Session III - Femur/Knee

Surgical Management of Traumatic Knee Dislocation: Results of a Standard Surgical Approach

Brian A. Klatt, MD; Robert L. Waltrip, MD; Craig H. Bennett, MD; James J. Irrgang, PhD; Bruce Ziran, MD; Christopher D. Harner, MD, University of Pittsburgh, Pittsburgh, PA

Introduction: Controversy still exists regarding the appropriate management of traumatic knee dislocation because of the use of inconsistent treatment protocols and a variety of different surgical techniques and because clinical studies have been relatively small with poorly defined patient populations. Our purpose was to evaluate the clinical results in a large series of patients with use of a standard surgical protocol.

Methods: Forty-seven patients presented with knee dislocations between 1990 and 1995. Sixteen patients were excluded from our standard protocol because of confounding variables, including blood vessel injury, fractures, and open dislocations. The remaining 31 patients underwent a standard surgical approach, including anatomical repair and/or reconstruction of all associated injuries with fresh-frozen allograft tissue. All patients returned for a detailed subjective and objective evaluation.

Results: Thirty-one patients were evaluated at a mean follow-up of 44 months (range, 24 to 72). Nineteen patients underwent an operation acutely (<3 weeks) and 12 procedures were delayed (>3 weeks). The mean Lysholm score was 91 (range, 72 to 100) for the acute treatment group and 80 (range, 51 to 100) for the delayed group. Knee Outcome Survey (KOS) activities of daily living scores averaged 91 points (range, 73 to 99) for acute and 84 points (range, 64 to 99) for delayed. KOS sports activity scores averaged 89 (range, 60 to 100) for the acute and 69 (range, 0 to 100) for the delayed group. International Knee Documentation Committee ratings included no normal, 11 nearly normal, 12 abnormal, and 8 severely abnormal knees. Ten of the 11 patients who received nearly normal ratings were treated acutely and 1 had delayed treatment. Meyers ratings included excellent or good scores in 23 (74%) and fair or poor scores in 8 (26%) patients. Sixteen of 19 (84%) acute and 7 of 12 (58%) delayed knees received excellent or good Meyers scores. Mean extension loss was 1.2^o (range, 0 to 5^o) and flexion loss was 12^o (range, 0 to 33^o). There was no difference in range of motion between the acute and the delayed patients. Four patients required manipulation for loss of flexion (two acute, two delayed). All patients demonstrated improved stability in laxity testing, although restoration of posterior and valgus stability was more reliable for knees treated acutely.

Discussion: We describe the largest series of reconstructed knee dislocations reported to date. Surgical treatment of knee dislocations with a consistent protocol provides satisfactory clinical outcomes at 2 to 6 years. Patients treated acutely had higher subjective scores and better objective restoration of knee stability than did the patients whose treatment was delayed. Nearly all patients were able to perform daily activities with few problems. However, the ability to return to high-demand sports and heavy manual labor was less predictable.

Conclusion: With the observed trend toward better outcomes for acutely reconstructed knees, we advise close collaboration of the orthopaedic traumatologist with a knee reconstruction specialist to allow for early planning of the appropriate operative repair.