Dynamic intraligamentary stabilization and primary repair: a new concept for the treatment of knee dislocation

Sandro Kohl; Anna Stock; Sufian S Ahmad; Matthias Zumstein; Marius Keel; Aristomenis Exadaktylos; Hendrik Kohlhof; Stefan Eggli; Dimitrios Stergios Evangelopoulos

doi:10.1016/j.injury.2014.10.012

Dynamic intraligamentary stabilization and primary repair: a new concept for the treatment of knee dislocation

Injury. 2015 Apr;46(4):724-8. doi: 10.1016/j.injury.2014.10.012. Epub 2014 Oct 16.

Authors

Sandro Kohl¹, Anna Stock¹, Sufian S Ahmad¹, Matthias Zumstein¹, Marius Keel¹, Aristomenis Exadaktylos², Hendrik Kohlhof¹, Stefan Eggli³, Dimitrios Stergios Evangelopoulos⁴

Affiliations

¹ Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland.
² Department of Emergency Medicine, University of Bern, Switzerland.
³ Sonnenhof Orthopaedic Clinics, Bern, Switzerland.
⁴ Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland; 3rd Department of Orthopaedic Surgery, KAT Hospital, University of Athens, Greece. Electronic address: ds.evangelopoulos@gmail.com.

PMID: 25456494
DOI: 10.1016/j.injury.2014.10.012

Abstract

Background: Traumatic knee dislocation represents a rare but devastating injury. Several controversies persist regarding type of treatment, surgical timing, graft selection, repair versus reconstruction of the medial and lateral structures, surgical techniques and postoperative rehabilitation. A new technique for primary ACL stabilization, dynamic intaligamentary stabilization (DIS) was developed at the authors' institution. The purpose of this study was to analyze the clinical and radiological outcomes of surgically treated traumatic knee dislocations by means of the DIS technique for the ACL, primary suturing for PCL, MCL and LCL.

Methods: Between 2009 and 2012, 35 patients treated surgically for traumatic knee dislocation with primary anterior cruciate ligament (ACL) reconstruction with DIS, suturing of the posterior cruciate ligament (PCL) and primary complete repair of collaterals, were evaluated clinically (IKDC score, SF12 health survey, Lysholm score, Tegner score) and radiologically with a mean follow up of 2.2 years (range 1.00-3.50 years) years. Instrumented anterior-posterior translation was measured (KT-2000).

Results: Anterior/posterior translation (KT-2000) for the healthy and injured limb was 4.8mm (range 3-8mm) and 7.3mm (range 5-10) (89N) respectively. Valgus and varus stress testing in 30° flexion was normal in 26 (75%) and 29 (83%) patients, respectively. The IKDC score was B in 29 (83%) and C in 6 (17%) patients, while the mean Tegner score was 6 (range 4-8). The mean Lysholm score was 90.83 (range 81-95) and mean SF-12 physical and mental scores were 54.1 (range 45-60) and 51.0 (range 39-62) respectively. In 2 patients, a secondary operation was performed.

Conclusions: Early, one stage reconstruction with DIS can achieve good functional results and patient satisfaction with overall restoration of sports and working capacity without graft requirements.

Keywords: Acute ligament repair; Dislocation; Dynamic intraligamentary stabilization; Knee.

Publication types

Evaluation Study

MeSH terms

Adolescent
Adult
Anterior Cruciate Ligament / surgery*
Anterior Cruciate Ligament Injuries
Anterior Cruciate Ligament Reconstruction*
Female
Follow-Up Studies
Fracture Healing*
Humans
Knee Dislocation / physiopathology
Knee Dislocation / rehabilitation
Knee Dislocation / surgery*
Male
Middle Aged
Patient Satisfaction / statistics & numerical data*
Range of Motion, Articular
Recovery of Function
Suture Techniques
Trauma Severity Indices
Treatment Outcome