High prevalence of knee osteoarthritis at a minimum 10-year follow-up after knee dislocation surgery

Abstract

Purpose

Long-term outcomes and the prevalence of osteoarthritis after surgical treatment of knee dislocations are lacking in the literature. The purpose of this study was to investigate the prevalence of knee osteoarthritis and knee function at a minimum of 10 years after knee dislocation surgery.

Methods

Sixty-five patients surgically treated for knee dislocations at a single level I trauma center between May 1996 and December 2004 were evaluated at a minimum of 10 years. Patients were evaluated with radiographs for knee osteoarthritis using the Kellgren–Lawrence (KL) grading system, Tegner activity score, Lysholm score, IKDC-2000, KOOS, subjective stability on physical examination, KT-1000 arthrometer, and single-leg hop tests. Osteoarthritis was defined as KL grades 2 or greater.

Results

The median follow-up time was 12.7 years (range 10.0–18.8 years), and the median age was 46.9 years (range 26.8–76.1 years). Radiographic osteoarthritis was present in 42% (23, 14, and 5% in KL grades II, III, and IV, respectively) of the patients in the operated knee compared to 6% in the uninjured knee. Knee function was generally improved with a median Tegner activity score of 4 (range 1–8), an average Lysholm score of 84 ± 17, and an average IKDC-2000 score of 73 ± 19.

Conclusion

Twenty-seven patients (42%) developed OA 10 years after surgical treatment of knee dislocations. Patients reported improved knee function and minimal-to-moderate pain. Age at surgery was a predictor of development of OA, with more patients >30 years at the time of surgery developing OA. Meniscal and cartilage injuries at time of surgery were not associated with development of OA. Patients being treated for knee dislocation should be counselled about the increased long-term risk of post-traumatic OA.

Level of evidence

III.

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Abbreviations

ACL:

Anterior cruciate ligament

PCL:

Posterior cruciate ligament

MCL:

Medial collateral ligament

FCL:

Fibular collateral ligament

PLC:

Posterolateral corner

OA:

Osteoarthritis

IKDC:

International knee documentation committee

KOOS:

Knee injury and osteoarthritis outcome score

CPM:

Continuous passive motion

AL:

Anterolateral

ROM:

Range of motion

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Author contributions

L.E, S.L, and T.L were involved in patient treatment, study design, data analysis, and manuscript writing. R.F.L, G.M, and G.D were involved in study design, data analysis, and manuscript writing.

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Correspondence to Gilbert Moatshe.

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Conflict of interest

One or more of the authors have declared the following potential conflict of interest or source of funding: L.E.: Acta Orthopaedica: Editorial or governing board, AOSSM: Board or committee member, BJSM: Publishing royalties, financial or material support, ESSKA: Board or committee member, JBJS–American: Editorial or governing board, Knee: Editorial or governing board, KSSTA: Editorial or governing board. Research grants from Health South East Norway, Smith and Nephew and Biomet. Arthrex Inc. (consultant, IP royalties), R.F.L.: Arthrex Inc. (consultant, IP royalties, research support), Ossur (consultant, research support), Smith & Nephew (consultant, IP royalties, research support). G.M: South Eastern Norway Health Authorities (research grant), Arthrex Inc. (research grant). The other authors report no potential conflict of interest.

Ethical standards

Institutional Review Board approval was obtained (Regional Committee for Medical and Health Research Ethics South East Norway, Section C—IRB00001870 REK Sør-Øst C).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Moatshe, G., Dornan, G.J., Ludvigsen, T. et al. High prevalence of knee osteoarthritis at a minimum 10-year follow-up after knee dislocation surgery. Knee Surg Sports Traumatol Arthrosc 25, 3914–3922 (2017). https://doi.org/10.1007/s00167-017-4443-8

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Keywords

  • Knee dislocation
  • Knee
  • Multiple ligament knee injury
  • Osteoarthritis