Arthroscopy and Knee Preservation Service, Centre for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India.
Department of Orthopaedics, Ramakrishna Ayurvedic Medical College Hospital and Research Centre, Bangalore, Karnataka, India.
J Knee Surg. 2023 Sep;36(11):1116-1124. doi: 10.1055/s-0042-1750062. Epub 2022 Jul 7.
The management of unreduced knee dislocations who present late is challenging. The aim of this study was to determine the clinical, radiological, and functional outcomes following open reduction and reconstructive surgery for chronic irreducible knee dislocations. This retrospective study analyzed prospectively collected data of patients with an unreduced fixed anterior or posterior knee dislocation of 1 to 6 months' duration, treated with open reduction, hinged external fixator application, and ligament reconstruction who had a minimum 2-year follow-up. Patients were classified based on presence of prior periarticular surgery and direction of dislocation. Data on pre- and posttreatment clinical, radiological, and functional scores were analyzed. A total of 21 patients (age range: 19-43 years) fulfilled all inclusion criteria. These included 13 missed dislocations and 8 neglected postoperative dislocations. There were 18 posterior and 3 anterior dislocations. The mean follow-up was 6.9 years (range: 2.7-16.2 years). On final follow-up, all 21 patients were independently ambulatory with mean knee range of motion 127 degrees. No patient had symptomatic knee instability at final follow-up, despite four having isolated grade-III posterior cruciate ligament (PCL) laxity. Anatomical reduction was achieved in 19 patients, whereas 2 patients had incomplete joint reduction with a persistent grade-II fixed posterior subluxation. Scanograms revealed coronal alignment within 5 degrees of the opposite unaffected limb in 17 patients. Mean functional scores improved from preoperative 9.4 ± 4.7 (range: 2-19) to postoperative 75.9 ± 8.0 (range: 64-95) for Lysholm's and preoperative 10.7 ± 1.8 (range: 8.3-13.7) to postoperative 73.5 ± 6.7 (range: 66.7-88.7) for knee injury and osteoarthritis outcome score (KOOS) scores. Prior periarticular surgery was associated with significantly inferior Lysholm's scores ( < 0.04). Although 23.8% knees developed posttraumatic knee arthritis, no patient had undergone conversion to knee arthroplasty or arthrodesis. The study concludes that open reduction and reconstructive surgery is an effective surgical treatment for chronic irreducible knee dislocations of up to 6 months duration. An individualized, often staged approach that prioritizes joint reduction, early knee mobilization, and knee stability, ensures satisfactory clinical, radiological, and functional outcomes in the medium term. This is a clinical case series and reflects level of evidence IV.
对于迟发性未复位膝关节脱位的处理具有挑战性。本研究旨在确定慢性不可复位膝关节脱位患者行切开复位、铰链外固定架应用和韧带重建术后的临床、影像学和功能结果。这项回顾性研究分析了接受切开复位、铰链外固定架应用和韧带重建治疗的 1 至 6 个月持续时间的不可复位固定性膝关节前或后脱位的前瞻性收集数据，这些患者的随访时间至少为 2 年。患者根据是否存在关节周围手术和脱位方向进行分类。分析了治疗前后的临床、影像学和功能评分数据。21 名患者（年龄 19-43 岁）符合所有纳入标准。其中 13 例为漏诊脱位，8 例为术后未复位脱位。有 18 例为后脱位，3 例为前脱位。平均随访时间为 6.9 年（范围：2.7-16.2 年）。末次随访时，所有 21 例患者均能独立行走，平均膝关节活动度为 127 度。尽管有 4 例患者存在孤立性 III 级后十字韧带（PCL）松弛，但末次随访时无患者出现有症状的膝关节不稳定。19 例患者达到解剖复位，2 例患者存在关节复位不完全，持续存在 II 级固定性后脱位。扫描显示 17 例患者冠状面对线在对侧未受累肢体的 5 度以内。Lysholm 评分从术前的 9.4±4.7（范围：2-19）改善到术后的 75.9±8.0（范围：64-95），膝关节损伤和骨关节炎结果评分（KOOS）从术前的 10.7±1.8（范围：8.3-13.7）改善到术后的 73.5±6.7（范围：66.7-88.7）。关节周围手术与 Lysholm 评分显著降低相关（ < 0.04）。尽管 23.8%的膝关节发生创伤后膝关节关节炎，但无患者需要进行膝关节置换或关节融合术。本研究得出结论，切开复位和重建手术是治疗 6 个月内慢性不可复位膝关节脱位的有效手术治疗方法。个体化、通常分期的方法优先考虑关节复位、早期膝关节活动度和膝关节稳定性，可确保中期获得满意的临床、影像学和功能结果。这是一项临床病例系列研究，反映了证据等级 IV。
