Korthaus Alexander, Marx Paul, Braun Philipp-Johannes, Colcuc Sebastian, Behrendt Peter, Hoffmann Michael, Drenck Tobias, Akoto Ralph, Frosch Karl-Heinz, Schoepp Christian, Krause Matthias
Department of Trauma Surgery and Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany.
Orthop J Sports Med. 2025 May 29;13(5):23259671251338795. doi: 10.1177/23259671251338795. eCollection 2025 May.
Acute knee dislocations are devastating injuries that can be challenging for surgeons to treat. The bony integrity of the tibial plateau and the lateral femoral condyle has a fundamental meaning for translational and rotational knee joint stability. Posterolateral tibial plateau depression fractures (PLTPFs) and lateral femoral condyle impaction fractures (LFCIFs) can influence clinical outcomes, but their frequency and characteristics in the setting of acute knee dislocations are unknown.
To report the incidence of PLTPFs and LFCIFs in acute knee dislocations as well as to describe concomitant soft tissue lesions associated with these bony injuries.
Cross-sectional study; Level of evidence, 3.
In this retrospective multicenter study, acute knee dislocations (at least bicruciate ligament injuries) were identified from hospital information systems based on diagnosis-related group coding as well as operation and procedure classification coding at 5 participating level 1 trauma centers from 2018 to 2022. The knee dislocations were categorized according to the Schenck classification. Soft tissue injuries were assessed on magnetic resonance imaging within 2 weeks of the trauma. PLTPFs and LFCIFs were categorized on magnetic resonance imaging and computed tomography according to the Menzdorf and Bernholt classifications.
A total of 157 knee dislocations were identified, comprising 106 men and 51 women with a mean age of 39.3 ± 15.1 years. A PLTPF was detected in 42 (26.8%) knee dislocations, with the highest frequency in Schenck type III medial dislocations. Of these 42 cases, 26 (61.9%) PLTPFs were rated as high-grade fractures, theoretically requiring reduction and fixation. An LFCIF was found in 31 (19.7%) of the cases.
A PLTPF was observed in one-quarter, and an LFCIF in one-fifth, of acute knee dislocations. They occurred particularly in knee dislocations with medial collateral ligament ruptures. Almost two-thirds of all PLTPFs presented as high-grade fractures according to the Menzdorf or Bernholt classification, potentially requiring a surgical intervention.
急性膝关节脱位是严重的损伤，对外科医生的治疗具有挑战性。胫骨平台和外侧股骨髁的骨质完整性对膝关节的平移和旋转稳定性具有重要意义。胫骨平台后外侧凹陷骨折（PLTPF）和外侧股骨髁撞击骨折（LFCIF）会影响临床结果，但它们在急性膝关节脱位情况下的发生率和特征尚不清楚。
报告急性膝关节脱位中PLTPF和LFCIF的发生率，并描述与这些骨损伤相关的伴随软组织损伤。
横断面研究；证据等级，3级。
在这项回顾性多中心研究中，根据诊断相关组编码以及2018年至2022年期间5个参与的一级创伤中心的手术和操作分类编码，从医院信息系统中识别出急性膝关节脱位（至少双交叉韧带损伤）。膝关节脱位根据申克分类法进行分类。在创伤后2周内通过磁共振成像评估软组织损伤。PLTPF和LFCIF根据门兹多夫和伯恩霍尔特分类法在磁共振成像和计算机断层扫描上进行分类。
共识别出157例膝关节脱位，其中男性106例，女性51例，平均年龄39.3±15.1岁。在42例（26.8%）膝关节脱位中检测到PLTPF，在申克III型内侧脱位中发生率最高。在这42例病例中，26例（61.9%）PLTPF被评为高级别骨折，理论上需要复位和固定。在31例（19.7%）病例中发现了LFCIF。
在四分之一的急性膝关节脱位中观察到PLTPF，在五分之一的病例中观察到LFCIF。它们尤其发生在内侧副韧带断裂的膝关节脱位中。根据门兹多夫或伯恩霍尔特分类，几乎三分之二的PLTPF表现为高级别骨折，可能需要手术干预。
