Ibrahim Samir Abdul Razik, Ahmad Fawzy Hamido F, Salah Mahmoud, Al Misfer Abdul Rahman Khalid, Ghaffer Samy Abdul, Khirat Shrief
Department of Orthopaedics, Ministry of Health, Al-Razi Hospital, Safat, Kuwait.
Arthroscopy. 2008 Feb;24(2):178-87. doi: 10.1016/j.arthro.2007.08.007. Epub 2007 Nov 26.
The purpose of this study was to evaluate our method of surgical treatment of traumatic knee dislocation, by use of a standardized protocol, and to report our clinical results.
Thirty-six consecutive patients presented with a grossly dislocated or reduced knee. Ten of these patients were not included in this series. Five had vascular or neurovascular injury. Three had open fracture dislocation, and two had associated severe injury. The remaining 26 patients were treated by primary arthroscopic reconstruction with autologous grafting of the anterior cruciate ligament, posterior cruciate ligament, and collateral ligaments. The anterior cruciate ligament and posterior cruciate ligament were reconstructed via the gracilis and semitendinosus tendons of the uninjured and injured limbs. The collateral ligaments were reconstructed via artificial ligaments (LARS Ligament; J. K. Orthomedic, Dollard-des-Ormeaux, Quebec, Canada). Of the 26 patients, 20 returned for subjective and objective evaluation at a minimum of 24 months after the operation. Early mobilization via a continuous passive motion machine and active exercise were started on the fourth day postoperatively.
At a mean follow-up of 43 months, the mean Lysholm score was 91 points, the mean score on the survey of daily activities was 90 points, and the sports activities score on the Knee Outcome Survey averaged 86 points. On the basis of the rating of Meyers et al., the results were excellent in 5 patients, good in 12, fair in 2, and poor in 1. The final International Knee Documentation Committee rating was not normal in any knee, nearly normal in 9, abnormal in 9, and severely abnormal in 2. The mean loss of extension was 0 degrees to 2 degrees , and the mean loss of flexion was 10 degrees to 15 degrees .
By use of the described method of arthroscopic-assisted reconstruction of the cruciate ligaments and repair or reconstruction of the collateral ligament and other injured structures, 45% of the patients had good subjective results and functional stability and 45% had satisfactory subjective and functional stability within 2 to 3 weeks after surgery. According to the International Knee Documentation Committee scale, 45% of knees were nearly normal, 45% were abnormal, and 10% were severely abnormal. No patient's rating returned to normal.
Level IV, therapeutic case series.
本研究旨在通过使用标准化方案评估我们对外伤性膝关节脱位的手术治疗方法，并报告我们的临床结果。
36例患者出现膝关节严重脱位或已复位。其中10例患者未纳入本系列。5例有血管或神经血管损伤。3例为开放性骨折脱位，2例伴有严重损伤。其余26例患者接受了一期关节镜下自体移植重建前交叉韧带、后交叉韧带和侧副韧带的手术。前交叉韧带和后交叉韧带通过未受伤和受伤肢体的股薄肌腱和半腱肌腱进行重建。侧副韧带通过人工韧带（LARS韧带；J.K.Orthomedic，加拿大魁北克多拉尔德-德索尔梅奥）进行重建。26例患者中，20例在术后至少24个月返回进行主观和客观评估。术后第四天开始通过持续被动运动机进行早期活动，并进行主动锻炼。
平均随访43个月时，Lysholm平均评分为91分，日常活动调查平均评分为90分，膝关节结果调查的体育活动评分平均为86分。根据迈耶斯等人的评级，结果为优5例，良12例，可2例，差1例。最终国际膝关节文献委员会的评级中，没有一个膝关节正常，接近正常9例，异常9例，严重异常2例。平均伸直丧失为0度至2度，平均屈曲丧失为10度至15度。
通过使用所述的关节镜辅助重建交叉韧带以及修复或重建侧副韧带和其他受损结构的方法，45%的患者在术后2至3周内获得了良好的主观结果和功能稳定性，45%的患者获得了满意的主观和功能稳定性。根据国际膝关节文献委员会的标准，45%的膝关节接近正常，45%异常，10%严重异常。没有患者的评级恢复正常。
IV级，治疗性病例系列。
