The purpose of this study was to assess the knowledge acquired from completing online case-based e-learning modules. A secondary objective was to identify how students use these independent resources and gauge their level of support for this novel instructional strategy. Fourth year medical students were randomized to either a module or control group. Both groups received the standard musculoskeletal medical school curriculum, while the students in the module group were also given access to case-based online modules created to illustrate and teach important orthopaedic concepts related to unique clinical presentations. The first module depicted an athlete with an acute knee dislocation while the second module portrayed a patient with hip pain secondary to femoral acetabular impingement (FAI). All participating students completed a knowledge quiz designed to evaluate the material presented in the module topics, as well as general musculoskeletal concepts taught in the standard curriculum. Following the quiz, the students were invited to share their thoughts on the learning process in a focus- group setting, as well as an individual survey. Demographic data was also collected to gauge student's exposure to and interest in orthopaedics, emergency medicine, anatomy and any prior relevant experience outside of medicine. Twenty-five fourth year medical students participated in the study with 12 randomized to the module group and 13 to the control group. The regression revealed students in the module group did on average 18.5 and 31.4 percentage points better on the knee and hip quizzes respectively, compared to the control group, which were both significant with a p-value < 0.01. Additionally, students who had completed an orthopaedics elective did 20 percentage points better than those who had not, while there was no significant improvement in students who had just completed their core orthopaedics rotation. The feedback collected from the survey and small group discussion was positive with students wishing more modules were available prior to musculoskeletal clinical skills sessions and their orthopaedics rotations. Medical students given access to online case-based e-learning modules enjoyed the innovative teaching strategy and performed significantly better on knowledge quizzes than their classmates who only received the standard musculoskeletal curriculum

Introduction. It is now widely accepted that acute knee dislocations should be managed operatively. Most published studies are from outside the UK and from major trauma or specialist centres. The aim of the study is to report the functional outcomes of all patients presenting with an acute knee dislocation at our institution all of whom were surgically managed. The results were then compared to other published series. The hypothesis being that there would be no significant difference in the functional outcome scores between the groups. Methods. All patients presenting with an acute knee dislocation over the last 15 years were included in the study. The patients were followed up using functional assessment scores: Knee outcome score (ADL), Knee outcome score (sports), Tegner Lysholm Scores and overall Patient Satisfaction. The patients were classified according to the Schecnk classification of knee dislocations. Results. There were 22 patients in total, 21 male and 1 female. Average age was 42 years (range 16–54 years). The mean follow up was 6.3 years (range 1–15 years). The mean Knee Outcomes Score for ADL was 86% (68–100) and for Sports was 84% (44–100). The mean Tegner Lysholm Score was 82% (59–91) and the Overall Patient Satisfaction mean score was 77% (60–95). These results are comparable to other published data with no significant difference between the groups. Conclusion. Satisfactory functional results can be obtained for surgically treated acute knee dislocations in a UK non-specialist centre

Introduction. It is now widely accepted that acute knee dislocations should be managed operatively. Most published studies are from outside the UK and from major trauma or specialist centres. The aim of the study is to report the functional outcomes of all patients presenting with an acute knee dislocation at our institution all of whom were surgically managed. The results were then compared to other published series. The hypothesis being that there would be no significant difference in the functional outcome scores between the groups. Methods. All patients presenting with an acute knee dislocation over the last 15 years were included in the study. The patients were followed up using functional assessment scores: Knee outcome score (ADL), Knee outcome score (sports), Tegner Lysholm Scores and overall Patient Satisfaction. The patients were classified according to the Schecnk classification of knee dislocations. Results. There were 22 patients in total, 21 male and 1 female. Average age was 42 years (range 16-54 years). The mean follow up was 6.3 years (range 1-15 years). The mean Knee Outcomes Score for ADL was 86% (68-100) and for Sports was 84% (44-100). The mean Tegner Lysholm Score was 82% (59-91) and the Overall Patient Satisfaction mean score was 77% (60-95). These results are comparable to other published data with no significant difference between the groups. Conclusion. Satisfactory functional results can be obtained for surgically treated acute knee dislocations in a UK non-specialist centre

Purpose. To study the initial presentation and subsequent investigation and management of acute knee dislocations at a regional trauma centre. Introduction. Knee dislocation requires high energy trauma, and often affects young working adults. The high incidence of associated arterial, neurological, ligamentous, and other soft tissue injuries, can produce potentially devastating outcomes. Rapid mobilisation of traditionally distinct surgical teams, with urgent vascular imaging and emergency surgery are often necessary. The extent and severity of ligamentous damage may require multiple operations to repair. Methods. A retrospective nine-year study of knee dislocations managed in the Trauma and Orthopaedic Department of the Royal Hospitals, Belfast was performed using a Fractures Outcomes Research Database (FORD), a chart review, and a review of relevant radiology. Demographic data, mechanisms of injury, associated neurovascular injuries, ligamentous damage, and operative intervention were recorded. Results. 15 patients were identified over 9 years (2000-2008 inclusive). Mean age at injury was 38 years, median 37. 14 (93%) of patients were male, 1 (7%) was female. 6 injuries (40%) were sport-related, 3 (20%) occurred as a result of road traffic collisions, 5 (33%) were accidents in the workplace, and 1 (7%) was a result of a fall while intoxicated with alcohol. 5 (33%) patients experienced a common peroneal nerve palsy. 10 (67%) received vascular imaging, and 2 (13%) underwent vascular surgery as part of the initial theatre episode. All 15 dislocations led to some degree of structural soft tissue knee injuries. These included 12 (80%) anterior cruciate ligaments, 8 (53%) posterior cruciate ligaments, 7 (47%) lateral collateral ligaments, and 5 (33%) medial collateral ligaments. 3 posterolateral corner injuries required repair. Of the 15 patients, 2 (13%) underwent no operative procedures following closed reduction, and the remaining 13 patients had 21 distinct theatre episodes recorded between them. 2 fasciotomies for compartment syndrome, and 2 common peroneal nerve decompression/explorations were performed in the initial theatre episode. 3 patients (20%) were managed with an external fixator initially. 1 patient (7%) developed complications and required trans-femoral amputation. Conclusions. Knee dislocation remains uncommon, and even major centres may receive only a few injuries per year. Orthopaedic, Vascular and Plastic surgeons, as well as Emergency Physicians and Radiologists must remain vigilant to the challenge which this injury can present, and the opportunity for excellent outcomes through a coordinated approach with close communication, awareness of injury patterns, and availability of theatre and imaging resources

Purpose: Treatment of knee dislocations remains challenging and controversial. Several strategies for the management of multiple ligament knee injuries have been described and there are multiple unresolved questions. These include the indications for surgery, repair versus reconstruction, surgical timing and graft selection. The aim of this survey was to identify areas of agreement and controversy, to define the current standard of care and help generate research questions. Method: Using the standard techniques for survey development we presented six clinical scenarios of acute knee dislocations (at least three ligaments) to all orthopaedic surgeons affiliated with Canadian medical schools. The scenarios were designed to cover the common combinations of knee dislocations in both a 25 year old active individual and a 50 year old sedentary individual. The responses were divided into three groups. Group A consisted of those with fellowship training, or practices focused on, sports knee. Group B was comprised of surgeons with trauma fellowship or a sub-specialty trauma practice. Group C were the remaining surgeons without these subspecialty foci. We report on the responses of groups A and B. Results: An average of ten different treatment algorithms were reported for each scenario but there was agreement on the need for early surgical management in the young active individual with a knee dislocation and all dislocations involving a lateral sided injury. Conversely, there was a lack of consensus regarding the need for surgical treatment of the 50 year old individual with bi-cruciate injury and medial collateral ligament. The most common combinations of reconstruction and repair are reported for each clinical scenario. Surgeons strongly favor early surgical intervention, within three weeks of injury, except for the 50 year old sedentary individual with a bi-cruciate plus medial sided injury. Allograft was the most popular choice to reconstruct the PCL and lateral ligament. For the ACL graft there was a near equal distribution between hamstrings, patellar tendon and the use allograft tissue. Conclusion: In the absence of higher level evidence, the information from this survey helps define the standard of care in Canada and identifies areas of controversy which would be a priority for a multi-centre prospective trial

Acute total knee dislocations are uncommon injuries for which some surgeons use artificial ligaments as their choice of graft for reconstruction. The goal of this study is to evaluate on a short and long term basis the stability and function of the LARS reconstructed knee. Flexion ROM was the only parameter which showed significant difference (p< 0.05) between subgroups. Therefore this treatment option for dislocated knee reconstruction seems to give good and lasting results even though patient’s quality of life may suffer. Although a variety of options have been proposed for the treatment of knee dislocations, the optimal one remains controversial. Allografts and autografts have both been used for reconstruction of the cruciate ligaments. The purpose of this study is to evaluate acute reconstruction of both cruciate ligaments using Ligament Advanced Reinforced System (LARS) artificial ligaments. We reviewed treatment of forty-eight acute knee dislocations. All patients had reconstruction of both cruciate ligaments with LARS ligaments. Patients were assed using SF-36, Lysholm and IKDC questionnaires as well as a physical exam. Stability of the reconstructed knee was evaluated radiologically using TELOS instrumentation. The controlateral knee was used as reference. The forty-eight patients were subdivided into four groups of post-operative intervals ranging from six months to seven years. The average ROM was 120°of flexion and −1.4° of extension. The differential average TELOS for LCA, LCP at 30° and LCP at 90° were respectively 2.9 mm, 2.8 mm, 6.9 mm. and their average Lysholm, SF-36 and IKDC scores were 72.0, 72.5, 53.5. Statistical results showed no significant difference (p> 0.05) between subgroups in terms function, laxity and extension but did in flexion. Our data show that patients treated by this method can regain a functional knee in terms of motion, stability and functional status and does not seem to deteriorate with time. Knee reconstruction with artificial ligaments shows promising results at short and longer term even though it seems to affect quality of life in this population. Financing: This study was partially financed by JK Orthomedic Inc

As a level I trauma hospital, OOU receives an increasing number of knee dislocations. This study evaluates acute knee dislocations seen at OOU from May 1. 1996 through Dec 2004. Patients and methods: 136 patients with 137 dislocated knees were admitted in the periode. All patients were students or working prior to the injury and all had a high functional level. 50% of the dislocations occured in conjunction with major traffic accidents- the majority of which were motorbikecyklists, while the remaining injuries were sustained during sports. 4 patients had a complete injury of the peroneal nerve on admittance, while an additional 4 had decreased motor strength and \or sensory dysfunction. In addition one patient had a ruptur of the patellar tendon and one a patella dislocation. Two of the patients in this group had a vascular injury. On admittance the patients underwent a diagnostic exam in the emergency room.. All the patients then had a MRI. The patients were the placed in a brace and on a CPM 2 hours 2 times a day for 7 days, and the vascular status was monitored closely. After 7–10 days the patients underwent surgery including arthroscopic reconstruction of the ACL and PCL with auto or preferably, if available allograft. Results for patient with a followup for more than 6 months are presented including IKDS, Cincinatti, Tegner and a clinical exam with KT1000. Results:. No serious complication occurred in conjuntion with surgery or the hospital stay. One infection with staf occurred successfully treated. Two patients underwent secondary arthroscopic debridement for arthrofibrosis All the patients have returned to work, but the majority have had to reduce or change their sports activities. Conclusion:. We have designed a treatment protocol for this difficult patient group. So far the complication frequency has been low

We treated 17 knees in 15 patients with severe ligament derangement and dislocation by open repair and reconstruction. We assessed the competence of all structures thought to be important for stability by clinical examination, MRI interpretation, and surgery.

Our findings showed that in these polytrauma patients clinical examination was not an accurate predictor of the extent or site of soft-tissue injury (53% to 82% correct) due mainly to the limitations of associated injuries. MRI was more accurate (85% to 100% correct) except for a negative result for the lateral collateral ligament and posterolateral capsule.

The detail and reliability of MRI are invaluable in the preoperative planning of the surgical repair and reconstruction of dislocated knees.