care hospital in Mumbai city. Revision cases, Post-traumatic and Inflammatory arthritis were excluded from the study. Results: Clinical, functional and radiological outcome were assessed by Knee Society Knee Score. Paired T-test and Pearson correlation coefficient formula were used. The mean pre-op Knee Clinical Score (KCS) was 28.28 which improved to 94.23 post-operatively. 52 patients (86.67%) had excellent results and 08 patients (13.33%) had Good results. The mean pre-op Knee Functional Score (KFS) was 41.67 in this study which improved to 87.33 post-operatively. 50 patients (83.34%) had Excellent, 08 patients (13.33%) had Good and 2 patients (03.33%) had Fair results respectively. KCS and KFS were found to be statistically significant (P<0.001).The value of R 2 coefficient of determination was 0.5938(P<0.00001). Conclusion: Total Knee Arthroplasty improves the functional ability of the patient and gets him back to the pre-disease state, which is to have a pain free mobile joint, as reflected by the improvement in the post-op KCS and KFS.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013
Purpose: To evaluate which questionnaire, the Knee Injury and Osteoarthritis Outcome Score (KOOS) or the International Knee Documentation Committee Subjective Knee Form (IKDC subjective), is most useful to evaluate patients with recent anterior cruciate ligament (ACL) ruptures or those within 1 year of an ACL reconstruction. Methods: Patients with recent (0-6 months) ACL ruptures or those with indications for ACL reconstruction were included. All patients completed the questionnaires shortly after trauma or preoperatively and again 1 year later. The KOOS has 5 subscales, each scored separately. The IKDC subjective consists of one total score. The following measurement properties of the KOOS and IKDC subjective were assessed: content validity (n ¼ 45), construct validity (n ¼ 100), test-retest reliability (n ¼ 50), and responsiveness (n ¼ 50). Results: Regarding content validity, 2 KOOS subscales (Pain and Activities of Daily Living) were scored as nonrelevant. Two of the 18 questions on the IKDC subjective were assessed as nonrelevant. Only the KOOS subscale Sport and Recreation Function had acceptable construct validity (79% confirmation of the predefined hypotheses). None of the KOOS subscales had a sufficient score for responsiveness (<75% confirmation of the predefined hypotheses). The IKDC subjective scored acceptable for construct validity (84% confirmation of the predefined hypotheses) and responsiveness (86% confirmation of the predefined hypotheses). All KOOS subscales and the IKDC subjective had a reliability (intraclass correlation coefficient [ICC]) of 0.81 or higher. Conclusions: The IKDC subjective is more useful than the KOOS questionnaire to evaluate both patients with recent ACL ruptures and those in the first year after ACL reconstruction. Level of Evidence: Level III, prognostic validation study. From Departments of Orthopaedic Surgery (B.L.V.M., D.E.M., M.M.V., S.M.A.B-Z., J.A.N.V., M.R.), and General Practice (S.M.A
The Journal of Bone and Joint Surgery. British volume, 2012
The success of total knee replacement (TKR) depends on optimal soft-tissue balancing, among many other factors. The objective of this study is to correlate post-operative anteroposterior (AP) translation of a posterior cruciate ligament-retaining TKR with clinical outcome at two years. In total 100 patients were divided into three groups based on their AP translation as measured by the KT-1000 arthrometer. Group 1 patients had AP translation < 5 mm, Group 2 had AP translation from 5 mm to 10 mm, and Group 3 had AP translation > 10 mm. Outcome assessment included range of movement of the knee, the presence of flexion contractures, hyperextension, knee mechanical axes and functional outcome using the Knee Society score, Oxford knee score and the Short-Form 36 questionnaire.At two years, patients in Group 2 reported significantly better Oxford knee scores than the other groups (p = 0.045). A positive correlation between range of movement and AP translation was noted, with patien...