Abstract. Introduction. Traumatic knee dislocations are devastating injuries and there is no single best accepted treatment. This study looked at functional outcome of a single surgeon case series of patients who underwent surgical management of their knee dislocation. Methods. Eighty-seven patients with knee dislocation were treated at a major trauma centre. Acute surgical repair and reconstruction with fracture fixation within 4 weeks was preferred unless the patient was too unstable (Injury severity score>16). The collaterals were repaired and augmented using a variety of autografts, allografts or synthetic grafts. PCL was primarily braced and reconstructed subsequently, if required. Outcome was collected prospectively using IKDC score, KOOS and Tegner score. Results. The mean age of the patients was 33.6yrs (SD 11.9), 66 males and 21 females. According to Schenck classification, 26 were KD-I (30%), 6 KD-II (7%), 13 were KD-III (15%), 7 were KD-IV (8%) and 35 were KD-V (40%). 7 patients had CPN injury (8%), 3 had vascular injury (3.4%), 2 had combined CPN and vascular injury (2.3%). Acute surgical treatment was done in 62 patients while 10 had staged reconstruction. 22 patients had delayed reconstruction. The mean follow-up period was 5.8 years (1- 12 yrs), mean IKDC score was 57.6 (SD 23.6). The mean Tegner activity scale postoperatively was 4.5(SD 2) and the mean KOOS score was 74.9 (SD 19.6). Conclusion. A large proportion of cases were KD-V but still had a good outcome with surgical management. Current classification systems do not cover all dislocation patterns and a modification is proposed

Abstract. Background. Traumatic knee dislocations are devastating injuries and there is no single best accepted treatment. Treatment needs to be customised to the patient taking into consideration injury to the knee; associated neurovascular and systemic injuries. Objective. This study looked at functional outcome of a single surgeon case series of patients who underwent surgical management of their knee dislocation. Methods. Seventy patients with knee dislocation were treated with multi-ligament reconstruction at a major trauma centre. Acute surgical repair and reconstruction with fracture fixation within 3 weeks was preferred unless the patient was too unstable (Injury severity score>16). PCL was primarily braced and reconstructed subsequently, if required. Outcome was collected prospectively using IKDC score, KOOS and Tegner score. Results. The mean age of the patients was 35yrs (17–74), 53 males and 17 females. 5 patients had CPN injury (7%), 3 had vascular injury (4.2%), 2 had combined CPN and vascular injury (2.8%). Acute surgical treatment was done in 48 patients while 10 had staged reconstruction. 22 patients had delayed reconstruction. The mean follow-up period was 4.8 years (1–12 yrs). According to the IKDC score 67% of the patients had near-normal knee function. The mean Tegner activity scale postoperatively was 4.5 (preinjury 6.5) and the mean KOOS score was 75.3. Four patients had stiffness and needed arthroscopic arthrolysis, two patients had a residual foot drop from the original injury and needed tendon transfer. Conclusion. Traumatic knee dislocation is a challenging problem but good outcomes can be achieved by surgical management

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: Traumatic knee dislocations are rare but devastating injuries. We have evaluated the clinical results of ligament repair and reconstruction. Knee dislocation was defined as an acute event that produced multidirectional instability with at least 2 of the 4 major ligaments disrupted. Materials: Twenty-one patients with 22 knee dislocations presented between 1994 and 2001. There was one vascular and one common peroneal nerve injury. Eight (38%) patients were treated in the acute period (< 14 days), 5 (24%) had reconstructions within 1 year of injury. The remainder were late reconstructions. The patients were evaluated at mean follow-up of 32 months (11 to 77). This included ROM measurement, clinical and instrumented ligament laxity testing. Posterior stress view with 10kg weight was used to evaluate the PCL reconstruction. Function was evaluated using the IKDC chart, the Lysholm Score, the Tegner Activity Level, the Knee Outcome Survey and WOMAC. Results: The mean extension deficit was 6.8 degrees (0–25) and mean flexion deficit was 8.6 degrees (0–20). Of the ACL reconstructions, 4 knees had 0–3mm side-to-side difference, 15 knees had 3–5mm and 1 knee had 6–10mm. Of the PCL reconstructions, 2 were within 3–5mm of side-to-side difference, 9 knees were 6–10mm and 4 were more than 10mm. Posterolateral corner repair/reconstructions appeared durable. None of the knees were IKDC Grade A, 8 knees were Grade B, 9 were as Grade C and 5 were Grade D. The mean Lysholm Score was 81 (66–100) and the mean Tegner Activity Level was 4.9 (1–7). The mean Knee Outcome Survey score was 75 (41–99). Acutely treated knees had better scores than late reconstructions. Conclusion: Our study has demonstrated good function in the operatively treated knee dislocations at 1–7 years. Nearly all had few problems with daily activities. The ability to return to high-demand sports and heavy manual labour was less predictable

Traumatic knee dislocations are rare but devastating injuries. We have evaluated the clinical results of ligament repair and reconstruction. Knee dislocation was defined as an acute event that produced multidirectional instability with at least 2 of the 4 major ligaments disrupted. Twenty-one patients with 22 knee dislocations presented between 1994 and 2001. There was one vascular and one common peroneal nerve injury. Eight (38%) patients were treated in the acute period (< 14 days), 5 (24%) had reconstructions within 1 year of injury. The remainder were late reconstructions. The patients were evaluated at mean follow-up of 32 months (11 to 77). This included ROM measurement, clinical and instrumented ligament laxity testing. Posterior stress view with 10kg weight was used to evaluate the PCL reconstruction. Function was evaluated using the IKDC chart, the Lysholm Score, the Tegner Activity Level, the Knee Outcome Survey and WOMAC. The mean extension deficit was 6.8 degrees (0–25) and mean flexion deficit was 8.6 degrees (0–20). Of the ACL reconstructions, 4 knees had 0–3mm side-to-side difference, 15 knees had 3–5mm and 1 knee had 6–10mm. Of the PCL reconstructions, 2 were within 3–5mm of side-to-side difference, 9 knees were 6-10mm and 4 were more than 10mm. Posterolateral corner repair/reconstructions appeared durable. None of the knees were IKDC Grade A, 8 knees were Grade B, 9 were as Grade C and 5 were Grade D. The mean Lysholm Score was 81 (66–100) and the mean Tegner Activity Level was 4.9 (1–7). The mean Knee Outcome Survey score was 75 (41–99). Acutely treated knees had better scores than late reconstructions. Our study has demonstrated good function in the operatively treated knee dislocations at 1–7 years. Nearly all had few problems with daily activities. The ability to return to high-demand sports and heavy manual labour was less predictable

Tibiofemoral joint dislocations are uncommon. Four cases of paediatric knee dislocation are described, none in British journals. We report two paediatric patients who presented with a 3-ligament knee injury following in-field or spontaneous reduction. One case was initially diagnosed as patella dislocation. One patient, age 12 years, had associated nerve and vessel injury so underwent fixation, vascular grafting and fasciotomy emergently. The second, age 15 years, underwent acute reconstruction following MRI evidence of both cruciates and medial-collateral ligament ruptures, with tears to both menisci. History is essential to diagnosis as the knee is often relocated at the scene. Tibiofemoral dislocation can be confused with patellofemoral dislocation. There are important differences on examination, which should be performed carefully, and must include neurovascular status. Knee AP and lateral radiographs can exhibit subtle signs, posterior subluxation of the tibia is pathognomonic of PCL rupture and should raise suspicion of dislocation. These cases show that traumatic dislocation is an important differential diagnosis in a child that presents with a painful knee. Although an uncommon injury, particularly in the skeletally immature, it is essential to recognise the possibility of knee dislocation in children so that prompt diagnosis and treatment of this limb threatening injury can occur

Aims: The results of surgical repair and reconstruction of knee dislocations were reviewed at average follow-up of 32 months. Methods: Twenty-one patients with 22 knee dislocations presented between 1994 and 2001. There was one vascular and one common peroneal nerve injury. Eight (38%) patients were treated in the acute period (< 14 days), the remainder were late reconstructions. The patients were evaluated at mean follow-up of 32 months (11 to 77). This included ROM measurement, clinical and instrumented ligament laxity testing. Posterior stress view with 10kg weight was used to evaluate the PCL reconstruction. Function was evaluated using the IKDC chart, the Lysholm Score and the Tegner Activity Level. Results: The mean Lysholm score in the acute group was 87 (range 81 to 93) and in the delayed group 75 (range 53 to 100), the mean Tegner activity rating was 5 in the acute group and 4.4 in the delayed group. IKDC assessment revealed no differences between the two patient groups. Instrumented testing of knee stability indicated better results for ACL reconstructions performed in the acute phase but no difference in the outcome of PCL reconstruction. There was no difference in loss of knee movement between the two groups. Conclusions: Good function can be obtained in the operatively treated knee dislocations at 1–7 years. Although the differences were small, the outcome in terms of overall knee function, activity levels and anterior tibial translation were better in those knees reconstructed within two weeks of injury

Purpose: Knee dislocation is associated with blunt popliteal artery trauma in almost 30% of cases. In such injuries, prompt diagnosis and appropriate management is essential for limb salvage. Both our methods and outcomes of popliteal artery thrombosis treatment after knee dislocation are presented in this retrospective study. Methods: During the last six years, eight patients (all male, average age 25 years) were admitted to our hospital with knee dislocation and associated blunt popliteal artery thrombosis following automobile accidents (7/8) and fall from height (1/8). The average delay before accessing the emergency room was 14 hours (ranging from 2 to 24 hours). Seven patients were experiencing signs of distal ischemia (absence of distal pulses, motor and sensory loss) and one patient, admitted two hours after vehicle accident, was presented with absent distal pulses but maintained motor and sensory ability. Seven patients underwent external fixation and one plaster cast immobilization. In all cases, digital subtraction arteriography was performed. Results: All patients were treated by performing below knee femoropopliteal bypass, using reversed saphenous vein in seven cases and a vscs graft in one. All patients underwent fasciotomies. One above knee amputation was performed postoperatively while three patients experience permanent neurologic discrepancy. Conclusions: In any case of knee dislocation, there must be a high clinical suspicion of popliteal artery thrombosis. Meticulous and repeated physical examination and rapid admission to a department of vascular surgery are of vital importance for limb salvage and minimization of amputation rate and permanent neurologic deficiency

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

Introduction: Knee dislocations are uncommon injuries with most series reporting only few cases over a period of many years. The association of knee dislocations with femoral shaft fractures is exceedingly rare and further complicates the management of this injury. We describe four patients managed at our tertiary care trauma center and evaluate the outcome. Patients and Methods: Out of 187 femoral fractures treated in our institution over a period of 6 years (1994–1999), 4 patients with 5 femoral fractures and ipsilateral knee dislocations were identified. All four patients (2 female) were in early twenties and involved in high energy road traffic accidents. One woman had bilateral knee dislocation with fractures of both femora and tibiae. None of these four patients had head, chest or major visceral injury. No patient had neurovascular damage or compartment syndrome. All were managed by immediate relocation of the knee, angiography, locked intramedullary nailing of femur and post-operative bracing of the knee for six weeks – either by external fixator or hinged brace. Following discharge from the hospital they were followed up regularly in the fracture clinic. Secondary reconstructive procedures were planned depending on the severity of injury and patient demands. The minimum follow up was two years. Results: Four of five femoral fractures united within expected time scale. One with nonunion had exchange nailing twice and is presently under follow up. Out of the five knees, four underwent a secondary reconstructive procedure. One patient had an open dislocation of the knee with loss of quadriceps tendon, part of patella and patellar tendon, which was reconstructed with Leeds-Keio ligament strips and a free flap. One other patient required an ACL reconstruction two years after injury and finally had a stable painless knee. The lady with bilateral injury had reconstruction of both PCL 2 years after injury. At the final follow up seven years later, there was residual PCL laxity in one knee and she was mobile with one stick. At final follow up all the patients were assessed by the American knee score. Conclusion: Femur fractures with knee dislocations are orthopaedic emergencies. These injuries should be treated by immediate relocation of the knee, stabilization of the femoral fracture and ensuring normal distal circulation. In our patients, we have braced the knee initially and symptomatic instability was later on managed by appropriate ligament reconstruction procedures. Cross instability may require application of bridging external fixator to facilitate knee ligament healing. Two patients in this series had a good outcome with stable painless knees. The treatment has to be individualized in each situation to achieve an optimum result

Purpose: Midterm follow up of complete knee dislocation and clinical outcome evaluation. Materials and Methods: Between 1990–2004, we retrospectively reviewed the records of patients with complete knee dislocation. Eighteen patients, 19 knees were followed. Twelve males and 6 females. The average age at follow up was 40.7 years. Treatment consisted of primary knee stabilization with tutor cast in 10 knees and 9 by external fixation for 6 weeks. Following rehabilitation program, further surgical treatment was according to clinical relevancy. Functional and subjective evaluation was registered by the WOMAC questionnaire. Results: Eleven were multiple trauma patients, involved in RTA, 2 had a crush injury, one patient involved in aviation accident had bilateral dislocation and 4 patients had low energy injury. Out of 7 patients, 8 knees had isolated dislocation. One died, 3 were not available for clinical follow up. Twelve patients returned the questionnaire. The average result of the WOMAC score was 46.5, range 7–91. Four knees presented advanced osteoarthritis with painful stiffness. Eight knees presented at the end of the follow up with instability as chief compliant. Five patients underwent later reconstructive procedures. One patient underwent knee arthrodesis. Conclusion: In patients with knee dislocation, associated polytrauma should be regarded as a bed prognostic sign. The results suggest the need to revaluate the initial treatment strategy. The overall outcome shows that nearly all patients were able to perform daily activities, no patients in our study attempted any strenuous activity

Knee dislocation is a rare injury in high energy trauma, but it is even rarer in low energy injuries. We present, to our knowledge, the only case in the world literature of knee dislocation following a cricketing injury. The patient was a 46 year old recreational fast bowler who, whilst bowling, slipped on the pitch on the follow through. He sustained an anteromedial knee dislocation which was reduced under intravenous sedation. He also sustained a neuropraxia of the common peroneal nerve with grade 2 weakness of ankle and toe dorsiflexion. Magnetic Resonance Imaging (MRI) confirmed a complete rupture of anterior cruciate ligament (ACL), lateral collateral ligament (LCL) and postero-lateral corner (PLC). Patient underwent surgical reconstruction and repair of his PLC along with repair of LCL with combination of anchor sutures and metal staple within 72 hours of the injury. He was treated in a cast brace. The ACL insufficiency was treated conservatively. Patient made an uneventful recovery and follow up at 3 months revealed a full range of knee movements with asymptomatic ACL laxity

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

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.

Introduction. Knee dislocations, vascular injuries and floating knee injuries can be initially managed by a external fixator. Fixator design constructs include the AO pattern and the Diamond pattern. However, these traditional constructs do not adhere to basic principles of external fixation. The Manchester pattern knee-spanning external fixator is a new construct pattern, which uses beam loading and multiplanar fixation. There is no data on any construct pattern. This study compares the stability of these designs. Materials & Methods. Hoffman III (Stryker, USA) external fixation constructs were applied to articulated models of the lower limb, spanning the knee with a diamond pattern and a Manchester pattern. The stiffness was loaded both statically and cyclically with a Bose 3510 Electroforce mechanical testing jig (TA Instruments). A ramp to load test was performed initially and cyclical loading for measurement of stiffness over the test period. The results were analysed with a paired t-test and ANOVA. Results. The mean stiffness with the diamond pattern fixator was significantly less stiff than the Manchester pattern fixator – by a factor of 3 (40N/mm vs 115N/mm). Displacement increased in all patterns over simulated loading equating to six weeks. The diamond pattern demonstrated a 50%% increase in displacement over time. The Manchester pattern demonstrated only 20% increase in displacement over time. These are all statistically significant (p<0.01). Conclusions. The aim of an external fixator in knee dislocations and vascular injuries is to provide stability, prevent displacement and protect repairs. Vascular injuries often require fixation for several weeks to protect a repair. The Manchester pattern, applying the principles of external fixation, provides a stiffer construct and also confers greater stability over the time a fixator may be required. We commend this more informed design for the management of knee dislocations and vascular injuries

Orthopaedic injuries in the knee are often associated with vascular injury. When these vascular injuries are missed devastating there are devastating outcomes like limb ablation. Pulse examination in these patients is not sensitive to exclude vascular injuries. That often lead to clinicians opting for Computed Tomography Angiogram (CTA) to exclude vascular. this usually leads to a burden in Radiology Department. This study aimed to evaluate the prevalence of vascular injury in patient with orthopaedic injury in the knee. The computed tomography (CT) done in patients with distal femur fracture, knee dislocation and proximal tibia fractures were retrieved from the picture archiving and comunication system (PACS). The CTs were done between June 2017 and June 2022. The computed tomography angiogram (CTA) reports were reviewed to determine cases that vascular injury. A sample size of 511 cases was collected. 386 cases were done CTA and 125 cases were not done CTA. There were 218 tibial plateau fractures, 79 knee dislocations, 72 distal metaphyseal femur fractures, 61 floating knees, 55 distal femure intraarticular and 26 proximal metaphyseal tibia fractures. The mechanisms of injury in these were gunshot, fall from standing height, fall from height, MVA, MBA, PVA and sports. Prevalance was 9.17% (47) of the total injuries in the knee. Prevalance in patients who were sent for CTA was 12.08%. Routine CTA in patients with injuries in the knee is not recomended. The use of ankle brachial index may decrease the number of CTA done

Poor availability of allografts in South Africa has led to an increased use of synthetic augmentation to stabilize knee joints in the treatment of knee dislocations. This study aims to evaluate multiligament knee injuries treated with a posterior cruciate ligament internal brace. The study included patients with knee dislocations who were treated with a PCL internal brace. The internal brace involved the insertion of a synthetic suture tape, which was drilled into the femoral and tibial footprint. Chronic injuries were excluded. Patient-reported outcome scores (PROMs), range of motion, stress X-Rays, and MRI scans were reviewed to assess outcomes. Acceptable outcomes were defined as a Lysholm score of 84 or more, with grade II laxity in no more than one ligament and a range of motion from full extension to 90° or more. The study included eight patients, with a median age of 42, of which five were female. None of the patients had knee flexion less than 90° or an extension deficit of more than 20°. PROMs indicated acceptable outcomes (EQ5D, Tegner Lysholm). Stress radiographs showed less than 7mm (Grade I) of posterior translation laxity in all patients. Four patients underwent MRI scans 1–2 years after the initial surgery, which revealed healing of the PCL in all patients. However, increased signal in a continuous ligament suggested only partial healing in two patients. Tunnel widening of 200% and 250% was noted around the tibial and femoral PCL footprints, respectively. All patients demonstrated stable knees and acceptable PROMs. Tunnel widening was observed in all patients who had MRI scans. Factors such as suspensory fixation, anisometric tunnel position, and the absence of PCL tear repair may have contributed to the tunnel widening

Abstract. Introduction. Knee dislocations (KDs) are complex injuries which are often associated with damage to surrounding soft tissues or neurovascular structures. A classification system for these injuries should be simple and reproducible and allow communication among surgeons for surgical planning and outcome prediction. The aim of this study was to formulate a list of factors, prioritised by high-volume knee surgeons, that should be included in a KD classification system. Methods. A global panel of orthopaedic knee surgery specialists participated in a Delphi process. A list of factors to be included in a KD classification system was formulated by 91 orthopaedic surgeons, which was subsequently prioritised by 27 experts from 6 countries. The items were analysed to find factors that had at least 70% consensus for inclusion in a classification system. Results. The four factors that reached consensus agreement and thus deemed critical for inclusion in a classification system were vascular injuries (89%), common peroneal nerve injuries (78%), number of torn ligaments (78%), and open injuries (70%). Conclusion. The wide geographic distribution of participants provides diverse insight and makes the results of the study globally applicable. The most important factors to include in a classification system as determined by the Delphi technique were vascular injuries, common peroneal nerve injuries, number of torn ligaments, and open injuries. The Schenck anatomic classification system most accurately identifies these patient variables with the addition of open injuries. The authors propose to update the Schenck classification system with the inclusion of open injuries as an additional modifier

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