Dislocation and bicruciate lesions of the knee: epidemiology and acute stage assessment in a prospective series.

INTRODUCTION

Knee dislocation and bicruciate lesions are rare. Assessments of results from retrospective series carry an insufficient level of evidence. A prospective multicenter study was therefore set up, under the auspices of the French Society of Orthopedic Surgery.

MATERIAL AND METHODS

The inclusion period covered the whole of 2007. Clinical, imaging (dynamic X-ray and MRI) and vascular (angioscan and arteriography) assessment was performed systematically. In patients over the age of 60 years, ligament lesions were always managed non-surgically; in those under the age of 60 years, surgery was considered in the absence of associated vascular lesion or open dislocation and if there was frontal laxity exceeding 15 degrees or a posterior drawer test greater than 10mm. The posterior cruciate ligament (PCL) and peripheral ligament tears were repaired or reinforced under arthroscopy or by arthrotomy. The anterior cruciate ligament was never operated on. In all other cases, management was conservative.

RESULTS

Sixty-seven knees were included (55 male, 11 female; mean age: 37 years). Fifteen patients (25.4%) had bicruciate lesion, and 44 (74.6%) knee dislocation. Mean trauma-to-reduction interval was 3 hrs 50 min. Only one of the nine cases of popliteal artery lesion exhibited discernible distal pulse wave. Only three of these patients underwent vascular surgical repair. Twelve knees (five bicruciate lesions, seven dislocations) had isolated common peroneal nerve damage.

DISCUSSION

This prospective study detailed the epidemiology and treatment of the lesions encountered, with the option of PCL and peripheral ligament reconstruction. The results, however, still require long-term analysis.