Surgical treatment of traumatic knee dislocation in elite athletes - What longterm outcome can we expect? A longterm study and review of the literature
Friederich NF 1,2 Hirschmann MT2, Zimmermann N2, Müller We2, Hudetz 2,3, Candrian C2, Rychen T2,
1. Center of Biomechanics, University of Basel, CH-4056 Basel, Switzerland
2. Department of Orthopaedic Surgery and Traumatology, CH-4101 Bruderholz, Basel, Switzerland
3. University Hospital Sveti Duh, HR 1000- Zagreb
Background: Traumatic knee dislocations represent a deleterious injury, particularly for
athletes having highest demands on their knee function.
Hypothesis/Purpose: Our aim was to analyze the long-term outcomes and return to sport of
elite athletes treated surgically according to a standardized treatment protocol and to identify
predictive factors for a successful outcome. This presentation includes too a review of the
current literature.
Study Design: Retrospective consecutive case series
Methods: All elite athletes treated surgically (n=26) underwent an open complete single
stage reconstruction/refixation or repair of the cruciates and collateral ligaments including the
posterolateral corner. Return to sport and activity level preinjury and postoperatively were
recorded. With a mean follow up of 10±8 years 24 patients (92% follow up rate) were
evaluated for visual analogue scale (pain, satisfaction), instrumented anterior-posterior laxity
(KT-1000), International Knee Documentation Committee form IKDC, American Knee Society
score and Lysholm and Tegner score. Standard weight bearing and stress radiographs were
performed.
Results: 79% of patients returned to their previous sport in mean time 8±8 months with 2/5
of them returning to preinjury levels. 8% had a VAS pain >3. Most patients had a full range of
motion, 13% showed a flexion deficit >15° and 8% an extension deficit >10°. The mean sideto-side differences for anterior and posterior laxity were 2.5±1.3mm and 2.5±1.2mm
respectively.
The total IKDC score was normal in 16 and abnormal in 8 patients. The mean Lysholm score
was 84.7±18.4. The median Tegner score decreased from 9 (7-10) to 7 (2-10). The mean
American Knee Society score was 187.5±13.0. The mean side-to-side differences in stress
radiographs in 30° and 90° flexion were 1.0±1.5/1.5±4.1mm and 2.5±5.1/3.0±5.5mm
respectively. Patients who underwent treatment longer than 20 days from injury
demonstrated a poorer outcome as 3 measured by satisfaction and relative Tegner score.
This group was also unsuccessful returning to sport compared to patients treated earlier.
Conclusions: Athletes treated by early open complete single stage reconstruction within 2040 days from injury showed favorable results to those treated later. Although 2/3 of patients
had good functional outcome scores and stress radiographs proved ligamentous stability and
longevity, only 2/5 of athletes reached their identical sport activity level
References:
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ligament injuries in complex knee trauma. The American Journal of Knee Surgery, Vol 13(2):74-82, 2000
2. Hirschmann MT, Iranpour F, Müller W, Friederich NF: Surgical treatment of complex bicruciate knee ligament injuries in
elite athletes: What outcome can we expect. Am J Sports Med 38:1103-1109, 2010; DOI 10.1177/0363546509356978
(March 9, 2010)
3. Hirschmann MT, Zimmermann N, Rychen T, Candrian C, Hudetz D, Lorez LG, Ameler F, Müller W, Friederich NF: Clinical
an radiological outcomes after management of traumatic knee dislocation by open singel stage complete reconstruction.
BMC Musculoskeletal Disorders 2010. 11:102. DOI 10.1186/1471-2474-11-102
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cruciale ligament reconstruction and nonanatomical popliteus bypass. Internations Orthopedics (SICOT): DOI
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mjeseci nakon luksacije koljena povratak na svjetski vrh – Unbeliveable comeback of young Janica Kostelic return to the top
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