Chronic Irreducible Knee Dislocations: Outcomes following Open Reduction and Reconstructive Surgery

Abstract

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 (p < 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.

Keywords

chronic knee dislocation - multiple ligament deficient knee - open reduction - hinged external fixator - fixed posterior dislocation

Publication History

Received: 01 February 2021

Accepted: 26 April 2022

Article published online:
07 July 2022

• References

• 1 Richter M, Lobenhoffer P. Chronic posterior knee dislocation: treatment with arthrolysis, posterior cruciate ligament reconstruction and hinged external fixation device. Injury 1998; 29 (07) 546-549
• 2 Polyzois VD, Stathopoulos IP, Benetos IS, Pneumaticos SG. A two-stage procedure for the treatment of a neglected posterolateral knee dislocation: gradual reduction with an Ilizarov external fixator followed by arthroscopic anterior and posterior cruciate ligament reconstruction. Knee 2016; 23 (01) 181-184
• 3 Van Thiel GS, Baker III CL, Bush-Joseph C. A chronic posterolateral knee and patella dislocation: case report. J Orthop Trauma 2009; 23 (07) 541-545
• 4 Khamaisy S, Haleem AM, Williams RJ, Rozbruch SR. Neglected rotatory knee dislocation: a case report. Knee 2014; 21 (05) 975-978
• 5 Henshaw RM, Shapiro MS, Oppenheim WL. Delayed reduction of traumatic knee dislocation. A case report and literature review. Clin Orthop Relat Res 1996; (330) 152-156
• 6 Simonian PT, Wickiewicz TL, Hotchkiss RN, Warren RF. Chronic knee dislocation: reduction, reconstruction, and application of a skeletally fixed knee hinge. A report of two cases. Am J Sports Med 1998; 26 (04) 591-596
• 7 Watanabe K, Yamada Y, Kura H. et al. Chronic knee fracture dislocation treated by the Ilizarov technique: case report. J Trauma 2001; 50 (01) 151-154
• 8 Pardiwala DN, Subbiah K, Rao N, Jain V. Complications of multiple ligament knee injury surgery: prevention and salvage. Asian Journal of Arthroscopy 2020; 5 (01) 58-65
• 9 Said HG, Learmonth DJ. Chronic irreducible posterolateral knee dislocation: two-stage surgical approach. Arthroscopy 2007; 23 (05) 564.e1-564.e4
• 10 Vicente-Guillen P, Figa-Mataró J, Coloma-Bellver J. Long-standing unreduced dislocation of the knee. A case report. Int Orthop 1998; 22 (04) 275-276
• 11 Petrie RS, Trousdale RT, Cabanela ME. Total knee arthroplasty for chronic posterior knee dislocation: report of 2 cases with technical considerations. J Arthroplasty 2000; 15 (03) 380-386
• 12 Chen H, Chiu F. Chronic knee dislocation treated with arthroplasty. Inj Extra 2007; 38: 258-261
• 13 Saini R, Mootha AK, Goni VG, Dhillon MS. Neglected irreducible posterolateral knee dislocation. Indian J Orthop 2010; 44 (04) 468-470
• 14 Karn N, Khanal G, Singh D. Long-standing unreduced anterior dislocation of the knee - a case report. Internet Journal of Medical Update 2010; 5 (01) 51-53
• 15 Matthai T, Bhowmick K, Boopalan PR, George JC. Neglected anterior dislocation of the knee with common peroneal palsy. Case Rep Orthop 2015; 2015: 174965
• 16 Kapil Mani KC, Dirgha Raj RC, Parimal A, Ram PB. Open reduction of neglected knee dislocation: case report of a rare injury. Malays Orthop J 2016; 10 (03) 56-57
• 17 Moatshe G, Chahla J, LaPrade RF, Engebretsen L. Diagnosis and treatment of multiligament knee injury: state of the art. J ISAKOS 2017; 2 (03) 152-161
• 18 Peskun CJ, Whelan DB. Outcomes of operative and nonoperative treatment of multiligament knee injuries: an evidence-based review. Sports Med Arthrosc Rev 2011; 19 (02) 167-173
• 19 Bagherifard A, Jabalameli M, Ghaffari S. et al. Short to mid-term outcomes of single-stage reconstruction of multiligament knee injury. Arch Bone Jt Surg 2019; 7 (04) 346-353