Surgical management of traumatic knee dislocation.

PURPOSE: The purpose of this study was to evaluate our method of surgical treatment of traumatic knee dislocation, by use of a standardized protocol, and to report our clinical results. METHODS: Thirty-six consecutive patients presented with a grossly dislocated or reduced knee. Ten of these patients were not included in this series. Five had vascular or neurovascular injury. Three had open fracture dislocation, and two had associated severe injury. The remaining 26 patients were treated by primary arthroscopic reconstruction with autologous grafting of the anterior cruciate ligament, posterior cruciate ligament, and collateral ligaments. The anterior cruciate ligament and posterior cruciate ligament were reconstructed via the gracilis and semitendinosus tendons of the uninjured and injured limbs. The collateral ligaments were reconstructed via artificial ligaments (LARS Ligament; J. K. Orthomedic, Dollard-des-Ormeaux, Quebec, Canada). Of the 26 patients, 20 returned for subjective and objective evaluation at a minimum of 24 months after the operation. Early mobilization via a continuous passive motion machine and active exercise were started on the fourth day postoperatively. RESULTS: At a mean follow-up of 43 months, the mean Lysholm score was 91 points, the mean score on the survey of daily activities was 90 points, and the sports activities score on the Knee Outcome Survey averaged 86 points. On the basis of the rating of Meyers et al., the results were excellent in 5 patients, good in 12, fair in 2, and poor in 1. The final International Knee Documentation Committee rating was not normal in any knee, nearly normal in 9, abnormal in 9, and severely abnormal in 2. The mean loss of extension was 0 degrees to 2 degrees , and the mean loss of flexion was 10 degrees to 15 degrees . CONCLUSIONS: By use of the described method of arthroscopic-assisted reconstruction of the cruciate ligaments and repair or reconstruction of the collateral ligament and other injured structures, 45% of the patients had good subjective results and functional stability and 45% had satisfactory subjective and functional stability within 2 to 3 weeks after surgery. According to the International Knee Documentation Committee scale, 45% of knees were nearly normal, 45% were abnormal, and 10% were severely abnormal. No patient's rating returned to normal. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: patellar tendon versus gracilis and semitendinosus autograft.

PURPOSE: To evaluate the clinical results of anterior cruciate ligament (ACL) reconstruction in patients with ACL-deficient knee in 2 similar groups of patients. TYPE OF STUDY: A prospective randomized comparison of patellar tendon (PT) versus semitendinosus and gracilis tendon (STG) autografts for ACL reconstruction. METHODS: Between 1994 and 1996, 85 consecutive male patients with chronic ACL-deficient knees underwent arthroscopically assisted reconstruction with either autologous PT or double-loop STG (4-strand) graft. PT grafts were used in patients with even-numbered birth dates and STG grafts for those with odd-numbered birth dates. Preoperatively, no significant differences between the 2 groups were noted with respect to age, level of activity, and degree of laxity (chi-square analysis). A standardized rehabilitation program was used for both groups postoperatively that included immediate active extension and early weight bearing and gradual flexion. Return to sports was permitted 8 months postoperatively. Assessment of the patients was carried out using a questionnaire, clinical assessment, Lysholm knee scores, the International Knee Documentation Committee scale, and radiological examination. RESULTS: At a mean follow-up of 81 months, there was no significant difference between the 2 groups with respect to subjective complaints (recurrent giving way, functional level) or objective laxity evaluation, including KT-1000 measurement or return to sports. Loss of extension of < or =5 degrees was greater in the PT group (12 patients, 30 %) than in the STG group (8 patients, 17 %). There was loss of flexion of < or =15 degrees in 5 patients (12 %) in the PT group and 1 patient (2.2 %) in the STG group. Anterior knee pain was recorded in 10 patients (24 %) in the PT group and 3 patients (5 %) in the STG group. The Lysholm knee score was 91.6 and 92.7 for the PT and STG groups, respectively, and the Tegner activity score decreased from 8.9 preoperatively for both groups to 7.9 for the PT group and 7.8 for the STG group. CONCLUSION: In this study, the 2 groups had comparable results in terms of patient satisfaction, activity level, and knee function. Our study showed that patellofemoral problems and loss of knee motion are more frequent in patients with PT grafts than in those with STG grafts. LEVEL OF EVIDENCE: Level I, Randomized Controlled Trial.