Primary repair of multiligament knee injury with InternalBrace ligament augmentation

Multiligament injury of the knee usually occurs as a result of high-energy trauma causing tibiofemoral dislocation. These are rare but potentially limb-threatening injuries, frequently involving nerve or arterial damage and often leading to severe complex instability. Management generally favours surgical reconstruction of the affected ligaments, with controversy regarding optimal treatment. We present a severe multiligament knee injury (Schenk classification KD-IV involving both cruciate and both collateral ligaments) in a competitive showjumper. A combined arthroscopic/open technique of single-stage surgical repair and suture augmentation was used, repairing all affected ligaments. The patient made an excellent recovery, returning to work after 12 weeks and riding after 22 weeks. After 5-year follow-up, she has regained her previous level of competition without subsequent injury. Multiligament repair with suture augmentation is a viable approach to the management of knee dislocation injuries. We propose that this could provide superior outcomes to traditional reconstruction techniques using autograft or synthetic reconstruction.

Congenital dislocation of the knee in combination with Meyer-Gorlin syndrome: A case report

BACKGROUND: Meyer-Gorlin syndrome is a rare genetic and autosomal recessive disease that is characterized by the classical triad, including, microtia, very small size or complete patellar absence, and nanism. CLINICAL CASE: Herein, presented the first clinical case description of a Russian patient with Meyer-Gorlin syndrome in combination with congenital anterior shin dislocation. The main clinical disease manifestations are characterized by a combination of microtia, patellar pathology, and dwarfism. DISCUSSION: In the practice of pediatric orthopedic surgeons, cases of congenital knee dislocations are extremely rare, especially as part of any syndromes, which cause interest in the presented clinical case publication. Our patient analysis, as well as the patients described in the literature, showed the presence of typical clinical manifestations, which allowed us to suspect the presence of Meyer-Gorlin syndrome during a clinical examination. CONCLUSIONS: This report is the first case of combined congenital knee dislocation and Meyer-Gorlin syndrome with a diagnostic triad (short stature, microtia, and patellar aplasia) in the Russian Federation. Conservative treatment with constant traction and flexion must be carefully performed to avoid complications. Without the effect of conservative therapy, surgical treatment is indicated.

Popliteal Artery Injury Following Traumatic Knee Dislocation – Case Report

Knee dislocation is a devastating injury that can compromise the limb's viability. This trauma is associated with muscular and ligamentar extensive lesions. Obese patients can suffer of knee dislocation resultant from falls at the same level, and these “super-low” energy dislocations are associated with a surprising rate of neurovascular complications. The popliteal artery may be involved in up to 60% of cases, and the prognosis is considerably worse. In these cases an emergent approach is mandatory. Delayed diagnosis and treatment can result in up to 80% of amputations of the extremity. The authors present a patient that was admitted at the Emergency Room with knee pain and deformity after a fall at the same high. After the diagnose and reduction of the anterior dislocation, an echo-doppler and CT angiography were performed, and revealed a lesion in popliteal artery. After immobilized with a long leg plaster cast, the patient was transferred to a hospital with Vascular Surgery Department, and underwent revascularization of the limb. Despite the severity of the vascular injury the patient had a very good outcome.

Vascular and Neurological Injury in Children With Posterior Traumatic Knee Dislocation

Posterior knee dislocations (PKD) in children are uncommon but may be associated with vascular injury. The purpose of this study is to characterize the frequency of vascular injury in PKD as well as define patient characteristic, procedures, types of treating hospitals, and clinical outcomes. This study utilized the National Trauma Data Set (NTDS) from the American College of Surgeons on years 2015 and 2016. All demographic and clinical data on pediatric patients (≤18 years) with the ICD codes for PKD were obtained. 44 PKD were identified. The median age was 17 years [IQR 15,18], 70% male; 49% white. The mean body mass index was 29.6 [IQR 23-38]. We found that vascular injury was present in 16 patients (36%); 14 (30%) underwent repair (eight with saphenous vein graft) and fasciotomies in eight patients. Nerve injury was present in five patients (11%). Lower extremity amputation was performed in three patients (7%).

Total Knee Arthroplasty to Treat Acute Knee Dislocation Associated With Osteoarthritis: a Case Report

Background: Knee dislocation (KD) is a common disease in the young people. It is rare to report treatment of the KD associated with osteoarthritis (OA) in the old population. In this case report, we present two cases in which total knee arthroplasty (TKA) was performed to treat acute KD associated with osteoarthritis (OA) in two female patients. Methods: The two patients underwent knee injuries and limited range of motion (ROM). After diagnosing acute KD, including KD II and KD III-M, associated with OA with X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) investigations, we considered TKA to be the best management.Results: TKA was successfully used to treat acute KD associated with OA, and the patients achieved significant improvements in their clinical and functional outcomes.Conclusion: Acute KD associated with OA could be an indication for TKA. However, early TKA procedures can lead to a risk of arthrofibrosis and joint stiffness.Level of evidence V.

Demographic analysis of knee dislocation: A rare mechanism of injury

Purpose The aim of this study was to present to the literature a rare injury mechanism that causes knee dislocation (KD) and describe its characteristics. Methods A retrospective review of patients with KD who were treated between January 2014 and December 2019 at our hospital was performed. Patients with KD due to rotavator machine injury were included in Group 1 and all patients with KD due to other etiological reasons were included in Group 2. Patients’ age, gender, side, injury mechanism, time to surgery, length of stay (LOS), operation time, follow-up time, neurological injury status, vascular injury status, open injury status, and surgical interventions were evaluated. Results A total of 34 patients were evaluated in the study. There was no statistically significant difference between the groups in terms of age, gender, side, or follow-up time ( p = .915, p = 1.000, p = .682, p = .374, respectively). However, LOS and time to surgery were statistically significantly longer in Group 1 ( p = .037, p = .010, respectively). Moreover, neurovascular damage was statistically significantly more common in Group 1. Conclusion As a rare injury mechanism for KD, rotavator machine injuries cause more neurovascular injuries in patients compared to other injury mechanisms and increase the time to surgery and LOS due to preoperative soft tissue damage.