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Knee dislocations: experience at the hôpital du sacré-coeur de montréal

Original Article
Article original

Knee dislocations: experience at the
Hôpital du Sacré-Coeur de Montréal

Max Talbot, MD;* Greg Berry, MD;† Julio Fernandes, MD;‡ Pierre Ranger, MD‡ Introduction: Although many options exist for ligament reconstruction in knee dislocations, the opti-
mal treatment remains controversial. Allografts and autografts have both been used to reconstruct the
cruciate ligaments. We present the results of reconstruction using artificial ligaments at Hôpital du
Sacré-Coeur in Montréal. Methods: We reviewed the treatment of all patients with knee dislocations
seen between June 1996 and October 1999. The Lysholm score, ACL-quality of life (QoL) questionnaire,
physical examination and Telos instrumented laxity measurement were used to evaluate the results.
Results: Twenty patients (21 knees) participated in the study. The mean (and standard deviation [SD])
Lysholm score was 71.7 (18). Results from the ACL-QoL questionnaire showed a global impairment in
QoL. Mean (and SD) range of motion and flexion were 118° (10.9°) and 2° (2.9°) respectively. Mean
(and SD) radiologic laxity evaluated with Telos for the anterior and posterior cruciate ligaments were
6.1 (5.7) mm and 7.3 (4.5) mm respectively. Conclusions: Knee reconstruction with artificial ligaments
shows promise, but further studies are necessary before it can be recommended for widespread use. This
is the first study to show specifically a severe impairment in QoL in this patient population.
Introduction : Même s’il existe plusieurs possibilités de reconstruction ligamentaire dans les cas de luxa-
tion du genou, le traitement optimal suscite toujours la controverse. On a utilisé à la fois les allogreffes
et les autogreffes pour reconstruire des ligaments croisés. Nous présentons les résultats de reconstruc-
tions au moyen de ligaments artificiels effectuées à l’Hôpital du Sacré-Cœur à Montréal. Méthodes :
Nous avons passé en revue le traitement de tous les patients ayant subi une luxation du genou et qui ont
consulté entre juin 1996 et octobre 1999. On a utilisé le score de Lysholm, le questionnaire sur la quali-
té de vie (QdV) LCA, l’examen physique et la laxité mesurée au Telos pour évaluer les résultats. Résul-
tats :
Vingt patients (21 genoux) ont participé à l’étude. Le score médian de Lysholm (et l’écart type
[ET]) s’est établi à 71,7 (18). Les résultats du questionnaire QdV-LCA ont montré un déficit global de
la QdV. L’amplitude médiane (et l’ET) du mouvement et celle de la flexion se sont établies à 118 °
(10,9 °) et 2 ° (2,9 °) respectivement. La laxité radiologique médiane (et l’ET) mesurée au Telos dans le
cas des ligaments croisés antérieur et postérieur s’est établie à 6,1 (5,7) mm et 7,3 (4,5) mm respec-
tivement. Conclusions : La reconstruction de genou au moyen de ligaments artificiels est porteuse de
promesses, mais d’autres études s’imposent avant que l’on puisse en recommander l’application
générale. Il s’agit de la première étude qui montre spécifiquement un déficit grave de la QdV dans cette
population de patients.
Knee dislocations are uncommon ated injuries. Traditionally, the term with very low functional demands.
From the Division of Orthopædic Surgery, *Université de Montréal, †McGill University and ‡Hôpital du Sacré-Coeur de Montréal,Montréal, Que.
Accepted for publication Oct. 16, 2003.
Correspondence to: Dr. Greg Berry, McGill University Health Centre, Room B5 159.4, Division of Orthopædic Surgery, Montréal
General Hospital, 1650 Cedar Ave., Montréal QC H3G 1A4; fax 514 934-8394; greg.berry@muhc.mcgill.ca
Knee dislocations
according to a standardized protocol.
ate ligaments, cartilage and menisci.
anterior tibia to the PCL footprint.
on low-resistance stationary cycling.
Patients and methods
Can J Surg, Vol. 47, No. 1, February 2004 Talbot et al
amentous laxity and range of motion.
Discussion
difference. Clinical and radiologic laxi- ties were graded in the same manner.
paired t test was used to compare dif- ferent groups of patients. A p valueless than 0.05 was considered statisti- Anterior Cruciate Ligament Quality
Dislocations in 21 Knees According
of Life (QoL) Questionnaire Results
to the Classification of Schenck*
* Schenck RC Jr. The dislocated knee [review]. Instr Knee dislocations
ies.5–8,10,11,21–23 In all, there were 109 pa- with release of all intra-articular adhe- patients received uniform treatment.
since they have no healing potential.
Success or Failure of Knee
surgically treated knee dislocations.
Reconstruction in Patients
Followed for Longer Than 2 Years
Can J Surg, Vol. 47, No. 1, February 2004 Talbot et al
mentation device: a historical perspective.
Arthroscopy 1999;15:422-32.
13. Nau T, Lavoie P, Duval N. A new genera- tion of artificial ligaments in reconstruc- tion of the ACL. J Bone Joint Surg Br 14. Marshall JL, Warren RF, Wickiewicz TL, Reider B. The anterior cruciate ligament: a Competing interests: None declared for Drs.
technique of repair and reconstruction.
received travel expenses from J.K. Orthome- 15. Tegner Y, Lysholm J. Rating systems in dic Ltd. to present the preliminary results of this study at a convention related to the sub- the evaluation of knee ligament injuries.
16. Mohtadi N. Development and validation References
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