Retrospective analysis on treatment methods and curative effects of reducing the disability rate of multiple ligament injuries and dislocations of the knee joint / 中国骨伤

OBJECTIVE@#To investigate the clinical effects of individualized repair and reconstruction surgery for multiple ligament injury and dislocation of knee joint based on stage classification diagnosis.@*METHODS@#From January 2018 to January 2019, 42 patients with multiple ligament injury and dislocation of the knee joint were treated. There were 27 males and 15 females, aged from 30 to 63 (47.35±11.90) years old, including 17 left knees, 23 right knees and 2 bilateral knees. All patients with multiple ligament injuries and dislocations of the knee joint were classified by stages and improved Schenck diagnosis. Among them, 23 cases were in acute stage (≤3 weeks), 19 cases were in old stage (>3 weeks), 27 cases were type Ⅲ dislocation and type Ⅳ dislocation. There were 9 cases of dislocation and 6 cases of type Ⅵ dislocation. The corresponding repair methods such as closed manipulation and open release reduction, direct suture of ligament, anchor suture, bone penetrating suture, and routine ligament reconstruction were performed. The corresponding "progressive progressive excitation" rehabilitation program was adopted after the operation. After 2, 4, 6, 8 weeks and 3, 6, 9, 12 months after operation, the outpatient consultation and evaluation of knee joint function and stability were completed. The knee joint stability, excellent and good rate, disability rate and complication rate were compared before and after operation. Internation Knee Documentation Committee (IKDC) grade, IKDC subjective score, Lysholm score and Tegner score were used to evaluate knee joint function.@*RESULTS@#All patients completed the outpatient follow-up and follow-up on schedule. All patients had gradeⅠwound healing, 4 patients had lower extremity venous thrombosis after operation, and there were no serious complications after anticoagulant treatment; 5 patients with common peroneal nerve injury were treated with release surgery and active postoperative rehabilitation, and neurological function gradually recovered. At 12 months after operation, the muscle strength of the affected limb reached grade Ⅴ and the active and passive range of motion recovered to more than 120 degrees. In the acute stage, the IKDC subjective scores were 20.46±12.61, 22.58±16.83, 0.71±1.14, 69.55±16.57, 77.73±15.14 and 3.14±1.67, respectively. One year after operation, IKDC subjective score was 67.04±19.07, Lysholm was 74.87±14.58, Tegner was 3.06±1.70, and 6 of them were grade A. After 12 months, the knee function scores of all patients were significantly improved compared with those before operation(@*CONCLUSION@#According to the classification of multiple ligament injuries and dislocations of the knee joint, the corresponding surgical repair and reconstructiontreatment were adopted, and the corresponding rehabilitation program was adopted after the operation. The patients achieved good clinical treatment effect 12 months after operation, and the patients' satisfaction was high, which improved the excellent and good rate of treatment and reduced the disability rate.

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.

Diagnóstico y tratamiento de luxación tibioperonea proximal de rodilla. Reporte de caso en un deportista / Proximal tibiofibular dislocation. Diagnosis and treatment. Case report in athlete

La luxación traumática es una entidad infrecuente. El tratamiento de elección en el estadio agudo es la reducción cerrada, mientras que en el caso de inestabilidad crónica se opta por reducción y fijación interna. No habiendo reportes de luxaciones subagudas se presenta un caso de 20 días de evolución tratado mediante reducción cerrada y artroscopia el cual evolucionó favorablemente luego de la cirugía.

Traumatic dislocation is an infrequent entity. The treatment of choice in the acute stage is closed reduction, whereas in the case of chronic instability, reduction and internal fixation is the treatment of choice. In absence of subacute dislocation reports we present a case with 20 days of evolution treated by closed reduction and arthroscopy which evolved favorably after surgery.

Conducta inicial en la luxación aguda de rodilla. Nuestra experiencia de 20 años / Initial treatment of acute knee dislocation. Our experience of 20 years

Introducción: La luxación aguda de rodilla representa menos del 0,02% de toda la patología ortopédica. La mayoría de los casos se presentan en un contexto de pacientes politraumatizados generado por accidentes de alta energía o velocidad. Se trata de una lesión grave donde la reducción y la evaluación vascular son los pilares fundamentales del tratamiento inicial. El objetivo de este trabajo es presentar nuestra experiencia y conducta en el tratamiento de urgencia en luxaciones agudas de rodilla mediante la utilización de protocolos establecidos. Material y Métodos: Presentamos nueve luxaciones agudas de rodilla, incluyendo solo aquellos casos de rodillas luxadas en el momento del primer contacto con el paciente. Todas fueron generadas por traumatismos de alta energía y evaluadas de acuerdo a las clasificaciones de Kennedy y Schenck. Siete de las luxaciones tuvieron algún tipo de desplazamiento posterior y dos fueron anteriores. En relación a la clasificación de Schenck, dos luxaciones fueron grado KDI, cuatro KDIII, una KDIV y dos casos KDV. Utilizamos nuestro protocolo de urgencia, basado en la semiología y radiología para evaluar la luxación y controlar la reducción y el control de pulsos tibial posterior y pedio, índice ABI (índice tobillo-pie), ecodoppler y angiografía para evaluar de acuerdo al caso, el estado vascular. Resultado: Seis luxaciones pudieron ser reducidas manualmente de manera inmediata. En los tres casos restantes la reducción fue quirúrgica por tratarse de luxaciones irreductibles, luxofractura expuesta y rodilla reluxable. En ocho pacientes el índice ABI y ecodoppler resultaron normales, en un caso que presentaba índice ABI mayor a 0.9 pero ecodoppler alterado, se realizó una angiografía que descarto lesión vascular y en el paciente con la lesión expuesta, ante la alteración del estado circulatorio, se realizó una exploración vascular. Cinco pacientes presentaban compromiso del nervio ciático poplíteo externo. Conclusión: Si bien existen acuerdos y coincidencias en el tratamiento de las secuelas y consecuencias que una luxación de rodilla produce, no ocurre lo mismo sobre la conducta a adoptar ante la urgencia que significa una luxación aguda. Por ello creemos que es fundamental establecer conductas protocolizadas de urgencia, en donde los dos pilares fundamentales, se basan en la reducción inmediata y la evaluación del estado vascular del miembro afectado. Es por ello que creemos útil presentar nuestra experiencia relacionada exclusivamente en luxaciones agudas de rodilla y nuestro protocolo de urgencia.

Introduction: Acute knee dislocation represents less than 0.02% of all orthopedic pathology. Most cases appear in patients with multiple trauma as a consequence of high energy or speed accidents. It is a serious injury where reduction and vascular evaluation are the basis for initial treatment. The aim of this paper is to show our experience and conduct in the urgent treatment of acute knee dislocations following established protocols. Material and methods: Nine acute knee dislocations are presented; we included only cases of knee dislocations at the moment of first contact with the patient. All of them caused by high velocity trauma and evaluated according to the Kennedy and Schenck classifications. Seven cases showed some kind of posterior displacement and two cases anterior displacement. In relation to Schenck classification, two dislocations are classified as KDI, four as KDIII, one KDIV and two KDV. We used our Urgency protocol, based on semiology and radiology to assess dislocation and control reduction and control of posterior tibialis and pedal pulse, ABI index (ankle-brachial index); echo-doppler and angiography for assessment of vascular state according to each case. Results: Six dislocations were manually reduced immediately. In the remaining three cases, surgery was required for reduction due to irreducible dislocation, open fracture and dislocation, and re-dislocated knee. Eight patients showed normal ABI index and echo-doppler results, one showed ABI index higher than 0.9 but altered echo-doppler. An angiography was performed to discard vascular injury; and in the case with open fracture, due to alteration of vascular state, a vascular exploration was performed. Five patients showed external popliteal sciatic nerve compromise. Conclusion: Although there are agreements and coincidences regarding the treatment of sequels and consequences of knee dislocation, it is not the same regarding the conduct to follow in the urgency of an acute dislocation. We believe it is essential to establish urgency protocolized conducts, based on two fundamental actions, immediate reduction and assessment of vascular state of affected limb. Therefore, we think it would be useful to present our experience exclusively related to acute knee dislocations and our urgency protocol.

Elongación retináculo externo. Técnica quirúrgica / Lateral retinacular lengthening. Surgical technique

La liberación de retináculo externo es una técnica quirúrgica muy utilizada en la cirugía de patología patelofemoral que tuvo su auge en la décadas de 1970 y 1990 donde se efectuaba como un gesto “necesario e inocente” durante procedimiento de realineación de aparato extensor. Hoy en día se sabe que no está excenta de complicaciones y se conoce más sobre su indicación precisa y sus contraindicaciones. Hay poca bibliografía sobre elongación retinacular y sus ventajas frente a la liberación, pero hay evidencia publicada que la elongación en Z plastia mejora resultados, disminuyendo el número de complicaciones como hemartosis, hernia sinovial lateral, subluxación medial y atrofia muscular. El objetivo de este trabajo es describir la técnica de elongación retinacular externa, y sus indicaciones. Creemos que es una técnica sencilla reproducible que disminuye las complicaciones atribuidas a la liberación tradicional ya sea abierta o artroscópica, con la única desventaja de necesitar abordaje lateral accesorio.

The lateral retinacular release is one of the surgical procedure most often used in patellofemoral patology in the 70¨ and 90¨, when it was consider a “necessary and inocent” procedure during extensor mechanism realignement. Actually we know that it has complications and we know more about the right indications and contraindications of the lateral release. There are few articles about lateral retinacular lengthening and its advantages against the lateral release, but there is evidence that Z plasty lengthening improve results, lowering complications rate like hemarthrosis, lateral synovial hernia, medial subluxation and muscular atrophy. This article describe the technique of lateral retinacular lengthening and its indications. We believe that is a simply technique, reproductible and it decrease the complications rate of the traditional release open or arthroscopic, with the unique desadvantage that it needs an accesory 3-4 cm lateral midpatelar approach.

Luxación irreductible posterolateral de rodilla. Presentación de un caso / Irreductible posterolateral knee dislocation. Case report

La luxación irreductible de rodilla es una patología poco frecuente. Normalmente se trata de luxaciones posterolaterales, constituyendo una urgencia ortopédica con indicación formal de reducción abierta mediante artrotomía de rodilla y en algunos casos con un debridamiento asistido por artroscopía. Por su condición irreductible, no se recomienda la reducción manual cerrada. Presentamos un caso de luxación irreductible posterolateral de rodilla en una paciente de 21 años como consecuencia de un traumatismo de alta velocidad, su tratamiento mediante reducción abierta, desbridamiento artroscópico y reconstrucción del ligamento colateral medial en un solo tiempo. Tipo de estudio: Reporte de caso. Nivel de evidencia: V.

An irreducible knee dislocation is a rare condition. It is usually a posterolateral dislocation, (orthopedic urgency) constituting a formal indication of open reduction through knee arthrotomy and in some cases assisted with arthroscopic debridement. For its irreducible condition, closed manual reduction is not recommended. We present a case of an irreducible posterolateral knee dislocation in a patient of 21 years due to high-energy trauma, treatment by open reduction, arthroscopic debridement and sMCL reconstruction in an unstaged procedure. Type of study: Case presentation. Evidence level: V.

Uso do fixador externo articulado no tratamento cirúrgico da instabilidade multiligamentar crônica do joelho

INTRODUÇÃO: A instabilidade multiligamentar do joelho, normalmente, é provocada por um trauma que determina sua luxação, um evento pouco frequente, mas, que pode trazer sequelas devastadoras. Mesmo com o tratamento cirúrgico preconizado é alto o índice de complicações. A mobilização precoce no pósoperatório provoca afrouxamento dos ligamentos reconstruídos, o que leva à instabilidade residual. A imobilização melhora a estabilidade, mas provoca dor e rigidez. Este trabalho tem o objetivo de avaliar se o uso do fixador externo articulado proporciona melhora na mobilidade, estabilidade e na função subjetiva de pacientes submetidos à reconstrução ligamentar. MÉTODOS: Neste ensaio clínico randomizado com grupos paralelos, 33 pacientes do ambulatório do Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Universidade de São Paulo com mais que 3 semanas de lesão dos ligamentos cruzados anterior e posterior associado à lesão de ligamento colateral fibular e/ ou ligamento colateral tibial foram submetidos à cirurgia de reconstrução multiligamentar, após alocação cega aleatória ao grupo 0 - controle (18 pacientes), com órtese rígida ou ao grupo 1 - fixador externo articulado por 6 semanas (15 pacientes), no período entre novembro de 2010 e novembro de 2013. Após seguimento mínimo de um ano de pós-operatório, a estabilidade dos ligamentos reconstruídos foi avaliada ao exame físico, foram mensurados os déficits de extensão e de flexão residual em relação ao joelho contralateral não acometido e foi aplicado o questionário específico para sintomas do joelho de Lysholm...

NTRODUCTION: Multiligament knee instability is normally caused by a trauma which results in its dislocation, an infrequent event, but one which can have devastating aftereffects. Even with the recommended surgical treatment the rate of complications is high. Early post-operative mobilization provokes loosening of the reconstructed ligaments, which leads to residual instability. Immobilization improves the stability, but causes pain and stiffness. This study aims to assess whether the use of an articulated external fixator provides improvements in the mobility, stability and the subjective function of the patients submitted to ligament reconstruction. METHODS: In this randomized clinical trial with parallel groups, 33 patients of the outpatient clinic of the Institute of Orthopaedics and Traumatology of the Hospital das Clínicas of the University of Sao Paulo with more than 3 weeks of injury to the anterior cruciate ligaments and the posterior cruciate ligaments associated with injury to the fibular collateral ligament and/or medial collateral ligament, were submitted to multiligament reconstruction surgery, after blind random allocation to either: Group 0 - control (18 patients), with rigid bracing, or to Group 1 - articulated external fixator for 6 weeks (15 patients), in the period from November, 2010 to November 2013. The stability of the reconstructed ligaments were assessed after 1 year postoperatively by physical examination, the deficit of residual extension and flexion was measured in relation to the unaffected contralateral knee and the Lysholm knee scoring scale questionnaire was applied...

Knee dislocation: descriptive study of injuries / Luxação do joelho: estudo descritivo das lesões

OBJECTIVE:Describe the ligamentous and associated injuries that occur in the traumatic knee dislocation, relating them to the mechanisms of trauma and to identify patterns of injuries. METHODS: Twenty three knee dislocations were described in the period between March 2010 and March 2011. After the diagnosis of the lesions, the reduction and transarticular external fixation of the dislocated knees were done. At the second moment, the patients were evaluated with physical examination under anesthesia and the surgical exploration of peripheral lesions was perfomed by a surgeon of the knee surgery group of this institution.The patients data with the description of the injuries were found and registered. RESULTS: 65% of patients were male, the average age was 35 years and the most common mechanism of trauma was the motorcycle accident (60%). The lesion of the anterior cruciate ligament (ACL) occurred in 75% of the cases, and the lesion of posterior cruciate ligament (PCL) in 95%. The medial peripheral injuries happened in 65% of the dislocations, and the lateral lesions in 40%. The most common dislocations were classified as KDI (25%) and as KDIIIm (25%). The arterial injury was present in 15% of the cases, and the nervous injury where registered in one patient (5%). At the initial radiographic evaluation, 45% of the dislocations presented reduced. CONCLUSION: The characteristics of the knee dislocations described showed a great range of variability demonstrating that an individualized evaluation of each case is mandatory. The surgeon should be able to recognize and choose the correct treatment to these lesions. .

OBJETIVO:Descrever as lesões ligamentares e associadas ocorridas nas luxações traumáticas do joelho, relacioná-las aos mecanismos de trauma e identificar padrões de lesões. MÉTODOS: Foram descritas 23 luxações do joelho entre março de 2010 e março de 2011. Após o diagnóstico das lesões, foi procedida a redução e fixação externa transarticular das luxações. Num segundo tempo, os pacientes foram avaliados sob anestesia e a exploração cirúrgica das lesões periféricas foi feita pelos membros do grupo de cirurgia do joelho da instituição. Os dados dos pacientes, junto com as descrições das lesões encontradas, foram registrados. RESULTADOS: 65% dos pacientes eram do sexo masculino, a média de idade foi de 35 anos, o mecanismo de trauma mais comum foi o acidente com motocicleta (60%). A lesão do ligamento cruzado anterior (LCA) ocorreu em 75% dos casos, a lesão do ligamento cruzado posterior (LCP) em 95%. A lesão periférica medial aconteceu em 65% das luxações e as lesões laterais em 40%. As luxações mais comuns foram as classificadas como KDI (25%) e KDIIIm (25%). A lesão arterial esteve presente em 15% dos casos e a lesão nervosa foi registrada em um paciente (5%). Na avaliação radiográfica inicial, 45% das luxações apresentavam-se reduzidas. CONCLUSÃO: As luxações do joelho descritas apresentaram grande variabilidade, demonstrando que é preciso a avaliação individualizada de cada caso, sendo que o ortopedista precisa estar apto para o reconhecimento e tratamento específicos dessas diversas lesões. .

[Congenital dislocation of knee: results of the treatment in 29 cases between 1970 and 2010 years at Shafa Yahyaian Hospital in Tehran]

There are not many reports regarding the treatment approaches of congenital dislocation of the knee in the literature. Therefore, the preferred method of treatment of this rare congenital disease is still controversial. Hereby, we report the treatment outcome of 29 patients admitted in Shafa Yahyaian Hospital during 40 years. In this retrospective study done in Shafa Yahyaian Hospital in Tehran, Iran during 2010, we retrospectively reviewed the medical records of 29 patients treated conservatively or surgically for congenital dislocation of the knee. Patients had been evaluated for an average follow-up of 8.5 years. Overall, 54 knee dislocations had been treated surgically [58%] or conservatively [42%]. Range of knee motion, persistent recurvatum, instability, valgus deformity after treatment and limping were the more important factors reported in the two surgically or conservatively treated groups. Knee function was satisfactory in patients with conservative treatment. Despite 80% of instability in the operated knees, patients could ambulate with or without braces and had a range of motion equal to 80 degrees. Knee function was also good after quadricepsplasty with transarticular pins in selected cases. We recommend a conservative approach to the disease, regardless of the patient's age at the time of treatment and subsequent surgery in patients with dissatisfactory recovery. Quadricepsplasty with transarticular fixation is recommended as a good option in treating these patients. Posterior capsulorrhaphy for patients with CDK and ligamentous laxity is also recommended

Luxação traumática de joelho: análise clínica / Traumatic knee luxation: clinical analysis

Objetivo: comparar o resultado funcional final, obtido no tratamento da luxação traumática de joelho, com diferentes modalidades de tratamento. Pacientes e Método: na classificação das luxações, utilizou-se os critérios de Schenck e foram excluídos casos que apresentavam comorbidades que pudessem interferir no resultado funcional do joelho acometido.Os pacientes foram reexaminados e a avaliação constou dados objetivos e subjetivos:anamnese, exame físico e Escala de Lysholm. Resultados: a média de idade foi de 35,6 ±14,4 anos, com predomínio do gênero masculino. O mecanismo de trauma mais freqüente foi o acidente de trânsito. O padrão de luxação mais observado foi o KD-III. O ligamento cruzado posterior foi o mais lesado (86,8%), seguido pelo cruzado anterior (80%). Quatro pacientes (26,7%) tiveram lesão do nervo fibular comum, dois com recuperação completa.O tratamento cirúrgico na fase aguda foi realizado em 11 pacientes, dando-se prioridade para a reconstrução do ligamento cruzado posterior. A dor foi a queixa mais freqüente. Os pacientes operados, na fase aguda, obtiveram melhores resultados do que os tratados conservadoramente ou os operados na fase crônica. Não houve perda importante de amplitude de movimentos, mas foi observada a instabilidade residual, o que não chegou a limitar os pacientes na vida cotidiana. Conclusão: a luxação de joelho, sem dano vascular, tem bom prognóstico com tratamento adequado. Um grau variável de instabilidade residual é esperado e bem tolerado. Já o reparo ou reconstrução das lesões periféricas e do LCP (Ligamento Cruzado Posterior) foram satisfatórios, considerando-se os critérios subjetivos e objetivos.

Objective: to compare the final functional result, obtained in the treatment of traumatic knee luxation, with different treatment modalities. Patients and Methodology: the Schenk criteria were used in the luxations classification and the cases with comorbidities that might interfere in the impaired knee functional result were excluded. The patients were reexamined and the evaluation counted with objective and subjective data: anamneses, physical exam and Lysholm Scale...

Luxación abierta, intrauterina, rodila derecha: presentación de un caso / Open, intra-uterine luxación, right rodila: presentation of a case

La luxación traumática de rodilla es una de las lesiones más severas del miembro inferior y además una de las urgencias de manejo prioritario en Cirugía Ortopédica. Presentamos un caso clínico de un prematuro de 31 semanas de gestación por FUR, embarazo gemelar, tratado por comunicación arteriovenosa placentaria mediante cirugía endoscópica intrauterina a las 21 semanas, quien presentó una luxación posterior abierta de rodilla, traumática e intrauterina.

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.

Luxación de rodilla: tratamiento quirúrgico en casos agudos / Dislocation of the knee: surgical treatment in acute

Introducción: La luxación traumática de rodilla es una patología infrecuente con un alto subregistro, que implica un verdadero reto para el ortopedista por su gran variedad de presentación. Objetivo: Establecer un esquema de manejo quirúrgico para esta lesión compleja. Metodología: Estudio observacional, tipo serie de casos con pacientes del Hospital Universitario del Valle y del Centro Médico Imbanaco operados desde diciembre de 1999 hasta enero del 2003, se incluyeron 16 pacientes a quienes se repararon en forma aguda las estructuras extracapsulares y reinserción de los ligamentos cruzados en casos de avulsión. En los dos últimos pacientes se realizó reconstrucción simultánea del cruzado anterior y posterior con auto injerto, con un seguimiento de 12 a 50 meses con promedio de edad de 31 años y variacion de 13 a 64 años, 15 luxaciones cerradas y una expuesta, 14 sexo masculino y 2 sexo femenino, la luxación mas común fue la KDIII L según clasificación anatómica, un paciente con lesión vascular, dos con lesión del nervio ciático poplíteo externo y uno con ruptura del tendón patelar, los resultados se evaluaron de acuerdo a la escala de Lysholm, IKDC y del For Special Surgery. Conclusiones: El manejo agudo de las estructuras extrarticulares da los mejores resultados y debe motivarse a los ortopedistas a llevarlo a cabo, la reconstrucción de los cruzados es mas exigente y si no se tiene buena experiencia se debiera dejar para reconstrucción secundaria cuando el paciente tenga arco de movilidad normal.