Luxación expuesta de rodilla: ¿Qué hemos aprendido en los últimos 20 años? / Open knee dislocations: what have we learn about it in the last 20 years?

INTRODUCCIÓN: La luxación expuesta de rodilla es compleja, de incidencia baja con grandes secuelas funcionales. Existen escasos reportes de series en la literatura relativos a su manejo y resultados. OBJETIVO: El objetivo de este trabajo fue describir los resultados obtenidos de todos los pacientes con luxación expuesta de rodilla tratados durante las últimas dos décadas en nuestro hospital bajo un mismo estándar de tratamiento. MÉTODO: Estudio descriptivo retrospectivo en una serie quirúrgica de 11 pacientes con luxación expuesta de rodilla, tratados entre 1994 y 2015. Todos fueron estudiados y manejados según esquema estandarizado: Angiografía/ angioTC, aseo quirúrgico, fijador externo y reparación neurovascular en casos necesarios. Revisión de registros clínicos e imagenológicos consignando datos demográficos, lesiones concomitantes, número y tipo de cirugías, y complicaciones asociadas. Seguimiento promedio fue de 10,7 años con evaluación mediante encuesta funcionales SF-12/IKDC durante el mes de marzo de 2015. RESULTADOS: Diez pacientes eran hombres, 1 mujeres. Edad promedio al accidente 38,6 años. Mecanismo lesional de alta energía; como referencia la clasificación de Schenck, 1 lesión III-M, 4 tipo IV y los 6 restantes una tipo V. 4 lesiones vasculares (36.4%) y 7 lesiones neurológicas (63.6%). Tratamiento definitivo consistió en 4 reconstrucciones ligamentarias, 2 prótesis, 3 artrodesis y 2 amputaciones supracondíleas. Evaluaciones funcionales dieron como resultados un puntaje promedio de 37 y 48,5 para SF-12 físico y mental respectivamente, y de 44,1 para IKDC. CONCLUSIÓN: La luxación expuesta de rodilla es una lesión infrecuente, muy compleja, asociada a accidentes de alta energía, con complicaciones severas, lo que determina resultados funcionales relativamente malos. La estandarización permite sistematizar las distintas etapas de atención, racionalizar los recursos disponibles evitando la improvisación en momentos críticos, lo que podría incidir en la obtención de resultados.

INTRODUCTION: Open knee dislocation is a complex lesion of low incidence and large functional sequelae. There are few series reports in the literature regarding its management and outcomes. OBJECTIVE: Describe the results obtained from all patients with open knee dislocation treated during the last two decades in our hospital under the same treatment standard. METHOD: Retrospective descriptive study in a surgical series of 11 patients with open knee dislocation, treated between 1994 and 2015. All were studied and managed according to a standardized protocol: Angiography/angioCT, surgical debridement, external fixation and neurovascular repair in necessary cases. Review of clinical and imaging records, recording demographic data, concomitant injuries, number and type of surgeries and associated complications. Average follow-up was 10.7 years, with an evaluation through functional surveys SF-12/IKDC during March 2015. RESULTS: 10 patients were men, 1 woman. Average age at accident 38.6 years. High-energy trauma mechanism of injury; Schenk classification as reference, 1 lesion type III-M, 4 type IV and the remaining 6 type V. 4 vascular lesions (41.7%) and 7 neurological lesions (63.6%). Definitive treatment consisted in 4 ligamentous reconstructions, 2 prostheses, 3 arthrodesis and 3 supracondylar amputations. Functional evaluations showed an average score of 37 and 48.5 for SF-12 physical and mental respectively, and 44.1 for IKDC. CONCLUSION: Open knee dislocation is a rare, very complex, associated to high-energy trauma, with severe complications, which determines relatively poor functional outcomes. Standardization allows to systematize the different stages of attention and rationalize available resources avoiding improvisation at critical moments, which could affect the results.

Locked knee caused by lateral meniscal capsular disruption: verification by magnetic resonance imaging and arthroscopy.

Locking of the knee is commonly reported in patients presenting to an orthopedic surgeon. This case report describes a rare cause of knee locking: subluxation of the lateral meniscus without an associated tear. This case highlights the importance of the popliteus recess in stability of the lateral meniscus. Injury to this area may lead to meniscal subluxation and knee locking.

Luxacion traumatica de rodilla. Tratamiento y complicaciones / Traumatic knee dislocation treatment and complications

La luxaciòn traumàtica de la rodilla es una lesiòn poco frecuente que se asocia a graves lesiones càpsuloligamentosas y que a menudo afecta a estructuras neurològicas y vasculares..

[Pre- and postoperative functional status of patients subjected to anterior cruciate ligament reconstruction associated with knee dislocation]. / Estado funcional pre y postoperado de pacientes con reconstrucción de ligamento cruzado anterior asociado a luxación de rodilla.

INTRODUCTION: The injury of the cruciate ligaments secondary to knee dislocation is caused by high energy trauma; its incidence rate is less than 0.02%; there are multiple treatments, with surgery being the most common one. OBJECTIVE: To determine the functional characteristics of patients who underwent cruciate ligament plasty and sustained knee dislocation. MATERIAL AND METHODS: An observational, prospective, cross-sectional study was conducted including all adult patients with a diagnosis of cruciate ligament injury resulting from knee dislocation who were surgically treated from January 2006 to December 2007. Two knee functional assessment scales were used. RESULTS: A total of 16 patients were included, 12 males and 4 females; mean age was 32.1 years. The Knee Society Clinical Rating Scale had a positive correlation with the Lysholm Knee Scoring Scale (r = 0.836) with p = 0.001. DISCUSSION: The functional results of patients treated surgically are diverse. This study was not conducted as a controlled clinical trial due to the absence of randomization, which was not possible due to the infrequency of the condition. CONCLUSIONS: It will be necessary to confirm the results after a longer follow-up and in a comparative, double-blind study of patients undergoing surgery.

[Amputation as a treatment for complications on a traumatic dislocations of the knee. Case report]. / Amputación como tratamiento de complicaciones de la luxación traumática de rodilla. Presentación de un caso.

INTRODUCTION: Vascular lesion associated with knee dislocation represents a common and potentially devastating complication. A delay in revascularization that exceeds 8 hours can lead to amputation of the extremity. Therefore it is mandatory to do an immediate examination and an effective diagnosis to rule out this complication. CASE REPORT: A 19-year-old male was struck by a motor vehicle and caused traumatic dislocation of the left knee as observed on X-rays. The knee was reduced immediately. At 12 hours, the patient presented edema on the extremity and was then stabilized with external fixators. On the third day the patient developed a compartmental syndrome and artery obstruction, and required fasciotomies and revascularization of the popliteal artery. Twenty four hours later, again the artery was obstructed, conducing to supracondylar amputation. DISCUSSION: The purpose of this article is to show that a knee dislocation, with vascular complications, may lead to extremity amputation as a drastic treatment. It is important to emphasize that vigilance of vascular permeability has to be followed every 2-3 hours, for at least 72 hours after the injury, and assisted with Doppler study. And if needed, at the moment when a pulse abnormality is detected an arteriography study must be realized.

Luxación de rodilla con lesión aislada del ligamento cruzado anterior: reporte de un caso / Knee dislocation with anterior cross ligament isolated lesion: one case report

We describe a very unusual case of a 28 year old man with a complete anterior knee dislocation, following anterior cruciate ligament (ACL) disruption without any other ligament tears. The pathology of the knee joint was torn ACL, intact meniscus and other ligaments and bone bruise of the trochlear grove. After joint reduction the ACL reconstruction was performed two weeks after the injury, obtaining a complete functional recovery. He had a Lysholm score of 95 points and a normal IKDC score.

Este artículo escribe un caso poco usual de una luxación anterior de rodilla, con lesión aislada de ligamento cruzado anterior en un paciente deportista de 28 años. El estudio clínico y de resonancia magnética demostró lesión aislada el ligamento cruzado anterior (LCA), edema óseo en la tróclea femoral y ausencia de otras lesiones ligamentosas y meniscales de la rodilla. Luego de la reducción ortopédica, se programó una reconstrucción del LCA, dos semanas después el accidente. La evaluación alejada a dos años plazo, muestra una articulación estable. La aplicación de la escala de Lysholm fue de 95 puntos y un IKDC normal.