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Knee dislocation
This document discusses knee dislocations, including their epidemiology, stabilizers of the knee joint, clinical features, associated injuries, imaging, and classifications. It also reviews treatment indications and options for knee dislocations, such as early open repair, acute reconstruction, staged reconstruction, and use of an external fixator. Complications include stiffness, which can be addressed through early range of motion exercises and manipulation if needed.
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Knee dislocation
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- 2. EPIDIMOLOGY • 0.2% ofall orthopaedic injuries • Usually NOT reported – Spontaneous reduction • 14-44% associated with multiple trauma • 5% bilateral
- 3. STABILIZERS OF KNEEJOINT • Static • Joint Capsule • Collateral Ligaments • Medial Patellofemoral Ligament • Dynamic • Quadriceps • Biceps Femoris • Pes Anserinus • Gastronemius • Tensor Fascia Lata • Semimembranosus • Popliteus
- 5. CLINCAL FEATURES • MayPresent with irreducible dislocaton • Deformity, pain ,cannot ambulate • Spontaneously reduced- with only effusion • Normal Knee ,BUT on examination shows instability • Dislocation + Ipsilateral # lower extremity – Diagnostic Challenge • EUA following fracture stabilization
- 7. ASSOCIATED INJURIES • Vascular •Neurologic
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- 12. A- PCL INTACTKNEE DISLOCATION B- BICRUCIATE – Parallel arrangement of patella with femur
- 13. MRI • After reductionor suspected spontaneous reduction • To assess ligament status
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- 15. KENNEDY CLASSIFICATION • Anterior •Posterior • Medial • Lateral • Rotatory • Anteromedial • Anterolateral • Posteromedial • Posteolateral (MC ROTATORY)
- 16. POSTEROLATERAL • Hallmark –Irreducibility • Medial femoral condyle buttonholes through the medial capsule and medial collareral ligament invaginates into knee joint preventing closed reduction • TRANSVERSE FURROW in medial aspect of knee
- 25. Treatment Indications AdvantagesDisadvantages Early Open Repair (First week) Avulsions with large bony fragments 1.Secure fixation 2.Maintain native ligaments 1.Most injuries are either midsubstance tears or are avulsions without bone and repair is not possible 2.Wound healing problems due to soft tissue envelope injury 3.Increased risk of stiffness Acute (2-“4 weeks) reconstruction of all ligaments Knee dislocation with bicruciate injury and no large bony fragments 1.Early restoration of ligament 2.Fewer surgical procedures than staged cruciate reconstruction 3.Allows early rehabilitation Length of surgery Acute (2-4 weeks) reconstruction cruciates staged with delayed (6 weeks) ACL reconstruction Knee dislocation with bicruciate injury and no large bony fragments 1.Shorter initial procedure 2.Return to OR at 6 weeks allows manipulation to increase motion 3.Allows early rehabilitation 1.Requires one additional surgery 2.Rehabilitation in the first 6 weeks as in an ACL-deficient knee
- 26. Delayed (>1 month) reconstructionafter motion is reestablished and ipsilateral injuries are healed Knee dislocation with soft tissue injury 1.Establishes good motion prior to surgery 2.Simultaneous bicruciate reconstruction better tolerated 1.Delays full reconstruction 2.Delays functional recovery to job, sports, etc. 3.More difficult to obtain stable knee with chronic reconstruction Early spanning external fixator with removal at 6-8 weeks, manipulation, and reconstruction if necessary after motion is obtained Knee dislocation in poor rehabilitation candidate 1.Avoids lengthy procedure with significant complications until rehabilitation potential is clarified 2.Fewer complications 1.Difficult to obtain functional result equivalent to early reconstruction 2.Delayed recovery 3.Staged procedure that may require additional surgeries 4.Risk of infection
- 27. COMPLICATIONS Stifness Most common Early ROM MUAin 6 weeks if Physio does not yield good results