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Injury factors, surgical timing important in treatment of knee dislocations
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ORLANDO — In a presentation at the Arthroscopy Association of North America Annual Meeting, Bruce A. Levy, MD, noted the importance of recognizing whether a knee dislocation is a limb-threatening injury.
For patients who present with high-energy knee trauma, Levy recommends surgeons acquire an ankle brachial index.
“If the [ankle brachial index] ABI is greater than or equal to 0.9, the odds of having a major arterial lesion are zero — 100% negative predictive value,” Levy said in his presentation.
Patients with an ABI less than 0.9 should undergo CT angiogram, which Levy noted is fast, less invasive than conventional angiography, has one-fourth the radiation exposure and has high sensitivity.
Vascular lesions also affect outcomes of a dislocated knee, according to Levy. He cited results from a previously published study which showed patients with a vascular lesion that required a popliteal artery bypass graft experienced significantly lower functional outcomes than patients without a vascular lesion.
Levy also reviewed results on patients with vs. those without peroneal injury, which showed a higher restoration of normal anti-gravity dorsiflexion among patients with partial nerve palsy.
“No matter what we did to that nerve, only 38% [of patients] regained anti-gravity dorsiflexion if they had a complete peroneal nerve palsy,” Levy said.
Levy noted that optimal surgical timing for the dislocated knee is still unknown, with previous research showing an increase of arthrofibrosis with early surgery despite improvement in patient outcomes, as well as good outcomes with staged surgery. He said a new, multicenter randomized clinical trial to compare early vs. delayed surgery of the dislocated knee is underway.
“[There are] two arms in the trial: Patients are randomized to acute vs. delayed surgery and early vs. delayed rehab,” Levy said. “So, hopefully, this trial will shed some light on optimal patient outcomes.” – by Casey Tingle
Reference:
Levy BA. Dislocated knee: Current concepts. Presented at: Arthroscopy Association of North America Annual Meeting; May 2-4, 2019; Orlando.
Disclosure: Levy reports he receives IP royalties from Arthrex Inc.; is a paid consultant for Arthrex Inc. and Smith & Nephew; receives research support from Biomet, Smith & Nephew and Stryker; and is on the editorial or governing board of Clinical Orthopaedics and Related Research, Journal of Knee Surgery, Knee Surgery, Sports Traumatology, Arthroscopy and Orthopedics Today.