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One-Stage Arthroscopic Reduction Combined With Reconstruction of Knee Stability for Irreducible Knee Dislocation: A
Yang Sun1, Wei Zhao2, Shengshan Ma1
1Department of Sports Medicine, The First People's Hospital of Lianyungang, Affiliated Hospital of Xuzhou Medical University, Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China.
Background:
Irreducible knee dislocation (IKD) is a rare but severe injury, accounting for approximately 4% of all knee dislocations and characterized by soft tissue incarceration that precludes closed reduction. Current management remains debated, particularly regarding the optimal timing of ligament reconstruction (single- vs. two-stage) and the choice of surgical approach.
Purpose:
To investigate the short-term efficacy and outcomes of 1-stage arthroscopic reduction combined with reconstruction of knee stability for irreducible knee dislocation (IKD).
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A total of 16 patients with IKD, treated with 1-stage arthroscopic surgery between June 2015 and July 2022, were included in this study. The surgery involved arthroscopic knee reduction and simultaneous multiligament reconstruction or repair. Side-to-side differences determined with a KT-1000 arthrometer and physical examinations-including the Lachman test, the pivot shift test, the drawer test, and the varus and valgus stress test-were performed for the evaluation of knee joint stability. Other assessments included the International Knee Documentation Committee (IKDC) score, the Lysholm score, pain scores, and satisfaction scores. A paired t test was used to determine the difference between the pre- and postoperative clinical outcomes.
Results:
One patient experienced traumatic redislocation at 1 month due to noncompliance with bracing and was excluded from functional outcome analysis. The remaining 15 patients completed a 2-year follow-up. For all patients included in this study, the mean time from injury to surgery was 5.5 ± 1.4 days, and the mean follow-up time was 27.4 ± 2.6 months. At the last follow-up, all patients had normal or nearly normal Lachman, pivot shift, drawer, and varus and valgus stress tests. The IKDC score was 76.07 ± 2.84 (range, 70-82), the Lysholm score was 81.87 ± 4.22 (range, 74-87), and the pain score was 1±1 (range, 0-3). The satisfaction score was 8.53 ± 0.74 (range, 7-10), which significantly improved compared with the preoperative score (P < .05). No severe complications-including infection, compartment syndrome, neurovascular complications, graft ruptures, or deep vein thrombosis -were observed during follow-up.
Conclusion:
One-stage arthroscopic reduction, combined with reconstruction of knee stability, can effectively restore knee stability and improve clinical outcomes in the treatment of IKD.