Epidemiology and treatment of knee luxation
Article Sidebar
Main Article Content
Abstract
Introduction: Knee dislocation is a rare and serious injury, associated with complications such as ligament instability, neurovascular injuries, loss of range of motion and associated fractures. High-energy traumas are the most common, with young men being the most affected.
Objectives: Analyze ligament and concomitant injuries, trauma mechanisms, patient profile and treatment for knee dislocations.
Method: Data collection through medical records of patients who met the diagnosis of knee dislocation, covering epidemiological, therapeutic and prognostic data, and treated at a trauma reference hospital. Demographic variables, causes of dislocation, mechanisms of trauma, side of the dislocated knee, injured ligaments and neurovascular impairment, fractures or concomitant injuries and their Schenck classification, were investigated.
Results: The most affected knee was the right, with greater involvement of the cruciate ligaments, with the KDI classification being more prevalent. Regarding therapeutic management, it was found that 18 patients (56.25%) had spontaneous reduction of the dislocation, while 14 (43.75%) needed to undergo closed reduction. Regarding treatment, 27 (84.37%) were treated surgically, with external fixator and ligament reconstruction, while 5 (15.62%) underwent conservative treatment with the use of an inguinopedic and inguinomaleolar plaster splint, brace and plaster.
Conclusion: Knee dislocation has a clear predilection for young men, being frequently caused by traffic accidents, and the high rate of associated injuries results in a worse prognosis. The most affected ligaments were the cruciates and the most prevalent classification was the KDI. This dislocation has a high rate of associated injuries, such as fractures, meniscal and neurovascular injuries, which leads to a worse prognosis, affecting quality of life. Knee dislocation has a heterogeneous profile and there are divergences between management and epidemiological data.
Article Details
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Howells NR, Brunton LR, Robinson J, Porteus AJ, Eldridge JD, Murray JR. Acute knee dislocation: An evidence based approach to the management of the multiligament injured knee. Injury. 2011;42(11):1198-204. Doi: 10.1016/j.injury.2010.11.018
Seroyer ST, Musahl V, Harner CD. Management of the acute knee dislocation: The Pittsburgh experience. Injury. 2008;39(7):710-8. Doi: 10.1016/j.injury.2007.11.022
Kennedy JC. Complete dislocation of the knee joint. J Bone Joint Surg Am. 1963;45:889-904.
Schenck-Junior RC. The dislocated knee. Instr Course Lect. 1994;43:127-36.
Pedroni MA, Martins M, Junior AVB, Fratti SR, Secchi F, Iida WC. Luxação traumática de joelho associada a lesão arterial em atleta jogador de futebol. Rev Bras Ortop. 1997;32(12):954-8.
Boyce RH, Singh K, Obremskey WT. Acute Management of Traumatic Knee Dislocations for the Generalist. J Am Acad Orthop Surg. 2015;23(12):761-8. Doi: 10.5435/JAAOS-D-14-00349
Werier J, Keating JF, Meek RN. Complete dislocation of the knee. The long-term results of ligamentous reconstruction. Knee. 1998;5(4):255-60. Doi: 10.1016/S0968-0160(98)00015-5
Engebretsen L, Risberg MA, Robertson B, Ludvigsen TC, Johansen S. Outcome after knee dislocations: a 2-9 years follow-up of 85 consecutive patients. Knee Surg Sports Traumatol Arthrosc. 2009;17(9):1013-26. Doi: 10.1007/s00167-009-0869-y
Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am. 2004;86(2):262-73. Doi: 10.2106/00004623-200402000-00008
Wong C, Tan J, Chang H, Khin L, Low C. Knee dislocations: a retrospective study comparing operative versus closed immobilization treatment outcomes. Knee Surg Sports Traumatol Arthrosc. 2004;12(6):540-4. Doi: 10.1007/s00167-003-0490-4
Levy BA, Fanelli GC, Whelan DD, Stannard JP, Macdonald PA, Boyd JL, et al. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg. 2009;17(4):197-206. Doi: 10.5435/00124635-200904000-00001
Clark SJ, Engebresten L. Surgical treatment of acute knee dislocation. Techn Knee Surg. 2011;10:28-36. Doi: 10.2106/JBJS.D.02711
Peskun CJ, Whelan DB. Outcomes of operative and nonoperative treatment of multiligament knee injuries: an evidence-based review. Sports Med Arthrosc. 2011;19(2):167-73. Doi: 10.1097/JSA.0b013e3182107d5f
Robertson A, Nutton RW, Keating JF. Dislocation of the knee. The Journal of bone and joint surgery 2006;88(6):706-11. Doi: 10.1302/0301-620X.88B6.17448
Hollis JD, Daley BJ. 10-year review of knee dislocations; is angiography always necessary. J Trauma 2005;59(3):672–5.
Mills WJ, Barei DP, McNair P. The value of ankle brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma 2004;56(6):1261–5. Doi: 10.1097/01.ta.0000068995.63201.0b
Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am 1977;59:236–9.
Miranda FE, Dennis JW, Veldenz HC, Dovgan PS, Frykberg ER. Confirmation of the safety and accuracy of physical examination in the evaluation of knee dislocation for injury of the popliteal artery: a prospective study. J Trauma 2002;52(2):247–51. Doi: 10.1097/00005373-200202000-00008
Lachman JR, Rehman S, Pipitone PS. Traumatic Knee Dislocations: Evaluation, Management, and Surgical Treatment. Orthop Clin North Am. 2015;46(4):479-93. Doi: 10.1016/j.ocl.2015.06.004
Twaddle BC, Bidwell TA, Chapman JR. Knee dislocations: Where are the lesions? A prospective evaluation of surgical findings in 63 cases. Journal of Orthopaedic Trauma. 2003;17(3):198-202. Doi: 10.1097/00005131-200303000-00008
Hill JA, Rana NA. Complications of posterolateral dislocation of the knee: case report and literature review. Clin Orthop. 1981;154:212–5.
Wand JS. A physical sign denoting irreducibility of a dislocated knee. J Bone Joint Surg Br. 1989;71(5):862. Doi: 10.1302/0301-620X.71B5.2584265
Crupzacki AP, Pereira CIP, Skare TL. Lesões musculoesqueléticas relacionadas ao trabalho em indivíduos em home office durante a pandemia Covid-19. BioSCIENCE. 2022;80(2):28-31; Doi: 10.55684/80.2.6
Da Silva MS, Nisiide MA, Rodrigues PH de OR. Abscesso de músculo psoas de provável origem em coluna lombossacral: relato de caso. BioSCIENCE. 2022;80(2):47-50. Doi: 10.55684/80.2.11