Knee dislocations: experience at the hôpital du sacré-coeur de montréal
Original Article Article original Knee dislocations: experience at the Hôpital du Sacré-Coeur de Montréal
Max Talbot, MD;* Greg Berry, MD;† Julio Fernandes, MD;‡ Pierre Ranger, MD‡
Introduction: Although many options exist for ligament reconstruction in knee dislocations, the opti- mal treatment remains controversial. Allografts and autografts have both been used to reconstruct the cruciate ligaments. We present the results of reconstruction using artificial ligaments at Hôpital du Sacré-Coeur in Montréal. Methods: We reviewed the treatment of all patients with knee dislocations seen between June 1996 and October 1999. The Lysholm score, ACL-quality of life (QoL) questionnaire, physical examination and Telos instrumented laxity measurement were used to evaluate the results. Results: Twenty patients (21 knees) participated in the study. The mean (and standard deviation [SD]) Lysholm score was 71.7 (18). Results from the ACL-QoL questionnaire showed a global impairment in QoL. Mean (and SD) range of motion and flexion were 118° (10.9°) and 2° (2.9°) respectively. Mean (and SD) radiologic laxity evaluated with Telos for the anterior and posterior cruciate ligaments were 6.1 (5.7) mm and 7.3 (4.5) mm respectively. Conclusions: Knee reconstruction with artificial ligaments shows promise, but further studies are necessary before it can be recommended for widespread use. This is the first study to show specifically a severe impairment in QoL in this patient population. Introduction : Même s’il existe plusieurs possibilités de reconstruction ligamentaire dans les cas de luxa- tion du genou, le traitement optimal suscite toujours la controverse. On a utilisé à la fois les allogreffes et les autogreffes pour reconstruire des ligaments croisés. Nous présentons les résultats de reconstruc- tions au moyen de ligaments artificiels effectuées à l’Hôpital du Sacré-Cœur à Montréal. Méthodes : Nous avons passé en revue le traitement de tous les patients ayant subi une luxation du genou et qui ont consulté entre juin 1996 et octobre 1999. On a utilisé le score de Lysholm, le questionnaire sur la quali- té de vie (QdV) LCA, l’examen physique et la laxité mesurée au Telos pour évaluer les résultats. Résul- tats : Vingt patients (21 genoux) ont participé à l’étude. Le score médian de Lysholm (et l’écart type [ET]) s’est établi à 71,7 (18). Les résultats du questionnaire QdV-LCA ont montré un déficit global de la QdV. L’amplitude médiane (et l’ET) du mouvement et celle de la flexion se sont établies à 118 ° (10,9 °) et 2 ° (2,9 °) respectivement. La laxité radiologique médiane (et l’ET) mesurée au Telos dans le cas des ligaments croisés antérieur et postérieur s’est établie à 6,1 (5,7) mm et 7,3 (4,5) mm respec- tivement. Conclusions : La reconstruction de genou au moyen de ligaments artificiels est porteuse de promesses, mais d’autres études s’imposent avant que l’on puisse en recommander l’application générale. Il s’agit de la première étude qui montre spécifiquement un déficit grave de la QdV dans cette population de patients.
Knee dislocations are uncommon ated injuries. Traditionally, the term with very low functional demands.
From the Division of Orthopædic Surgery, *Université de Montréal, †McGill University and ‡Hôpital du Sacré-Coeur de Montréal,Montréal, Que.
Accepted for publication Oct. 16, 2003. Correspondence to: Dr. Greg Berry, McGill University Health Centre, Room B5 159.4, Division of Orthopædic Surgery, Montréal General Hospital, 1650 Cedar Ave., Montréal QC H3G 1A4; fax 514 934-8394; [email protected] Knee dislocations
according to a standardized protocol.
ate ligaments, cartilage and menisci.
anterior tibia to the PCL footprint.
on low-resistance stationary cycling. Patients and methods
Can J Surg, Vol. 47, No. 1, February 2004
Talbot et al
amentous laxity and range of motion. Discussion
difference. Clinical and radiologic laxi-
ties were graded in the same manner.
paired t test was used to compare dif-
ferent groups of patients. A p valueless than 0.05 was considered statisti-
Anterior Cruciate Ligament Quality Dislocations in 21 Knees According of Life (QoL) Questionnaire Results to the Classification of Schenck*
* Schenck RC Jr. The dislocated knee [review]. Instr
Knee dislocations
ies.5–8,10,11,21–23 In all, there were 109 pa-
with release of all intra-articular adhe-
patients received uniform treatment.
since they have no healing potential. Success or Failure of Knee
surgically treated knee dislocations. Reconstruction in Patients Followed for Longer Than 2 Years
Can J Surg, Vol. 47, No. 1, February 2004
Talbot et al
mentation device: a historical perspective. Arthroscopy 1999;15:422-32.
13. Nau T, Lavoie P, Duval N. A new genera-
tion of artificial ligaments in reconstruc-
tion of the ACL. J Bone Joint Surg Br
14. Marshall JL, Warren RF, Wickiewicz TL,
Reider B. The anterior cruciate ligament: a
Competing interests: None declared for Drs.
technique of repair and reconstruction.
received travel expenses from J.K. Orthome-
15. Tegner Y, Lysholm J. Rating systems in
dic Ltd. to present the preliminary results of
this study at a convention related to the sub-
the evaluation of knee ligament injuries.
16. Mohtadi N. Development and validation
References
(questionnaire) for chronic anterior cruci-
1. Brautigan B, Johnson DL. The epidemiol-
ate ligament deficiency. Am J Sports Med
ogy of knee dislocations [review]. Clin
17. Green NE, Allen BL. Vascular injuries
2. Wascher DC, Dvirnak PC, DeCoster TA.
associated with dislocation of the knee.
Knee dislocation: initial assessment and im-
J Bone Joint Surg Am 1977;59:236-9.
plications for treatment. J Orthop Trauma
18. Richter M, Bosch U, Wippermann B, Hof-
cal repair or reconstruction of the cruciate
matic dislocation of the knee: a report of
ligaments versus nonsurgical treatment in
forty-three cases with special reference to
patients with traumatic knee dislocations.
conservative treatment. J Bone Joint Surg BrAm J Sports Med 2002;30:718-27.
19. Safran MR. Graft selection in knee sur-
gery: current concepts [review]. Am J
analysis. Am J Knee Surg 2001;14:33-8.
5. Fanelli GC, Giannotti BF, Edson CJ.
DW, O’Brien SJ, Rodeo SA, et al. Relia-
Arthroscopically assisted combined anter-
bility, validity, and responsiveness of four
ior and posterior cruciate ligament recon-
knee outcome scales for athletic patients. JConclusions
struction. Arthroscopy 1996;12:5-14. Bone Joint Surg Am 2001;83:1459-69.
21. Almekinders LC, Logan TC. Results fol-
struction of the anterior and posterior cru-
lowing treatment of traumatic dislocations
ciate ligaments after knee dislocations. Am
of the knee joint. Clin Orthop 1992;284:
7. Shapiro MS, Freedman EL. Allograft re-
construction of the anterior and posterior
cruciate ligaments after traumatic knee dis-
location. Am J Sports Med 1995;23:580-7.
of surgical reconstruction and immobiliza-
tion. Am J Knee Surg 1995;8:97-103.
Blevins FT. Reconstruction of the anterior
and posterior cruciate ligaments after knee
comes of the operatively treated knee dislo-
dislocation: results using fresh-frozen non-
cation. Clin Sports Med 2000;19:503-18.
irradiated allografts. Am J Sports Med
baker’s dozen of knee dislocations. Am J
9. Schenck RC Jr. The dislocated knee [re-
view]. Instr Course Lect 1994;43:127-36.
10. Shelbourne KD, Porter DA, Clingman JA,
[Reliability of the KT-1000 arthrometer in
knee dislocation. Orthop Rev 1991;20:
reconstructions of the anterior cruciate lig-
dislocation: treatment of high-velocity knee
ament and intra- and interobserver repro-
dislocation. J Trauma 1999;46:693-701.
ducibility.] Rev Chir Orthop Reparatrice
12. Kumar K, Maffulli N. The ligament aug-