Fri., 10/14/11 Knee, Foot & Ankle, Paper #58, 3:47 pm OTA-2011
Immediate Primary Repair and Early Range of Motion of Acute Multiligamentous Knee Injuries: A Prospective Cohort Study
Philipp N. Streubel, MD; Justin E. Richards, MD; William T. Obremskey, MD;
Vanderbilt Medical Center, Nashville, Tennessee, USA
Purpose: Acute knee dislocations are complex injuries that lead to significant morbidity if not adequately managed. Most authors recommend ligamentous reconstruction within 3 weeks of injury. This approach, however, often requires staged procedures and prolonged periods of immobilization. The purpose of this study is to evaluate the clinical outcomes of a prospective cohort of patient with multiligamentous knee injuries, treated with a standard protocol of immediate primary repair (within 1 week of injury) and early postoperative range of motion. We hypothesize that this method of treatment can yield similar results to those of reconstruction.
Methods: After IRB approval, patients with combined anterior and posterior cruciate ligament tears with injury to the medial and/or lateral collateral ligaments (KD III and IV injuries) were prospectively enrolled after informed consent had been obtained. Diagnosis was performed with a combination of clinical examination, MRI, and intraoperative evaluation. Injuries with midsubstance tears and vascular injuries were excluded. Patients underwent open primary ligamentous repair within 1 week of injury, and were postoperatively started on continuous passive motion. Evaluations were performed at admission and at 3, 6, and 12 months after surgery using the International Knee Documentation Committee (IKDC) knee evaluation form, which includes both an objective physical examination (KT-1000 arthrometer) and a subjective patient questionnaire. Complications and reoperation rates were recorded at each follow-up visit.
Results: From July 2007 to January 2010, 25 patients were enrolled. Two patients were lost and 2 died before completing follow-up, leaving 21 for final evaluation (67% males; average age, 35 years; range, 19-56 years, 65% smokers). Mechanisms of injury included traffic accidents in 20 and sports-related injury in 1 case. Injuries were classified as KD IIIL in 13, KD IIIM in 6, and KD IV in 2 cases. After 12 months of follow-up, all knees achieved full extension with a mean arc of motion of 126° (range, 100°-140°). In the interim, 1 patient had required surgical arthrolysis, while 3 patients had required manipulation under anesthesia. According to the IKDC knee examination form, 35% of knees were found to be normal, 57% near normal, and 7% (1 case) severely abnormal. Mean subjective IKDC score was 62 (range, 41-88).
Conclusions: A standard protocol of early primary repair and early range of motion of severe multiligamentous knee injuries can yield near-normal results or better in over 90% of cases.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.