Sisto D J, Warren R F
Clin Orthop Relat Res. 1985 Sep(198):94-101.
Twenty knee dislocations in 19 patients (one bilateral) occurred over a period of 20 years. The age range was 21 to 65 years, with an average age of 40.8 years. There were two popliteal artery and eight peroneal nerve injuries in the group. All patients were managed by early closed reduction at the scene of the accident or at the admitting hospital. Treatment consisted of 13 acute arthrotomies with complete ligamentous repair, one partial ligament repair, two delayed repairs, and four cast applications. Both anterior and posterior cruciate ligaments were torn in each knee surgically examined. In contrast to cruciate injuries in nondislocated knees, avulsion of bone of the PCL was present in 14 of 16 and of the ACL in ten of 16. Complete follow-up study including examination and radiographic evaluation was obtained on 18 knees in 17 patients. Special investigations of 13 with acute complete ligament repair, followed from 12 months to 48 months (average of 24 months), showed loss of joint motion following this injury. Clinical instability was generally not a problem, but chronic pain and discomfort were present in 46%. The average knee diagnostic score was 43. Seventy-seven percent of the patients returned to vigorous sports activities. Early operative repair followed by cast bracing and manipulation at three months (if flexion was less than 90 degrees) is recommended in young, active patients.
在20年的时间里，19名患者（其中1例为双侧）共发生了20次膝关节脱位。年龄范围为21至65岁，平均年龄为40.8岁。该组中有2例腘动脉损伤和8例腓总神经损伤。所有患者均在事故现场或收治医院进行了早期闭合复位。治疗包括13例急性关节切开术并进行完全韧带修复、1例部分韧带修复、2例延迟修复以及4例应用石膏固定。在每例接受手术检查的膝关节中，前后交叉韧带均有撕裂。与非脱位膝关节的交叉韧带损伤不同，16例中有14例后交叉韧带附着处有骨撕脱，16例中有10例前交叉韧带附着处有骨撕脱。对17例患者的18个膝关节进行了包括检查和影像学评估在内的完整随访研究。对13例进行急性完全韧带修复的患者进行了特殊检查，随访时间为12个月至48个月（平均24个月），结果显示该损伤后关节活动度丧失。临床不稳定一般不是问题，但46%的患者存在慢性疼痛和不适。膝关节诊断平均评分为43分。77%的患者恢复了剧烈的体育活动。对于年轻、活跃的患者，建议早期进行手术修复，随后在三个月时应用石膏支具并进行手法治疗（如果屈曲度小于90度）。
