Cutting edge Orthopedics

Knee Dislocations • 47  What is required to definitively answer many of these questions is prospective studies looking at specific treatment options: in particular, open versus arthroscopic treatment and primary repair versus reconstruction. Studies involving multiple treatment centers may also be required in order to obtain adequate data on these injuries. Evidentiary Table and Selection of Treatment Method Table 2 [13, 15, 17, 19, 22, 26, 34, 35, 42] presents a summary of the quality of evidence for early operative open treatment of knee dislocations with reconstruction of the posterolateral corner. The goal of treatment in MS is to restore stability and function of the knee. In the past 20 years with improved operations and postoperative rehabilitation regimens, the literature clearly demonstrates better outcomes with operative treatment as compared to nonoperative treatment Table 2: Evidentiary table: a summary of the quality of evidence for early operative open treatment of knee dislocations with reconstruction of the posterolateral corner. Author (year) Description Summary of results Level of evidence Dedmond et al. (2001) [13] Meta-analysis Compared 132 knee dislocations treated operatively to 74 treated nonoperatively. Lysholm knee scores, 85.2 in operative group compared to 66.5 in nonoperative group I Frosch et al. (2013) [22] Meta-analysis Compared 27 nonsurgically treated, 40 sutured, and 75 reconstructed ACL/PCL injuries involving knee dislocations. Surgically managed patients had significantly better clinical outcomes IV Harner et al. (2004) [15] Retrospective cohort study Compared 19 knees treated early (within 3 weeks) to 12 treated delayed (average 6.5 months). Lysholm knee scores 91 in early group versus 80 in delayed group III Ibrahim et al. (2013) [42] Case series Reported a mean Lysholm score of 90 points in 20 patients treated by primary arthroscopic reconstruction at a mean follow-up time of 44 months IV Fanelli et al. (2002) [26] Prospective cohort study Reported 35 knees treated with arthroscopically assisted cruciate reconstruction with open collateral reconstruction. Average Lysholm knee scores 91.2 III McCarthy et al. (2015) [34] Retrospective cohort study Compared 26 knees (17 reconstructed and 9 repairs) at a mean of 38 months for reconstructions and 42 months for repairs postoperatively. Lysholm scores, IKDC, and failures were not significantly different IV Owens et al. (2007) [17] Retrospective cohort study Reported 28 knees treated with early open primary repair of torn ligaments. Average Lysholm knee score 89.0 IV Stannard et al. (2012) [35] Retrospective cohort study Compared PMC repair in 25 patients experiencing 5 (20%) failures versus reconstruction in 48 patients with 2 failures (4%) IV Stannard et al. (2005) [19] Prospective cohort study Compared 35 PLC repaired primarily to 22 PLC undergoing reconstruction. Primary repair with higher failure rates (37% versus 9%). Equivocal Lysholm knee scores II