EFFECTIVENESS OF ONE-STAGE REPAIR AND RECONSTRUCTION FOR KNEE DISLOCATION WITH MULTIPLE LIGAMENT INJURIES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUNZhengyu , ZHANGChenghao , TANGXin , CHENGang ,  LIJian

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

LIJian, Email: hxlijian.china@163.com

Keywords：

Knee dislocation; Multiple ligament injuries; Avulsion injury; Repair and reconstruction; Arthroscopy

DOI：

10.7507/1002-1892.20160140

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the surgical procedure and short-term effectiveness of one-stage repair and reconstruction of knee dislocation with multiple ligament injuries (KDMLI). Methods Between September 2010 and April 2014, 9 cases (9 knees) of KDMLI were treated. There were 7 males and 2 females with an average age of 42 years (range, 27-57 years). Injury was caused by traffic accident in 3 cases, heavy-weight crushing in 3 cases, sports sprain in 2 cases, and falling from height in 1 case. The average time from injury to operation was 11 days (range, 3-19 days). The results of posterior drawer test and Lachman test were positive in all patients. The results of varus stress testing were three-degree positive in 4 cases, and the results of valgus stress testing were three-degree positive in 6 cases. The Lysholm score of knee was 27.2±6.3; the International Knee Documentation Committee (IKDC) score was 29.7±6.5; and the range of motion (ROM) was (52.6±12.8)°. All patients suffered from posterior cruciate ligament (PCL) injury and femoral avulsion injury of anterior cruciate ligament (ACL). Combined injuries included medial collateral ligament (MCL) injury in 4 cases (medial meniscus injury in 1 case), lateral collateral ligament (LCL) injury in 2 cases, and MCL and LCL injuries in 2 cases (medial meniscus and lateral meniscus injuries in 1 case). Autologous harmstring tendon was used to reconstruct PCL under arthroscopy combined with limited open in situ suture for repair of femoral avulsion injury of ACL, and repair of MCL, LCL, and other injury in one-stage operation. Results All incisions healed by first intention. Joint effusion of knee occurred in 1 case and was cured after removal of fluid combined with pressure bandage. All patients were followed up 12-36 months with an average of 22 months. At last follow-up, the result of posterior drawer test was negative in all patients. The results of Lachman test were one-degree positive in 2 cases; the result of varus stress testing was one-degree positive in 1 case; the results of valgus stress testing were one-degree positive in 2 cases; and flexion dysfunction of the knee was observed in 1 case. The Lysholm score of knee was 87.3±6.6; the IKDC score was 88.9±6.8; and the ROM was (121.7±12.3)°, all showing significant differences when compared with preoperative ones (t=44.246, P=0.000; t=37.903, P=0.000; t=19.894, P=0.000). Conclusion For KDMLI, one-stage repair and reconstruction using autologous harmstring tendon to reconst ruct PCL under arthroscopy combined with limited open in situ suture repair of femoral avulsion injury of ACL, and repair MCL, LCL, and other injury has such advantages as minimal invasiveness, reliable fixation, less complications, and fast recovery, which can significantly improve the stability, ROM, and function of knee and obtain good short-term effectiveness.

Citation： SUNZhengyu, ZHANGChenghao, TANGXin, CHENGang, LIJian. EFFECTIVENESS OF ONE-STAGE REPAIR AND RECONSTRUCTION FOR KNEE DISLOCATION WITH MULTIPLE LIGAMENT INJURIES. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(6): 690-694. doi: 10.7507/1002-1892.20160140 Copy

1.	Howells NR, Brunton LR, Robinson J, et al. Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee. Injury, 2011, 42(11): 1198-1204.
2.	McKee L, Ibrahim MS, Lawrence T, et al. Current concepts in acute knee dislocation. The missed diagnosis? Open Orthop J, 2014, 8(Suppl 1: M5): 162-167.
3.	Lachman JR, Rehman S, Pipitone PS. Traumatic knee dislocations: evaluation, management, and surgical treatment. Orthop Clin North Am, 2015, 46(4): 479-493.
4.	Krackow KA, Thomas SC, Jones LC. Ligament-tendon fixation: analysis of a new stitch and comparison with standard techniques. Orthopedics, 1988, 11(6): 909-917.
5.	Fanelli GC, Orcutt DR, Edson CJ. The multiple-ligament injured knee: evaluation, treatment, and results. Arthroscopy, 2005, 21(4): 471-486.
6.	Wong CH, Tan JL, Chang HC, et al. Knee dislocations-a retrospective study comparing operative versus closed immobilization treatment outcomes. Knee Surg Sports Traumatol Arthrosc, 2004, 12(6): 540-544.
7.	Levy BA, Dajani KA, Whelan DB, et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy, 2009, 25(4): 430-438.
8.	Peskun CJ, Whelan DB. Outcomes of operative and nonoperative treatment of multiligament knee injuries: an evidence-based review. Sports Med Arthrosc, 2011, 19(2): 167-173.
9.	Harner CD, Waltrip RL, Bennett CH, et al. Surgical management of knee dislocations. J Bone Joint Surg (Am), 2004, 86-A(2): 262-273.
10.	Fanelli GC. Multiple ligament-injured (dislocated) knee. Sports Med Arthrosc, 2011, 19(2): 81.
11.	Khakha RS, Day AC, Gibbs J, et al. Acute surgical management of traumatic knee dislocations—Average follow-up of 10 years. Knee, 2016, 23(2): 267-275.
12.	Wilson SM, Mehta N, Do HT, et al. Epidemiology of multiligament knee reconstruction. Clin Orthop Relat Res, 2014, 472(9): 2603-2608.
13.	Owens BD, Neault M, Benson E, et al. Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years. J Orthop Trauma, 2007, 21(2): 92-96.
14.	Bin SI, Nam TS. Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation. Arthroscopy, 2007, 23(10): 1066-1072.
15.	Kohl S, Stock A, Ahmad SS, et al. Dynamic intraligamentary stabilization and primary repair: a new concept for the treatment of knee dislocation. Injury, 2015, 46(4): 724-728.
16.	陈平泉, 朱振康, 王胜. 膝前、后交叉韧带与内侧副韧带损伤的一期修复重建. 中国修复重建外科杂志, 2012, 26(6): 675-678.
17.	Engebretsen L, Risberg MA, Robertson B, et al. Outcome after knee dislocations: a 2-9 years follow-up of 85 consecutive patients. Knee Surg Sports Traumatol Arthrosc, 2009, 17(9): 1013-1026.
18.	Sillanpää PJ, Kannus P, Niemi ST, et al. Incidence of knee dislocation and concomitant vascular injury requiring surgery: a nationwide study. J Trauma Acute Care Surg, 2014, 76(3): 715-719.
19.	Mook WR, Ligh CA, Moorman CT 3rd, et al. Nerve injury complicating multiligament knee injury: current concepts and treatment algorithm. J Am Acad Orthop Sur, 2013, 21(6): 343-354.
20.	Edson CJ, Fanelli GC, Beck JD. Rehabilitation after multiple-ligament reconstruction of the knee. Sports Med Arthrosc, 2011, 19(2): 162-166.
21.	Chhabra A, Cha PS, Rihn JA, et al. Surgical management of knee dislocations. Surgical technique. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 1): 1-21.

1. Howells NR, Brunton LR, Robinson J, et al. Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee. Injury, 2011, 42(11): 1198-1204.
2. McKee L, Ibrahim MS, Lawrence T, et al. Current concepts in acute knee dislocation. The missed diagnosis? Open Orthop J, 2014, 8(Suppl 1: M5): 162-167.
3. Lachman JR, Rehman S, Pipitone PS. Traumatic knee dislocations: evaluation, management, and surgical treatment. Orthop Clin North Am, 2015, 46(4): 479-493.
4. Krackow KA, Thomas SC, Jones LC. Ligament-tendon fixation: analysis of a new stitch and comparison with standard techniques. Orthopedics, 1988, 11(6): 909-917.
5. Fanelli GC, Orcutt DR, Edson CJ. The multiple-ligament injured knee: evaluation, treatment, and results. Arthroscopy, 2005, 21(4): 471-486.
6. Wong CH, Tan JL, Chang HC, et al. Knee dislocations-a retrospective study comparing operative versus closed immobilization treatment outcomes. Knee Surg Sports Traumatol Arthrosc, 2004, 12(6): 540-544.
7. Levy BA, Dajani KA, Whelan DB, et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy, 2009, 25(4): 430-438.
8. Peskun CJ, Whelan DB. Outcomes of operative and nonoperative treatment of multiligament knee injuries: an evidence-based review. Sports Med Arthrosc, 2011, 19(2): 167-173.
9. Harner CD, Waltrip RL, Bennett CH, et al. Surgical management of knee dislocations. J Bone Joint Surg (Am), 2004, 86-A(2): 262-273.
10. Fanelli GC. Multiple ligament-injured (dislocated) knee. Sports Med Arthrosc, 2011, 19(2): 81.
11. Khakha RS, Day AC, Gibbs J, et al. Acute surgical management of traumatic knee dislocations—Average follow-up of 10 years. Knee, 2016, 23(2): 267-275.
12. Wilson SM, Mehta N, Do HT, et al. Epidemiology of multiligament knee reconstruction. Clin Orthop Relat Res, 2014, 472(9): 2603-2608.
13. Owens BD, Neault M, Benson E, et al. Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years. J Orthop Trauma, 2007, 21(2): 92-96.
14. Bin SI, Nam TS. Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation. Arthroscopy, 2007, 23(10): 1066-1072.
15. Kohl S, Stock A, Ahmad SS, et al. Dynamic intraligamentary stabilization and primary repair: a new concept for the treatment of knee dislocation. Injury, 2015, 46(4): 724-728.
16. 陈平泉, 朱振康, 王胜. 膝前、后交叉韧带与内侧副韧带损伤的一期修复重建. 中国修复重建外科杂志, 2012, 26(6): 675-678.
17. Engebretsen L, Risberg MA, Robertson B, et al. Outcome after knee dislocations: a 2-9 years follow-up of 85 consecutive patients. Knee Surg Sports Traumatol Arthrosc, 2009, 17(9): 1013-1026.
18. Sillanpää PJ, Kannus P, Niemi ST, et al. Incidence of knee dislocation and concomitant vascular injury requiring surgery: a nationwide study. J Trauma Acute Care Surg, 2014, 76(3): 715-719.
19. Mook WR, Ligh CA, Moorman CT 3rd, et al. Nerve injury complicating multiligament knee injury: current concepts and treatment algorithm. J Am Acad Orthop Sur, 2013, 21(6): 343-354.
20. Edson CJ, Fanelli GC, Beck JD. Rehabilitation after multiple-ligament reconstruction of the knee. Sports Med Arthrosc, 2011, 19(2): 162-166.
21. Chhabra A, Cha PS, Rihn JA, et al. Surgical management of knee dislocations. Surgical technique. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 1): 1-21.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF ONE-STAGE REPAIR AND RECONSTRUCTION FOR KNEE DISLOCATION WITH MULTIPLE LIGAMENT INJURIES

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content