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Long-term followup of surgically treated knee dislocations: stability restored, but arthritis is common.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Fanelli, Gregory C. Sousa, Paul L. Edson, Craig J.
Spatial Coverage	United States
Description	Author Affiliation: Fanelli GC ( Department of Orthopaedic Surgery, Sports Medicine and Arthroscopy, Geisinger Orthopaedics, Geisinger Medical Center, 115 Woodbine Lane, Danville, PA, 17822-5212, USA, gregorycfanelli@gmail.com.)
Abstract	BACKGROUND: 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. QUESTIONS/PURPOSES: We evaluated patients treated surgically for knee dislocations at 10-year followup to assess (1) knee stability; (2) return to preinjury level of function; (3) development of arthrosis; and (4) range of motion (ROM) loss. METHODS: This study was a retrospective review of 127 combined PCL, ACL, and medial and/or lateral side reconstructions performed by a single surgeon (GCF) between 1990 and 2008. Of these, 44 were available for clinical and functional evaluation (35%) at a minimum 5-year followup. Inclusion criteria were combined PCL/ACL plus medial and/or lateral side reconstruction. Evaluation methods included arthrometer measurements, stress radiography, knee ligament rating and activity scales (Lysholm and Tegner), plain radiographs with osteoarthritic assessment, and physical examination. RESULTS: Of the 44 patients, there were nine ACL/PCL medial, 22 ACL/PCL lateral, and 13 ACL/PCL mediolateral reconstructions. Followup was at a minimum of 5 years (mean, 10 years; range, 5-22 years). The mean age at the time of injury was 31 years with a range of 13 to 65 years. The mean arthrometer-measured side-to-side differences were as follows: PCL screen, 1.9 mm; corrected posterior, 2.4 mm; corrected anterior, 0.8 mm; and anterior displacement at 30° of knee flexion, 1.7 mm. Stress radiographic measurements at 90° of knee flexion revealed a mean side-to-side difference of 1.9 mm. Mean Lysholm, and Tegner scores were 84 of 100 and 4.1 of 9, respectively. Ninety-three percent (41 of 44) of patients returned to their preinjury level of activity or one Tegner grade lower. Ten of the 44 knees (23%) developed degenerative joint disease. The mean flexion loss was 12.5°, and flexion contractures were not seen in any of the patients. CONCLUSIONS: We found that a high proportion of patients treated for these severe injuries achieved static and functional stability, allowing the return to physically demanding work and recreational activities, but that nearly one-fourth of them will develop arthritis at a mean of 10 years. We cannot extrapolate our results to an elite athlete population, but our results probably apply well to working class populations. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
File Format	HTM / HTML
ISSN	0009921X
e-ISSN	15281132
DOI	10.1007/s11999-014-3707-6
Journal	Clinical Orthopaedics and Related Researchtextregistered
Issue Number	9
Volume Number	472
Language	English
Publisher	Springer
Publisher Date	2014-09-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Orthopaedics Knee Dislocation Surgery Knee Joint Physiopathology Orthopedic Procedures Osteoarthritis, Knee Etiology Range Of Motion, Articular Physiology Recovery Of Function Adolescent Complications Epidemiology Prognosis Reconstructive Surgical Procedures Risk Factors Time Factors
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Surgery Sports Science

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