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At least 19 recordsLinked to original sources
PubMed2006

One-stage posterior cruciate ligament inlay reconstruction combining anterior cruciate ligament reconstruction following knee dislocation.

Knee dislocation is a rare but severe injury that involves damage to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), lateral or medial ligamentous structures, and other soft tissues or bony structures surrounding the knee joint. No consensus exists regarding the best treatment method. This work presents a method of 1-stage ACL and PCL reconstruction in which a contralateral quadriceps tendon-bone autograft with tibial inlay technique is used for the PCL and contralateral hamstring tendon autograft with suspension fixation is used for the ACL. After harvesting grafts, the patient is put in the lateral decubitus position. Under arthroscopy, the femoral tunnel for the anterolateral bundle of the PCL is created using an 8-mm reamer via a prepositioned guide pin. Next, the tibial tunnel of the ACL is created with an appropriate diameter cannulated reamer. Directed by the femoral guide instrument with a 7-mm offset, a guide pin is positioned retrograde through the tibial tunnel. A reamer is then used to create a 35-mm long closed-ended femoral tunnel for the ACL. A posterior arthrotomy for the PCL inlay technique is performed. After capsulotomy, a unicortical window is created at the footprint of the PCL and the inlay graft is fixed using a 3.5mm-cancellous screw and washer. The PCL graft is then passed into the femoral tunnel. The ACL graft is passed in a retrograde fashion using the Beath pin. The ACL graft is fixed by tying with a washer on the femoral side and by tying with a screw on the tibial side. The PCL graft is then fixed on the femoral side.

Anterior Cruciate Ligament↗
PubMed2000

Historic perspectives of treatment algorithms in knee dislocation.

Knee dislocation remains a devastating injury with many complications. It necessitates prompt diagnosis, reduction if needed, and emergent repair of any vascular injury. Serial physical examinations and frequent use of arteriograms are necessary to avoid late vascular complications. Many authors are concerned that normal pulses, normal Doppler signals, and normal ABIs have preceded late ischemia and documented intimal tear, demonstrated by arteriography. More recently, other authors have challenged the gold standard of mandatory arteriography by describing studies in which physical examination was 100% accurate in diagnosing patients without operative vascular injury. If pedal pulses, Doppler signals, or ABIs are asymmetric before or after reduction then either immediate operative exploration or arteriography should be performed. If the initial physical examination is normal, serial examinations are used in the hospital to check for late artery thrombosis. Opponents of mandatory arteriography point to a 5% false-negative rate, high cost, and an 8% complication rate, such as contrast allergy, pseudoaneurysm, local hematoma, and arteriovenous fistula. Today a consensus is that repair and reconstruction of the PCL and posterolateral corner injuries are the primary concerns in the multiple-ligament injured knee after dislocation. The ACL may be repaired later if instability persists, but some investigators believe it should not be repaired acutely, thereby avoiding increased surgical trauma and possible stiffness. Recently one of the goals of ligamentous repair and reconstruction has been to provide stability with the least invasive surgical technique to avoid postoperative stiffness. Recent treatments have focused on early arthroscopic-assisted allograft reconstruction of the ACL and PCL. Allograft provides a less invasive means of graft support than autograft. Early, limited range of motion in a brace helps to maintain flexion and extension.

Algorithms↗
PubMed2006

Knee dislocation.

Knee dislocations are relatively uncommon. However, due to potential neurovascular complications, it is important that the diagnosis is not missed. There are two main classification systems. The position classification system, defined by the relation of the tibia to the femur, helps identify the mechanism of injury and possible associated complications. The Schenck classification system defines the dislocation based on ligamentous and associated injuries, and thus is useful for surgical planning. It is well recognized that treatment should consist of immediate closed reduction with frequent neurovascular assessment, followed by surgical repair/reconstruction. The timing and surgical technique remain controversial.

Female↗
PubMedDate not supplied

The acutely dislocated knee: evaluation and management.

Acute knee dislocations are uncommon orthopaedic injuries. Because they often spontaneously reduce before initial evaluation, the true incidence is unknown. Dislocation involves injury to multiple ligaments of the knee, resulting in multidirectional instability. Associated meniscal, osteochondral, and neurovascular injuries are often present and can complicate management. The substantial risk of associated vascular injury mandates that vascular integrity be confirmed by angiography in all suspected knee dislocations. Evaluation and initial management must be performed expeditiously to prevent limb-threatening complications. Definitive management of acute knee dislocation remains a matter of debate; however, surgical reconstruction or repair of all ligamentous injuries likely can help in achieving the return of adequate knee function. Important considerations in surgical management include surgical timing, graft selection, surgical technique, and postoperative rehabilitation.

Acute Disease↗
PubMed2000

The epidemiology of knee dislocations.

The traumatically dislocated knee can be a devastating injury; fortunately, it is uncommon. More attention is being given to the treatment of knee dislocations as the capability of ligamentous reconstruction increases. Great treatment advances are anticipated as this interest grows and outcomes are evaluated. Nonetheless, the complications of this injury, including loss of limb, still occur from the missed diagnosis of a knee dislocation. MR imaging and other technological advances do not relieve the clinician of the responsibility for performing a thorough physical examination. Suspicion of an associated neurovascular injury must always be high. To a certain degree, prevention of this injury may be possible in the high-velocity accidents that occur with motor vehicles and in industry. Advancement in vehicular designs, with specific attention to airbags, dashboards, and firewalls, needs to be made to reduce the incidence and magnitude of lower extremity trauma in motor vehicle accidents. Seat belts remain the most effective restraint in the prevention of lower extremity trauma in the motor vehicle.

Accidents, Traffic↗
PubMed1999

Knee dislocation: treatment of high-velocity knee dislocation.

BACKGROUND: We report the outcomes of patients treated with a new arthroscopic treatment modality for knee dislocation after high-velocity trauma. METHODS: Twenty-three patients (12 men, 11 women; 25 knees) with traumatic knee dislocation were treated with this technique. Under arthroscopy with gravity inflow irrigation, the ruptured posterior cruciate ligament was reconstructed with a patellar bone-tendon-bone graft, and the anterior cruciate ligament was debrided subacutely. The collateral ligament, meniscus, and capsules were repaired through additional incisions. RESULTS: The average interval between injury and surgery was 11.1+/-5 days (range, 5 to 25 days). After a mean follow-up period of 27.2+/-7.86 months, the mean extension was 1+/-2 degrees and the average flexion was 129.6+/-4.91 degrees. The mean Lysholm score was 84. There were no major complications. CONCLUSION: Arthroscopic posterior cruciate ligament reconstruction seems to be an effective treatment for traumatic knee dislocation.

Adolescent↗
PubMed1999

Recanalization of an occluded popliteal artery following posterior knee dislocation.

Posterior knee dislocation results in popliteal artery injury in up to one-third of cases. Prompt recognition and treatment of arterial injury is essential for limb salvage. We report a case of complete occlusion of the popliteal artery following posterior knee dislocation treated with saphenous vein bypass without exclusion of the injured arterial segment. Follow-up duplex scanning demonstrated a patent vein graft and a patent ipsilateral popliteal artery. This report suggests that, in some instances, a traumatically occluded popliteal artery may recanalize, and that revascularization with a bypass graft may be the preferred method of repair, particularly in young patients.

Child↗
PubMed1991

Low-velocity knee dislocation.

Complete knee dislocation is an uncommon but potentially devastating injury with a reported high rate of neurovascular injury. Treatment of this ligamentous injury is controversial. The operative (repair of all ligaments) and nonoperative management of ligament injuries appears to result in a stiff knee (decreased range of motion [ROM]), and/or a significant incidence of clinical instability and pain. We report our data on low-velocity knee dislocations and present a treatment plan of noninvasive assessment of the vascular status, a stabilizing procedure centered on posterior cruciate ligament reconstruction (PCL) and an aggressive rehabilitation program that can result in improved ROM, acceptable stability, and a more optimal functional outcome.

Adolescent↗
PubMed2002

Two-stage reconstruction with autografts for knee dislocations.

Traumatic knee dislocations are severe injuries that involve damage to the anterior cruciate ligament, the posterior cruciate ligament, and the lateral or medial ligamentous structures. There are no established methods of treatment. The objective of the current study was to report the clinical outcome of a two-stage autologous reconstruction on nine knees (eight patients). The mean followup was 40.1 months. The first stage of the reconstruction was done at a mean of 2 weeks after the injury, and the posterior cruciate ligament was reconstructed by an arthroscopically assisted technique using contralateral autogenous hamstring tendon as the graft material. Three months later, the second stage of the reconstruction was done for the ligaments that had not healed with conservative treatment. Arthroscopically assisted anterior cruciate ligament reconstruction was done on all of the knees using the ipsilateral autogenous hamstring tendon or bone-patellar tendon-bone as the graft material. At the same time, a medial collateral ligament reconstruction using an autogenous semitendinosus tendon was done on one knee, and reconstruction of the posterolateral ligamentous structures using a biceps tendon was done on three knees. Each of the knees that was reconstructed was capable of full extension, and the mean degree of passive flexion was 139.5 degrees +/- 5.2 degrees. The mean side-to-side difference in anteroposterior total laxity (KT-1000 arthrometer, manual maximum) was 2.3 +/- 1.9 mm. None of the knees had lateral or medial instability. All of the injured ligaments were able to be reconstructed with autografts, and severe contracture was able to be prevented. A good clinical outcome can be achieved when two-stage reconstruction is used for traumatic knee dislocations.

Adult↗
PubMed1993

Arthroscopic view of an irreducible knee dislocation.

Irreducible knee dislocation is a rare effection of the knee joint; only 23 cases have been reported in the literature. This is a case report of a 35-year-old man who injured his left knee in a motorcycle accident. Dislocation was documented on radiograph. His neurovascular status was intact. Attempts under sedation and anesthesia and even arthroscopy failed to reduce the dislocation. Eventually, the patient had open reduction of the dislocation. An arthroscopy view of the dislocation showed that the medial femoral condyle was buttonholed through the anteromedial capsule and retinaculum. Arthroscopy was an excellent tool for partial lateral meniscectomy and planning the open surgical procedure.

Accidents, Traffic↗
PubMed1995

The Dislocated Knee.

Knee dislocation, although relatively rare, may be the result of high-or low-velocity injuries. Well established is the need for urgent diagnosis and treatment to avoid vascular complications and amputation. The initial evaluation should include objective assessment of arterial circulation by means of Doppler pressure measurements; the finding of any asymmetric pressure warrants an arteriogram. Late arterial occlusion may occur, which mandates careful serial reexamination in all patients, including those with initially symmetric pressure. Injury to the peroneal nerve is also common, and the recovery of neurologic function is unpredictable. An operative approach for the young and otherwise healthy patient is outlined. In the absence of definitive clinical studies, the timing and extent of the repair/reconstruction and the optimum rehabilitation still remain uncertain. Therefore, individual patient management must be dictated by circumstances such as instability, swelling, activity level, and the risk of postoperative joint stiffness.

Journal Article↗
PubMed1994

Ipsilateral hip and knee dislocation.

Hip and knee dislocations individually are two of the relatively limited orthopaedic emergencies. Long-term results of treatment of these two types of injury are associated with avascular necrosis of the femoral head, knee instability, and knee stiffness. Correct early diagnosis, including arteriography in the case of knee dislocation, is crucial. Prompt treatment consisting of closed or open reduction of the dislocations is necessary. Additional treatment involving knee ligament reconstruction is warranted to maximize knee function in healthy, active patients. Simultaneous occurrence of ipsilateral hip and knee dislocations is a particularly morbid injury. We report such a case to emphasize that early, aggressive treatment and extensive physical therapy can result in a functional and painless lower extremity.

Adult↗
PubMed1987

The treatment of congenital knee dislocation. A review of nineteen knees.

The treatment of 19 congenitally dislocated knees in 11 patients is reviewed. The knees were subdivided into genu recurvatum, subluxation and dislocation. Nine knees were treated conservatively and ten surgically. A good result was obtained with conservative treatment if started before the age of three months; after this, surgery was likely to be required and was satisfactory if undertaken before two years of age. A successful surgical result was achieved with quadriceps lengthening. If the quadriceps tendon and the anterior cruciate ligament were divided, then only fair results were achieved. Untreated, patients developed stiff, unstable knees.

Female↗
PubMed2001

Orthopedic pitfalls in the ED: vascular injury associated with knee dislocation.

Tibial femoral knee dislocation is a severe injury, with a real potential for limb-threatening vascular compromise, primarily caused by injury to the popliteal artery. When unrecognized or inadequately evaluated and treated, these injuries often lead to a high incidence of morbidity and potential limb loss. Emergency medicine practitioners should be vigilant for vascular injury associated with knee dislocation. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.

Adult↗
PubMed2004

Surgical management of knee dislocations.

BACKGROUND: 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 a good Meyers score. The average loss of extension was 1 degrees, and the average loss of flexion was 12 degrees. 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.

Adolescent↗
PubMed1994

[Injury of the popliteal artery as a complication of knee dislocation].

Dislocation of the knee is rarely seen. Only 15 patients with a knee dislocation were treated in the surgical department of the university hospital in the last 18 years. One patient had bilateral dislocation of the knee. Injury to the popliteal artery is severe and often endangers the extremity. In seven patients with knee dislocation arterial ischemic was detected. Five patients were treated for arterial damage (31.25%).

Adult↗