UTILISATION OF A SYNTHETIC LIGAMENT FOR EMERGENCY TREATMENT OF KNEE DISLOCATION: A PROSPECTIVE STUDY OF 17 PATIENTS AT THREE YEARS FOLLOW-UP

Abstract

Purpose: There is some controversy over the most appropriate management of knee dislocation. Following the 1995 SOFCOT symposium, the most promising results appeared to be obtained with emergency treatment using a synthetic reinforcement. The purpose of this prospective work was to validate this conclusion.

Material and methods: Between November 1994 and October 1998, 17 patients admitted for emergency care of a knee dislocation were included in this prospective study. Ten were men, mean age was 29 years (17–48). A complete work-up was acquired: plain radiographs with stress views, MRI in 14 patients. The central pivot was torn in all cases. Tears involved the lateral ligaments in eleven cases, the medial ligaments in six and the patellar tendon in one. There were no vessel lesions. One patient had popliteal sciatic nerve paralysis. Emergency surgery was performed to staple or suture the peripheral tissues and suture the posterior cruciate ligament plus a synthetic reinforcement (Ligastric); the anterior cruciate ligament was not repaired. Immediate rehabilitation started with mobilisation 0°/60°up to day 21 then with 0°/90° up to day 60. The lower limb was immobilised in an extension brace and weight-bearing was encouraged starting on day 60.

Results: All patients were reviewed at consultation with stress radiographs. Mean follow-up was three years (two to six years). The IKDC score was recorded. Four patients had arthrolysis, one had an isolated reconstruction of the anterior cruciate ligament, one had an ablation of the synthetic ligament and repair of the anterior cruciate ligament. The 70° posterior drawer was 18° preoperatively and 9 mm at last follow-up (21–0 mm). The greatest laxity corresponded to a patient who had had ablation of the synthetic ligament. The Pudda index was 6 mm, mean mobility was 0/130°, and two patients had asymmetric 10° recurvtum. Subjective outcome was very satisfactory for seven patients, satisfactory for nine and disappointing for one.

Conclusion: The objective result can still be improved by correcting the posterior laxity. Not repairing the anterior cruciate ligament immediately does not worsen prognosis. There were no complications related to the synthetic ligament. This therapeutic attitude can be proposed for major knee trauma.