High-energy bilateral knee dislocations in a young man: a case report

Bilateral Knee Dislocations in an Active Duty Service Member: A Case Report

This case highlights a staged operative approach for a patient who sustained bilateral knee dislocations and subsequent staged operative treatment and rehabilitation. This patient underwent bilateral multiligamentous knee reconstructions and left-sided peroneal nerve allografting because of complete peroneal nerve palsy. The initial treatment was bilateral medial collateral ligament reconstructions, posterolateral corner reconstructions, and capsular repairs with left leg peroneal nerve allografting and repair of avulsed biceps femoris tendon. The patient underwent physical therapy following the first stage procedure until he regained appropriate motion and soft tissue healing occurred. Subsequently, combined anterior cruciate and posterior cruciate ligament reconstructions were performed in a staged fashion to allow one leg to fully bear weight for rehabilitation purposes. With the help of a multidisciplinary surgical and rehabilitation team, the patient has regained the stability of his knees and achieved acceptable functional outcomes. A staged systematic approach to multiligamentous bilateral knee reconstruction can provide optimal pain management, obtain initial joint stability, minimize complications, and achieve acceptable functional outcomes. Surgical techniques to first restore medial and lateral structures can be utilized to provide initial valgus and varus stability while allowing for knee mobilization and, eventually, in-line ambulation, before staged anterior and posterior cruciate ligament reconstructions. This case demonstrates a multistaged approach to bilateral knee dislocations with favorable outcomes in a 23-year-old active duty patient.

Acute Femoropopliteal Bypass Graft Occlusion After Knee Manipulation Under Anesthesia: A Case Report and Review of Current Literature

Bilateral tibiofemoral knee dislocations are a relatively rare injury, and there is a scarcity of literature on its appropriate evaluation and treatment. Even less knee dislocations with concomitant popliteal artery injury have been described. Postoperative graft occlusion accounts for approximately half of the overall complication rate, occurring in up to 18% of the patients undergoing femoropopliteal bypass grafting. Furthermore, anticoagulation and antiplatelet therapy after graft placement is a point of contention. Here, we describe a case of a knee dislocation with associated popliteal artery transection treated initially with successful knee-spanning external fixation and arterial grafting, respectively. At 6 weeks after injury, the patient underwent external fixation removal and closed manipulation of the knee for arthrofibrosis. After manipulation, yet still under anesthesia, distal pulses were acutely diminished and subsequent CTA demonstrated femoropopliteal graft thrombosis. This case demonstrates successful recognition, thrombectomy, and restoration of arterial blood flow, which has since been maintained. Written consent by the patient involved in this case report was obtained.

Bilateral Knee Dislocations Treated with Acute, Single-Stage Multiligament Reconstructions

Bilateral knee dislocations are exceedingly rare in orthopaedics. Managing these injuries presents a difficult task given their high complication rate and guarded prognosis. We report the case of a 21-year-old male who presented to our institution with bilateral knee dislocations sustained in a motor vehicle collision. The patient subsequently underwent multiligament knee reconstruction surgeries for each knee at one and three weeks following the initial injury. At one-year follow-up, the patient has achieved a successful outcome and has returned to regular activities which include hiking and exercising at the gym.

Simultaneous Bilateral Knee Dislocation During Weight Training: A Case Report and Review of the Literature

CASE

We describe the clinical course and treatment of a patient who sustained simultaneous bilateral knee dislocation under low-velocity atraumatic conditions, and provide a review of the literature. Dislocations of the native knee joint are uncommon orthopaedic injuries but they are true emergencies because of the concern for concomitant neurovascular injury; therefore, they may be limb-threatening injuries.

CONCLUSION

To our knowledge, there are few reports of simultaneous bilateral knee dislocation and no reports of this occurring during weight training. The risk of knee dislocation can be reduced by avoiding locking and hyperextension of the knees during any type of leg press or squatting exercise.

Bilateral Multiligamentous Knee Injuries: A Case Report and Technique Review

Bilateral knee dislocations are rare musculoskeletal injuries. We report a case of a patient who sustained traumatic bilateral knee dislocations resulting in multiligamentous injuries to both knees. The patient subsequently underwent acute ligamentous reconstructions of both knees performed at 2 weeks and 3 weeks after the initial injury. One year after these procedures, the patient has achieved excellent functional outcomes and has returned to recreational sports.

Simultaneous bilateral multiligamentous knee injuries are associated with more severe multisystem trauma compared to unilateral injuries

PURPOSE

To compare the knee ligamentous injury patterns and associated multisystem trauma in patients who have sustained simultaneous bilateral knee multiligamentous injuries (MLI) to patients with unilateral MLIs.

METHODS

Patients with simultaneous bilateral and unilateral knee MLIs after motor vehicle accidents were identified from 2007 to 2014 at a single institution. Chart and radiographic reviews were performed to identify patient demographics, extremity fractures and associated head, thoracic, abdominal and spine injuries. The MLIs were characterized by ligamentous injury pattern and associated neurovascular deficits. Injury Severity Score (ISS) and New ISS (NISS) were calculated.

RESULTS

Seven bilateral MLIs and 32 unilateral MLIs were identified. Between the cohorts, there were no significant differences in ligamentous injury pattern or associated neurovascular injuries. For the bilateral MLI cohorts, 71.4 % of patients sustained chest trauma, 57.1 % abdominal trauma, 57.1 % at least a single-level spine injury and 28.6 % head trauma. The ISS was 33.4 ± 23.4 with patients spending an average of 12.4 days in the intensive care unit. Other than the number of days in the ICU, these values were all significantly higher than those of the unilateral knee MLI cohort. Additionally, there was a significantly higher post-operative complication rate in the bilateral MLI cohort (71.4 vs. 6.3 %, P < 0.0001).

CONCLUSION

Compared to unilateral MLIs with similar mechanisms, patients with traumatic simultaneous bilateral knee multiligamentous knee injuries are at high risk of concomitant head, chest and abdominal injuries. Although the ligament injury profile is similar, the post-operative complication rate is higher for simultaneous bilateral injuries.

LEVEL OF EVIDENCE

Case control study, Level III.