Worcestershire Acute Hospitals NHS Trust, Worcester, UK.
Orthopaedic Research Foundation of Western Australia, Australia.
Orthop Traumatol Surg Res. 2022 Dec;108(8):103415. doi: 10.1016/j.otsr.2022.103415. Epub 2022 Sep 17.
Irreducible knee dislocations (IKD) are rare and can often be missed or misdiagnosed. The incidence of knee dislocation is quoted between 0.01% and 0.2% of all orthopaedic injuries, with up to 4% of these dislocations sub-classified as irreducible. The primary aim of this systematic review was to analyse cases of IKD described in the literature, with a secondary aim of producing a streamlined approach for managing these patients.
A systematic review of the literature was conducted on 1st September 2021 in accordance with the PRISMA guidelines using the online databases Medline and EMBASE. The review was registered prospectively in the PROSPERO database. Case reports or clinical studies or reporting on IKD were included. The studies were appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool and Newcastle-Ottawa quality assessment scale.
The search strategy identified 60 studies eligible for inclusion, giving a total of 114 cases of IKD. Posterolateral dislocation was most common, seen in 85% of cases. The dimple sign was present in 70%. All cases required surgical intervention to achieve joint reduction. The most commonly involved structure blocking reduction was the medial collateral ligament (MCL)±medial structures, seen in 52.4%. MCL reconstruction or repair was carried out in 32.3% cases. The overall incidence of neurovascular injury was 9% and the overall complication rate was 14.4%.
Based on the findings of this SR we conclude that: the most common type of IKDs are PL dislocations, and the MCL, medial retinaculum and capsule and vastus medialis oblique form the most common structures involved in block to reduction and often will require open reduction and repair in acute setting if arthroscopic reduction fails. The most common pattern of injury to ligament is likely to be ACL, PCL, MCL±other structures but the MCL will be the most commonly repaired ligament. The dimple sign is often present and is highly pathognomonic of IKD. The incidence of neurovascular injury is uncommon. The most common post-operative complications likely to be encountered is medial skin necrosis and postoperative knee stiffness. Therefore, patients should be mobilised as early as possible with ROM in hinge brace.
IV.
不可复位的膝关节脱位（IKD）较为罕见，常易被漏诊或误诊。膝关节脱位的发生率约占所有骨科损伤的 0.01%至 0.2%，其中高达 4%的脱位可被归类为不可复位。本系统评价的主要目的是分析文献中描述的 IKD 病例，次要目的是为这些患者的治疗制定简化方法。
按照 PRISMA 指南，于 2021 年 9 月 1 日在 Medline 和 EMBASE 在线数据库中进行了系统的文献检索。该研究在 PROSPERO 数据库中进行了前瞻性注册。纳入病例报告或临床研究或报告 IKD 的研究。使用非随机研究方法学指数（MINORS）工具和纽卡斯尔-渥太华质量评估量表对研究进行评估。
检索策略确定了 60 项符合纳入标准的研究，共纳入 114 例 IKD 病例。后外侧脱位最为常见，占 85%。酒窝征的存在率为 70%。所有病例均需手术干预以实现关节复位。最常见的阻碍复位的结构是内侧副韧带（MCL）±内侧结构，占 52.4%。52.4%的病例进行了 MCL 重建或修复。神经血管损伤的总发生率为 9%，总并发症发生率为 14.4%。
基于本系统评价的结果，我们得出以下结论：最常见的 IKD 类型是 PL 脱位，MCL、内侧支持带和囊以及股内侧斜肌是最常见的阻碍复位的结构，在急性情况下如果关节镜复位失败，通常需要切开复位和修复。韧带最常见的损伤模式可能是 ACL、PCL、MCL±其他结构，但 MCL 将是最常修复的韧带。酒窝征通常存在，高度提示 IKD。神经血管损伤并不常见。最常见的术后并发症可能是内侧皮肤坏死和术后膝关节僵硬。因此，患者应尽早进行活动，使用铰链支具进行关节活动度ROM 锻炼。
IV 级。
