Knee joint dislocation: overview and current concepts

Combined articular and ligament reconstructions in neglected fracture-dislocation of the knee

Background

The management of neglected traumatic knee dislocations is challenging and is commonly associated with suboptimal outcomes. In this article we present two cases of neglected knee dislocations in two young trauma victims who presented late due to restrictions during the COVID-19 pandemic.

Methods

Two young patients presented at our center with neglected knee fracture-dislocations after eight weeks and six months of trauma. Comprehensive evaluation was performed using radiographs, computed tomography scans, and magnetic resonance imaging. Surgical intervention included open reduction and internal fixation of the mal-aligned intra-articular fracture fragments. Additionally, articular congruency was restored and repair or reconstruction of the posterior cruciate ligament, anterior cruciate ligament, and meniscus was conducted using suitable tendinous autografts and implants. Following surgery, the knees were immobilized for six weeks, followed by aggressive physical therapy.

Results

After three months of surgical intervention, fracture union and joint stability were achieved. At the >36-month follow-up appointments, both patients were pain-free at rest with a stable knee joint, achieving ≥90 degrees of knee flexion and without extensor deficits. Concurrent with radiographic evidence of osteoarthritic changes in the knee joint, there was mild pain (VAS 2) after prolonged knee movement activities and walking for long distances (>1 km).

Conclusion

Open reduction and internal fixation, along with simultaneous menisco-ligamentous reconstructions in neglected fracture-dislocations of the knee result in satisfactory clinical outcomes. This approach proves to be an effective joint preservation procedure in young patients, even in delayed and neglected conditions.

Knee Dislocation as a Result of a Ski Injury

Visible knee deformity as a result of a sporting activity is rare; however, it can be caused by a serious injury and have catastrophic consequences. Differential diagnosis includes patellofemoral or knee dislocations, fractures, and tendon or ligament ruptures. Immediate diagnosis and appropriate management are key. Diagnosis can be made using available tools such as plain radiography, ultrasound, CT scan, and MRI. Depending on the type and severity of the diagnosis, urgent transportation to a higher level of care facility may be indicated. We present a gentleman in his 20s with knee dislocation as a result of a ski injury. His knee was reduced and he was transported to a hospital with surgical capability. He underwent surgery to stabilize his injury and then staged reconstruction for rupture of multiple ligaments.

The effectiveness of physical therapy in the rehabilitation of patients after arthroscopy of the knee joint

OBJECTIVE

Aim: To determine the effectiveness of physical therapy on the functional state of law enforcement officers' knee joints after surgical intervention.

PATIENTS AND METHODS

Materials and Methods: The research involved law enforcement officers from different units of the National Police of Ukraine (n = 56) who had suffered knee joint injuries in the line of duty, and underwent surgical intervention and rehabilitation procedures.

RESULTS

Results: It was found that 78.2 % of respondents had suffered knee joint ligament injuries as a result of falls during rapid movement, while 43.9 % were in full gear (armored protection, helmet, etc.). It was determined that after surgical intervention, the functional state of the knee joint of law enforcement officers who followed the recommendations of physical therapy specialists and systematically performed special sets of physical exercises was significantly different (p < 0.001). Worse results were noted in people who partially followed the recommendations of rehabilitation therapists and performed part of the prescribed procedures and physical exercises.

CONCLUSION

Conclusions: The effectiveness of the complex use of physical rehabilitation means for restoring the functioning of the knee joint after surgical intervention, which included arthroscopy, partial menisectomy of the damaged areas, debridement, vaporization of damaged cartilage, etc. was revealed. The positive effect of physical exercises on the functional state of the knee joint was proven. The sets of exercises that are advisable to use to restore the functioning of the knee joint were determined.

Two-stage ligament reconstruction with remnant preservation as treatment of knee dislocation

OBJECTIVE

The purpose of this study was to evaluate the clinical outcomes of two-stage reconstruction (peripheral reconstruction in phase I and central anterior cruciate ligament (ACL) / posterior cruciate ligament (PCL) reconstruction in phase II) with remnant preservation for patients with knee dislocation.

METHODS

A total of 70 patients (10 IIIM, 17 IIIL, and 43 IV) with knee dislocation were randomly divided into the remnant-preserved group and the simple reconstruction group. Patients underwent two-stage reconstruction, including the reconstruction of collateral ligament in phase I and the reconstruction of ACL/PCL in phase II (12 weeks after phase I). Grafts were harvested from the semitendinosus and gracilis tendons from both lower limbs. After the surgery, the joint flexion and extension, bone tunnel and ligament healing, and joint stability were evaluated.

RESULTS

After the surgery, the lateral stability recovered in all patients, and X-ray revealed a good position of bone tunnel. Follow-up was performed at 12 months postoperatively and ranged from 24 to 91 months. At the final follow-up, knee flexion angle, IKDC, Lysholm, and Tegner scores were all higher in both groups compared to the preoperative period. Notably, the remnant-preserved group showed superior results in these parameters compared to the simple reconstruction group. There was statistical significance between the two groups in terms of the Lachman test.

CONCLUSION

The knee function was well recovered after two-stage ligament reconstruction with remnant preservation.