Knee dislocations: an evaluation of surgical and conservative treatment.

BACKGROUND We evaluated the results of surgical or non-operative treatment of knee dislocations and the effect of associated soft tissue injuries on the planning of treatment. METHODS The study included 12 patients (10 males, 2 females; mean age 34 years; range 17 to 75 years). Knee dislocations were caused by low-energy injuries in five patients, and by high-energy injuries in seven patients. All the knees were dislocated posteriorly. Three dislocations were open. Three patients had popliteal artery injuries and three patients had peroneal nerve injuries. Dislocations affecting the anterior and/or posterior cruciate ligaments were treated surgically (n=6), whereas the medial collateral ligament and lateral ligament injuries were treated non-operatively (n=6). The Lysholm scores and the range of motion of the knees were compared between surgically and conservatively treated groups. The mean follow-up period was 46 months (range 26 to 82 months). RESULTS The mean range of motion of the knees (116 degrees versus 72 degrees ; p<0.01) and the mean Lysholm scores (84.6 versus 74; p<0.01) differed significantly between patients undergoing surgical and non-operative treatment. Chronic laxity occurred in two knees (one with surgical, one with conservative treatment). Arthrofibrosis developed in four patients (one with surgical, three with conservative treatment). There were no deep infections. Superficial infections occurred in two open dislocations. CONCLUSION Knee dislocations should be regarded as significant limb-threatening injuries. Evaluation and immediate treatment of vascular insufficiency is of primary importance. Then, treatment depending on the presence and severity of ligamentous injuries is essential to provide a stable and functional extremity.