TRAUMATIC DISLOCATIONS OF THE KNEE- A RETROSPECTIVE CLINICAL EVALUATION

Abstract

Background: Traumatic dislocations of the knee are uncommon (< 1% of all dislocations), but they account to the most serious ligament and soft tissue injuries of the knee. Diagnosis and treatment of the dislocated knee present a major challenge to the orthopaedic surgeon. The purpose of our retrospective study was to critically analyze the clinical outcome of all traumatic knee dislocations treated operatively between 1996 and 2006 in our institution.

Methods: Retrospective clinical case series study of all patients treated for traumatic knee dislocation (m: w=12:4; mean age 31 yrs, range 17–63 yrs) from 1998–2006.

The mechanism of injury was a traffic accident (n=7), a sport trauma (n=8) and slip and fall (n=1). The charts of all patients were analyzed.

The clinical outcome was assessed by personal telephone interview by a modified SSK questionnaire by Insall. Surgery was performed by one team of surgeons 2–89 days after trauma.

Mean and range were reported for continuous variables and relative and absolute frequencies vor categorial variables. Data were analyzed using Stata version 8. The level of significance was defined as p< 0.05.

Results: The injury pattern is reported below:

• 15 anterior cruciate ligament (ACL) lesions (11x ACL reconstruction), 15 posterior cruciate ligament (PCL) lesions (9x refixation, 3x reconstruction), 13 medial collateral ligament (MCL) lesions (8x reconstruction), 6 medial posterior collateral ligament (MPCL) lesions (4x reconstruction), 4 lateral collateral ligament (LCL) lesions (1x reconstruction), 3 popliteal muscle injuries (2x reconstruction), 5 medial meniscal lesions, 10 lateral meniscal lesions (9x suture, 1x partial meniscectomy), 3 femoral fractures, 1 proximal tibial fracture.

• One angiography was performed. No vascular lesion was observed.

• The follow up rate was 93% complete. The mean follow up time was 58 months (range 35–156).

• 83% of patients were able to return to work without any impairment. 62% of patients returned to the same level of sport activity. 54% of patients were absolutely painfree.

• Based on a modified SSK score by Insall a mean of 182 points (range 129–200) on a scale with maximum 200 points could be noted.

Conclusions: Even though in a orthopaedic clinic specialized in the treatment of knee injuries traumatic knee dislocations remain a demanding therapeutic challenge. A highly specialized, customized and sophisticated treatment strategy of a experienced team of surgeons, nurses and physiotherapists is mandatory for acheivement of optimal functional and subjective outcome.