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Outcome after knee dislocations: a 2–9 years follow-up of 85 consecutive patients

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Dislocation of the knee is a relatively rare injury with modern arthroscopic techniques, operative reconstruction has become the standard of care. The primary aim of this study was to prospectively follow a large, consecutive series of patients with knee dislocation to document associated injuries, surgical treatment, knee function, and knee osteoarthritis (OA) at a minimum of 2 years follow-up. Hundred and twenty-two consecutive patients with a traumatic knee dislocation (Schenck II–IV) were treated at the Oslo University Hospital, Ulleval, between May 1996 and December 2004. Follow-up evaluation of 85 patients consisted of evaluation of knee joint laxity using the KT1000, the Lachman test, the pivot shift test, the reversed pivot shift, the posterior drawer test, the dial test, and the varus–valgus tests compared to the uninjured knee. Knee function was evaluated using the Lysholm score, the Tegner activity level score, the IKDC2000 score, and four single leg hop tests. Radiographic evaluation was performed using the Kellgren & Lawrence classification grade 0–4. Knee function at a minimum of 2 years after surgery disclosed a Lysholm score of a median of 83, a Tegner activity score of 5, and above 83% on all single leg hop tests compared to the uninjured side. Knee function was lower in the patients with a knee dislocation caused by high-energy trauma compared to low energy trauma. Eighty-seven percent had Kellgren & Lawrence grade 2 or higher for the injured knee compared to 35% for the uninjured knee.

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References

  1. Almekinders LC, Logan TC (1992) Results following treatment of traumatic dislocations of the knee joint. Clin Orthop Relat Res 20:3–207

    Google Scholar 

  2. Bin SI, Nam TS (2007) Early results of high-flex total knee arthroplasty: comparison study at 1 year after surgery. Knee Surg Sports Traumatol Arthrosc 15:350–355

    Article  PubMed  Google Scholar 

  3. Bratt HD, Newman AP (1993) Complete dislocation of the knee without disruption of both cruciate ligaments. J Trauma 34:383–389

    Article  PubMed  CAS  Google Scholar 

  4. Brautigan B, Johnson DL (2000) The epidemiology of knee dislocations. Clin Sports Med 19:387–397

    Article  PubMed  CAS  Google Scholar 

  5. Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR (2009) The reliability, validity, and responsiveness of the Lysholm Score and Tegner Activity Scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 37:898–901

    Article  PubMed  Google Scholar 

  6. Cooper A (1825) A treatise on dislocations and fractures of the joints, American edn. 1. Wells and Lilly, Boston, pp 142–157

  7. Cooper DE, Speer KP, Wickiewicz TL, Warren RF (1992) Complete knee dislocation without posterior cruciate ligament disruption. A report of four cases and review of the literature. Clin Orthop Relat Res 22:8–233

    Google Scholar 

  8. Dedmond BT, Almekinders LC (2001) Operative versus nonoperative treatment of knee dislocations: a meta-analysis. Am J Knee Surg 14:33–38

    PubMed  CAS  Google Scholar 

  9. Fanelli GC, Edson CJ (2002) Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2- to 10-year follow-up. Arthroscopy 18:703–714

    PubMed  Google Scholar 

  10. Fanelli GC, Giannotti BF, Edson CJ (1996) Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction. Arthroscopy 12:5–14

    PubMed  CAS  Google Scholar 

  11. Frassica FJ, Sim FH, Staeheli JW, Pairolero PC (1991) Dislocation of the knee. Clin Orthop Relat Res 263:200–205

    PubMed  Google Scholar 

  12. Gaski IA, Martinussen BT, Engebretsen L, Johansen S, Ludvigsen TC (2004) Knee luxation—follow-up after surgery. Tidsskr Nor Laegeforen 124:1078–1080

    PubMed  Google Scholar 

  13. Gogia PP, Braatz JH, Rose SJ, Norton BJ (1987) Reliability and validity of goniometric measurements at the knee. Phys Ther 67:192–195

    PubMed  CAS  Google Scholar 

  14. Granan LP, Bahr R, Steindal K, Furnes O, Engebretsen L (2008) Development of a national cruciate ligament surgery registry: the Norwegian National Knee Ligament Registry. Am J Sports Med 36:308–315

    Article  PubMed  Google Scholar 

  15. Hambly K, Griva K (2008) IKDC or KOOS? Which measures symptoms and disabilities most important to postoperative articular cartilage repair patients? Am J Sports Med 36:1695–1704

    Article  PubMed  Google Scholar 

  16. Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ (2004) Surgical management of knee dislocations. J Bone Joint Surg Am 86-A:262–273

    PubMed  Google Scholar 

  17. Hollis JD, Daley BJ (2005) 10-year review of knee dislocations: is arteriography always necessary? J Trauma 59:672–675

    PubMed  Google Scholar 

  18. Ibrahim SA, Ahmad FH, Salah M, Al Misfer AR, Ghaffer SA, Khirat S (2008) Surgical management of traumatic knee dislocation. Arthroscopy 24:178–187

    PubMed  Google Scholar 

  19. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613

    PubMed  CAS  Google Scholar 

  20. Irrgang JJ, Ho H, Harner CD, Fu FH (1998) Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6:107–114

    Article  PubMed  CAS  Google Scholar 

  21. Kellgren JHL, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502

    Article  PubMed  CAS  Google Scholar 

  22. Kessler S, Guenther KP, Puhl W (1998) Scoring prevalence and severity in gonarthritis: the suitability of the Kellgren & Lawrence scale. Clin Rheumatol 17:205–209

    Article  PubMed  CAS  Google Scholar 

  23. Klimkiewicz JJ, Petrie RS, Harner CD (2000) Surgical treatment of combined injury to anterior cruciate ligament, posterior cruciate ligament, and medial structures. Clin Sports Med 19:479–492 vii

    Article  PubMed  CAS  Google Scholar 

  24. Klineberg EO, Crites BM, Flinn WR, Archibald JD, Moorman CT III (2004) The role of arteriography in assessing popliteal artery injury in knee dislocations. J Trauma 56:786–790

    Article  PubMed  Google Scholar 

  25. Kothari M, Guermazi A, von IG, Miaux Y, Sieffert M, Block JE, Stevens R, Peterfy CG (2004) Fixed-flexion radiography of the knee provides reproducible joint space width measurements in osteoarthritis. Eur Radiol 14:1568–1573

    Article  PubMed  Google Scholar 

  26. LaPrade RF (2005) Anatomic reconstruction of the posterolateral aspect of the knee. J Knee Surg 18:167–171

    PubMed  Google Scholar 

  27. LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Joint Surg Am 89:2000–2010

    Article  PubMed  Google Scholar 

  28. Liow RY, McNicholas MJ, Keating JF, Nutton RW (2003) Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg Br 85:845–851

    PubMed  CAS  Google Scholar 

  29. Lohmander LS, Englund PM, Dahl LL, Roos EM (2007) The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 35:1756–1769

    Article  PubMed  Google Scholar 

  30. Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154

    Article  PubMed  CAS  Google Scholar 

  31. Lysholm J, Tegner Y (2007) Knee injury rating scales. Acta Orthop 78:445–453

    Article  PubMed  Google Scholar 

  32. Mariani PP, Margheritini F, Camillieri G (2001) One-stage arthroscopically assisted anterior and posterior cruciate ligament reconstruction. Arthroscopy 17:700–707

    Article  PubMed  CAS  Google Scholar 

  33. Mariani PP, Santoriello P, Iannone S, Condello V, Adriani E (1999) Comparison of surgical treatments for knee dislocation. Am J Knee Surg 12:214–221

    PubMed  CAS  Google Scholar 

  34. Mills WJ, Barei DP, McNair P (2004) The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma 56:1261–1265

    Article  PubMed  Google Scholar 

  35. Niall DM, Nutton RW, Keating JF (2005) Palsy of the common peroneal nerve after traumatic dislocation of the knee. J Bone Joint Surg Br 87:664–667

    Article  PubMed  CAS  Google Scholar 

  36. Noyes FR, Barber SD, Mangine RE (1991) Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med 19:513–518

    Article  PubMed  CAS  Google Scholar 

  37. Noyes FR, Barber-Westin SD (1997) Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Use of early protected postoperative motion to decrease arthrofibrosis. Am J Sports Med 25:769–778

    Article  PubMed  CAS  Google Scholar 

  38. O’Donoghue DH (1955) An analysis of end results of surgical treatment of major injuries to the ligaments of the knee. J Bone Joint Surg Am 37-A:1–13

    PubMed  Google Scholar 

  39. Ohkoshi Y, Nagasaki S, Shibata N, Yamamoto K, Hashimoto T, Yamane S (2002) Two-stage reconstruction with autografts for knee dislocations. Clin Orthop Relat Res 16:9–175

    Google Scholar 

  40. Owens BD, Neault M, Benson E, Busconi BD (2007) Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years. J Orthop Trauma 21:92–96

    Article  PubMed  Google Scholar 

  41. Patterson BM, Agel J, Swiontkowski MF, Mackenzie EJ, Bosse MJ (2007) Knee dislocations with vascular injury: outcomes in the Lower Extremity Assessment Project (LEAP) Study. J Trauma 63:855–858

    Article  PubMed  Google Scholar 

  42. Pugh L, Mascarenhas R, Arneja S, Chin PY, Leith JM (2009) Current concepts in instrumented knee-laxity testing. Am J Sports Med 37:199–210

    Article  PubMed  Google Scholar 

  43. Richter M, Bosch U, Wippermann B, Hofmann A, Krettek C (2002) Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med 30:718–727

    PubMed  Google Scholar 

  44. Rihn JA, Groff YJ, Harner CD, Cha PS (2004) The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg 12:334–346

    PubMed  Google Scholar 

  45. Rios A, Villa A, Fahandezh H, de JC, Vaquero J (2003) Results after treatment of traumatic knee dislocations: a report of 26 cases. J Trauma 55:489–494

    Article  PubMed  Google Scholar 

  46. Robertson A, Nutton RW, Keating JF (2006) Dislocation of the knee. J Bone Joint Surg Br 88:706–711

    Article  PubMed  CAS  Google Scholar 

  47. Roman PD, Hopson CN, Zenni EJ Jr (1987) Traumatic dislocation of the knee: a report of 30 cases and literature review. Orthop Rev 16:917–924

    PubMed  CAS  Google Scholar 

  48. Schenck RC Jr (1994) The dislocated knee. Instr Course Lect 43:127–136

    PubMed  Google Scholar 

  49. Shapiro MS, Freedman EL (1995) Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation. Am J Sports Med 23:580–587

    Article  PubMed  CAS  Google Scholar 

  50. Shelbourne KD, Haro MS, Gray T (2007) Knee dislocation with lateral side injury: results of an en masse surgical repair technique of the lateral side. Am J Sports Med 35:1105–1116

    Article  PubMed  Google Scholar 

  51. Shelbourne KD, Pritchard J, Rettig AC, McCarroll JR, Vanmeter CD (1992) Knee dislocations with intact PCL. Orthop Rev 21:607 1

    PubMed  CAS  Google Scholar 

  52. Solomon DH, Simel DL, Bates DW, Katz JN, Schaffer JL (2001) The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination. JAMA 286:1610–1620

    Article  PubMed  CAS  Google Scholar 

  53. Stannard JP, Sheils TM, Lopez-Ben RR, McGwin G Jr, Robinson JT, Volgas DA (2004) Vascular injuries in knee dislocations: the role of physical examination in determining the need for arteriography. J Bone Joint Surg Am 86-A:910–915

    PubMed  Google Scholar 

  54. Stayner LR, Coen MJ (2000) Historic perspectives of treatment algorithms in knee dislocation. Clin Sports Med 19:399–413

    Article  PubMed  CAS  Google Scholar 

  55. Talbot M, Berry G, Fernandes J, Ranger P (2004) Knee dislocations: experience at the Hopital du Sacre-Coeur de Montreal. Can J Surg 47:20–24

    PubMed  Google Scholar 

  56. Taylor AR, Arden GP, Rainey HA (1972) Traumatic dislocation of the knee. A report of forty-three cases with special reference to conservative treatment. J Bone Joint Surg Br 54:96–102

    PubMed  CAS  Google Scholar 

  57. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 4:3–49

    Google Scholar 

  58. Wascher DC (2000) High-velocity knee dislocation with vascular injury. Treatment principles. Clin Sports Med 19:457–477

    Article  PubMed  CAS  Google Scholar 

  59. Wascher DC, Becker JR, Dexter JG, Blevins FT (1999) Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts. Am J Sports Med 27:189–196

    PubMed  CAS  Google Scholar 

  60. Wascher DC, Dvirnak PC, DeCoster TA (1997) Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma 11:525–529

    Article  PubMed  CAS  Google Scholar 

  61. Werier J, Keating JF, Meek RN (1998) Complete dislocation of the knee—the long-term results of ligamentous reconstruction. The Knee 5:255–260

    Article  Google Scholar 

  62. Wong CH, Tan JL, Chang HC, Khin LW, Low CO (2004) Knee dislocations-a retrospective study comparing operative versus closed immobilization treatment outcomes. Knee Surg Sports Traumatol Arthrosc 12:540–544

    Article  PubMed  Google Scholar 

  63. Yeh WL, Tu YK, Su JY, Hsu RW (1999) Knee dislocation: treatment of high-velocity knee dislocation. J Trauma 46:693–701

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Orthopedic Center, Oslo University Hospital, Ullevaal, Norway

    Lars Engebretsen, May Arna Risberg, Ben Robertson, Tom C. Ludvigsen & Steinar Johansen

  2. Faculty of Medicine, University of Oslo, Kirkeveien 166, 0407, Oslo, Norway

    Lars Engebretsen

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  1. Lars Engebretsen
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  2. May Arna Risberg
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Correspondence to Lars Engebretsen.

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Engebretsen, L., Risberg, M.A., Robertson, B. et al. Outcome after knee dislocations: a 2–9 years follow-up of 85 consecutive patients. Knee Surg Sports Traumatol Arthrosc 17, 1013–1026 (2009). https://doi.org/10.1007/s00167-009-0869-y

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