Sports Medicine and Sports Traumatology, Argon Orthopedics, Hamburg, Germany.
Division for Sports Orthopedics, ENDO-Klinik, Hamburg, Germany.
Knee Surg Sports Traumatol Arthrosc. 2019 Aug;27(8):2710-2718. doi: 10.1007/s00167-018-5317-4. Epub 2019 Jan 11.
The literature shows no consensus regarding the best method and timing for the treatment of acute knee dislocations. Studies indicate that a one-stage procedure performed in the early stages of injury can lead to superior results. The aim of this study was to evaluate the results after performing early surgical repair with additional suture augmentation (ligament bracing) of all torn ligaments in acute knee dislocations.
In this prospective multicentre study, 73 patients with an acute type III or IV knee dislocation were treated with one-stage ligament bracing within 10 days. Twenty-six patients sustained a type III medial dislocation, thirty-nine patients sustained a type III lateral dislocation, and eight patients presented a type IV dislocation. Four patients were lost to follow-up. Within the follow-up evaluation, various scores were collected (International Knee Documentation Committee IKDC Score, Tegner Score and Lysholm Score). Additional stress radiography was performed (Telos™) postoperatively.
Sixty-nine knee dislocations (Schenck III and IV) with a follow-up at a mean of 14 ± 1.6 months were evaluated. The average IKDC score was 75.5 ± 14.5, the average Lysholm score was 81.0 ± 15.5, and the median loss of activity in the Tegner score was 1 (range 0-3) point. Stress radiographs showed side-to-side differences at a mean of 3.2 ± 1.3 mm for the anterior cruciate ligament (ACL) and of 2.9 ± 2.1 mm for the posterior cruciate ligament (PCL). The operative revision rate (early and late) was 17.4%. In the early stage, one wound infection and one case of transient common peroneal nerve (CPN) paresis were successfully revised. In the later stage, four patients with knee stiffness and six cases with symptomatic knee instability needed reoperation. Patients without ultra-low velocity (ULV) dislocations or CPN showed good or excellent results in 87.5% according to the Lysholm score.
In cases of acute knee dislocation, primary ACL and PCL transosseous sutures with additional suture augmentation predominantly lead to good and excellent clinical results. Obese patients sustaining ultra-low velocity (ULV) dislocations and patients following injury to the CPN show inferior outcomes. In patients without ULV and CPN intraoperative and postoperative complications occurred in 10.1%. The obtained results and revision rates show that early primary suture repair is a promising option.
Prospective multicentre study, II.
文献中对于急性膝关节脱位的最佳治疗方法和时机尚无共识。研究表明，在受伤早期进行的一期手术可以获得更好的效果。本研究旨在评估急性膝关节脱位患者行早期手术修复并额外进行所有撕裂韧带缝合增强（韧带支撑）的效果。
在这项前瞻性多中心研究中，73 例急性 III 或 IV 型膝关节脱位患者在伤后 10 天内进行一期韧带支撑。26 例患者发生内侧 III 型脱位，39 例患者发生外侧 III 型脱位，8 例患者发生 IV 型脱位。4 例患者失访。在随访评估中，收集了各种评分（国际膝关节文献委员会 IKDC 评分、Tegner 评分和 Lysholm 评分）。术后还进行了额外的应力放射照相（Telos）。
对 69 例（Schenck III 和 IV 型）膝关节脱位患者进行了平均 14 ± 1.6 个月的随访评估。平均 IKDC 评分为 75.5 ± 14.5，平均 Lysholm 评分为 81.0 ± 15.5，Tegner 评分中活动丧失的中位数为 1 分（范围 0-3 分）。应力放射照相显示，前交叉韧带（ACL）的侧-侧差异平均为 3.2 ± 1.3 毫米，后交叉韧带（PCL）的侧-侧差异平均为 2.9 ± 2.1 毫米。（早期和晚期）手术翻修率为 17.4%。早期有 1 例伤口感染和 1 例暂时性腓总神经（CPN）麻痹成功翻修。晚期有 4 例膝关节僵硬和 6 例膝关节不稳定症状需要再次手术。无超低速度（ULV）脱位或 CPN 的患者根据 Lysholm 评分，87.5%的患者结果为优或良。
对于急性膝关节脱位，一期 ACL 和 PCL 经皮缝线加额外缝线增强主要可获得良好和优秀的临床效果。肥胖患者发生超低速度（ULV）脱位和 CPN 损伤的患者预后较差。无 ULV 和 CPN 的患者术中术后并发症发生率为 10.1%。获得的结果和翻修率表明，早期一期缝合修复是一种有前途的选择。
前瞻性多中心研究，II 级。
