Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Management of the Dislocated Knee 15 articles

Articles

Is the All-arthroscopic Tibial Inlay Double-bundle PCL Reconstruction a Viable Option in Multiligament Knee Injuries?

Alexander E. Weber MD, Benjamin Bissell MD, Edward M. Wojtys MD, Jon K. Sekiya MD

All-arthroscopic tibial inlay double-bundle (DB) posterior cruciate ligament (PCL) reconstruction avoids an open dissection and the “killer turn” while maintaining the advantage of an anatomic graft. However, clinical data on the viability of this surgical technique in multiligamentous knee injuries are lacking.

Risk Factors for the Development of Heterotopic Ossification After Knee Dislocation

Daniel B. Whelan MD, Andrew P. Dold MD, Tomce Trajkovski MD, Jas Chahal MD

Results of treatment for acute knee dislocations and multiligament knee injuries may be influenced by a multitude of patient- and injury-related factors, including neurologic function, vascular status, ipsilateral fractures, and joint stability. The development of heterotopic ossification (HO) may nullify any benefits of reconstruction, because it can cause stiffness and discomfort. Identifying factors associated with HO after knee dislocation may help identify patients who might benefit from prophylaxis.

Long-term Followup of Surgically Treated Knee Dislocations: Stability Restored, but Arthritis Is Common

Gregory C. Fanelli MD, Paul L. Sousa MBA, Craig J. Edson MS

Surgical treatment of knee dislocations is intended to correct the anatomic injury and restore knee stability and patient function. Several studies have shown successful results with surgical treatment of knee dislocations with up to 10 years of followup, but longer-term studies are uncommon.

Epidemiology of Multiligament Knee Reconstruction

Sean M. Wilson BA, Nabil Mehta BSE, Huong T. Do MA, Hassan Ghomrawi PhD, Stephen Lyman PhD, Robert G. Marx MD, MSc, FRCSC

The multiple-ligament-injured knee represents a special challenge, being an uncommon injury that is both severe and complicated to treat. Many studies have evaluated patients treated for this injury, but most are limited in their scope. The evaluation of this injury and its treatment using an administrative database might provide a different perspective.

Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Trevor R. Born MD, William M. Engasser MD, Alexander H. King, Aaron J. Krych MD, Diane L. Dahm MD, Bruce A. Levy MD, Michael J. Stuart MD

Reconstruction of the multiligament-injured knee often involves extended surgical and tourniquet use times and often is performed in patients who have sustained concomitant fractures as well as vascular injuries, all of which would appear to predispose the patient to the potentially serious complications of deep vein thrombosis and perhaps pulmonary embolism, yet little is known about the frequency of venous thromboembolic (VTE) events after multiligamentous knee reconstruction.

Is Stability of the Proximal Tibiofibular Joint Important in the Multiligament-injured Knee?

Michael Jabara MD, Jeffrey Bradley MD, Michael Merrick MD

The incidence of proximal tibiofibular joint instability in the setting of the multiligament-injured knee has not been previously reported. The integrity of the proximal tibiofibular joint is required to perform a fibular-based, lateral-sided knee reconstruction.

What Is the Frequency of Vascular Injury After Knee Dislocation?

Kyle M. Natsuhara BS, Michael G. Yeranosian MD, Jeremiah R. Cohen BS, Jeffrey C. Wang MD, David R. McAllister MD, Frank A. Petrigliano MD

Vascular injury secondary to an acute knee dislocation is a known complication. However, there exist wide discrepancies in the reported rate of vascular injury in this setting.

A Novel Posteromedial Approach for Tibial Inlay PCL Reconstruction in KDIIIM Injuries: Avoiding Prone Patient Positioning

Dustin Richter MD, Daniel C. Wascher MD, Robert C. Schenck MD

Treatment of traumatic knee dislocations remains controversial and challenging. Current techniques for PCL reconstruction utilize either a transtibial approach with potential risk of vascular injury from drilling toward the popliteal artery or a tibial inlay technique with prone patient positioning, which is cumbersome and adds operative time. We therefore developed a surgical technique using a supine posteromedial approach for PCL tibial inlay reconstruction for the treatment of Schenck KDIIIM (ACL/PCL/medial collateral ligament) knee dislocations. In patients undergoing this technique, we evaluated patient-reported outcome scores, ROM, stability, and complications.

Is Peroneal Nerve Injury Associated With Worse Function After Knee Dislocation?

Aaron J. Krych MD, Steven A. Giuseffi MD, Scott A. Kuzma MD, Michael J. Stuart MD, Bruce A. Levy MD

Peroneal nerve palsy is a frequent and potentially disabling complication of multiligament knee dislocation, but little information exists on the degree to which patients recover motor or sensory function after this injury, and whether having this nerve injury–with or without complete recovery–is a predictor of inferior patient-reported outcome scores.

Posterior Tibial Tendon Transfer Improves Function for Foot Drop After Knee Dislocation

Marius Molund MD, Lars Engebretsen MD, PhD, Kjetil Hvaal MD, PhD, Jan Hellesnes PT, Elisabeth Ellingsen Husebye MD, PhD

Knee dislocation may be associated with an injury to the common peroneal nerve with a subsequent foot drop. Previous studies have demonstrated good functional results after posterior tibial tendon transfer in patients with foot drop. No studies, to our knowledge, have focused exclusively on knee dislocation as the cause of common peroneal nerve injury leading to foot drop.

Vascular and Nerve Injury After Knee Dislocation: A Systematic Review

Omar Medina BS, Gabriel A. Arom BS, Michael G. Yeranosian MD, Frank A. Petrigliano MD, David R. McAllister MD

Vascular injury is a devastating complication of acute knee dislocation. However, there are wide discrepancies in the reported frequency of vascular injury after knee dislocations, as well as important differences among approaches for diagnosis of this potentially limb-threatening problem.

Medial Injury in Knee Dislocations: What Are the Common Injury Patterns and Surgical Outcomes?

Brian C. Werner MD, Michael M. Hadeed BS, F. Winston Gwathmey MD, Cree M. Gaskin MD, Joseph M. Hart PhD, ATC, Mark D. Miller MD

When associated with a knee dislocation, management of the medial ligamentous injury is challenging, with little literature available to guide treatment.

Stress Radiography for the Diagnosis of Knee Ligament Injuries: A Systematic Review

Evan W. James BS, Brady T. Williams BS, Robert F. LaPrade MD, PhD

Stress radiography is a widely used diagnostic tool to assess injury to the anterior and posterior cruciate ligaments and the medial and lateral structures of the knee. However, to date, numerous techniques have been reported in the literature with no clear consensus as to which methodology is best for assessing ligament stability.

The Changing Demographics of Knee Dislocation: A Retrospective Database Review

Gabriel A. Arom BS, Michael G. Yeranosian MD, Frank A. Petrigliano MD, Rodney D. Terrell MD, David R. McAllister MD

Knee dislocations are uncommon but devastating orthopaedic injuries. Little is known about their frequency and the types of patients who are affected.