Smith John-Rudolph H, Belk John W, Friedman Jamie L, Dragoo Jason L, Frank Rachel M, Bravman Jonathan T, Wolcott Michelle L, McCarty Eric C
Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado.
J Knee Surg. 2022 Oct;35(12):1333-1341. doi: 10.1055/s-0041-1723762. Epub 2021 Feb 5.
Knee dislocations (KDs) are devastating injuries for patients and present complex challenges for orthopaedic surgeons. Although short-term outcomes have been studied, there are few long-term outcomes of these injuries available in the literature. The purpose of this study is to determine factors that influence mid- to long-term clinical outcomes following surgical treatment of KD. A review of the current literature was performed by searching PubMed, the Cochrane Library, and Embase to identify clinical studies published from 2010 to 2019 with a minimum 2-year follow-up that reported outcomes following surgical treatment of KDs. Ten studies (6 level III, 4 level IV) were included. At mid- (2-10 y) to long-term (>10 y) follow-up, concomitant arterial, cartilage, and combined meniscus damage were predictive factors for inferior Lysholm and International Knee Documentation Committee (IKDC) scores when compared with patients without these associated injuries. Although concomitant neurological damage may influence short-term outcomes due to decreased mobility, at longer follow-up periods it does not appear to predict worse clinical outcomes when compared with patients without concomitant neurological injury. Frank and polytrauma KDs have been associated with worse mid- to long-term outcomes when compared with transient and isolated KDs. Patients who underwent surgery within 6 weeks of trauma experienced better long-term outcomes than those who underwent surgery longer than 6 weeks after the initial injury. However, the small sample size of this study makes it difficult to make valid recommendations. Lastly, female sex, patients older than 30 years at the time of injury and a body mass index (BMI) greater than 35 kg/m are factors that have been associated with worse mid- to long-term Lysholm and IKDC scores. The results of this review suggest that female sex, age >30 years, BMI >35 kg/m, concomitant cartilage damage, combined medial and lateral meniscal damage, KDs that do not spontaneously relocate, and KDs associated with polytrauma may predict worse results at mid- to long-term follow-up.
膝关节脱位（KDs）对患者来说是极具破坏性的损伤，给骨科医生带来了复杂的挑战。尽管已有对短期结果的研究，但文献中关于这些损伤的长期结果却很少。本研究的目的是确定影响KD手术治疗后中长期临床结果的因素。通过检索PubMed、Cochrane图书馆和Embase对当前文献进行综述，以识别2010年至2019年发表的临床研究，这些研究至少有2年的随访，报告了KD手术治疗后的结果。纳入了10项研究（6项III级，4项IV级）。在中期（2 - 10年）至长期（>10年）随访中，与没有这些相关损伤的患者相比，合并动脉、软骨以及半月板联合损伤是Lysholm评分和国际膝关节文献委员会（IKDC）评分较低的预测因素。尽管合并神经损伤可能因活动能力下降而影响短期结果，但与没有合并神经损伤的患者相比，在更长的随访期内，它似乎并不能预测更差的临床结果。与短暂性和孤立性KD相比，开放性和多发伤性KD与更差的中长期结果相关。创伤后6周内接受手术的患者比初次受伤6周后接受手术的患者有更好的长期结果。然而，本研究的样本量较小，难以提出有效的建议。最后，女性、受伤时年龄大于30岁以及体重指数（BMI）大于35kg/m²是与更差的中长期Lysholm和IKDC评分相关的因素。本综述结果表明，女性、年龄>30岁、BMI>35kg/m²、合并软骨损伤、内外侧半月板联合损伤、不能自发复位的KD以及与多发伤相关的KD可能在中长期随访中预测更差的结果。
