Cutting edge Orthopedics

Knee Dislocations • 41  3. Allow for stable, concentric early motion to prevent arthrofibrosis and end-stage arthritis of the knee 4. Return to normal life activities Treatment options include: 1. Nonoperative management 2. Open primary repair 3. Delayed arthroscopic reconstruction 4. A staged approach using a combination of primary repair and reconstruction Evaluation of the Literature In order to identify the relevant publications on knee dislocations, Medline and PubMed searches were performed. The term “knee dislocation” was queried, and the search was limited to 1970 to 2011. A total of 2176 articles were identified. These were then searched according to differ- ent subheadings including “surgical treatment,” “nonoperative treatment,” “primary repair,” and “reconstruction.” A total of 187 articles were read and reference lists were reviewed. We selected prospective or comparative articles and retrospective articles that addressed a specific question in management if no prospective or comparative data were available. We also included a consensus guideline. Outcome Measurements In terms of understanding the literature regarding ligamentous knee injuries, one must under- stand the outcome measurements. Clinical outcome measurement includes range of motion, liga- ment stability, and revision rate due to failure of repair or reconstruction. The most commonly used functional outcome measurements in studies involving acute knee dislocations are the Lysholm knee score, the Tegner activity scale, and the IKDC (International Knee Documentation Committee) score [13–19]. The Lysholm knee scale assesses functional knee outcome based on limp, swelling, locking, pain, support, instability, stair climbing, and squatting. A score of 0–100 is given with 95–100 being excellent, 84–94 good, 65–83 fair, and 64 and below poor. The Tegner activity scale assesses a patient’s activity level in order to negate the confounding effect of a less- active patient versus a more-active patient on Lysholm knee score. Tegner knee scores are based on the activity level of a postoperative patient. It scores patients on a scale of 0–10 with a score of 10 representing patients competitive in high-demand sports at an elite level, a score of 6 being allocated for patients playing recreational sports, and finally 0 being a person on disability or sick leave. The IKDC score is based on a series of questions about symptoms, sports activities, and daily function. It gives a score of 18–100 with a score of 100 as being asymptomatic with full return to sports and no limit in daily activities.