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Meta-Analysis
. 2013 Jul;21(7):1502-9.
doi: 10.1007/s00167-012-2154-8. Epub 2012 Aug 7.

Primary ligament sutures as a treatment option of knee dislocations: a meta-analysis

Karl-Heinz Frosch  1 , Achim Preiss, Saskia Heider, Dirk Stengel, Peter Wohlmuth, Martin F Hoffmann, Helmut Lill
Affiliations
Meta-Analysis

Primary ligament sutures as a treatment option of knee dislocations: a meta-analysis

Karl-Heinz Frosch et al. Knee Surg Sports Traumatol Arthrosc. 2013 Jul.

Abstract

Purpose: Treatment of knee dislocation is still controversial. There is no evidence to favour ligament suture or reconstruction. Until now, no meta-analyses have examined suture versus reconstruction of cruciate ligaments in knee dislocations with respect to injury pattern and rupture classification.

Methods: We searched Medline, the Cochrane Controlled Trial Database, and EMBASE for studies on surgical treatment for 'knee dislocation' and 'multiple ligament injured knee'. A meta-analysis was performed using individual patient data.

Results: Nine studies including 195 patients (200 knees) with a mean age of 31.4 (±13) years fulfilled the study requirements. Thirteen cases of type II dislocations, 63 cases of type III medial, 84 cases of type III lateral, and 40 cases of type IV dislocations, according to Schenck's classification, were found. Poor or moderate results were found in 70 % of patients without surgical treatment of ACL or PCL (n = 27). Patients (n = 40) treated by sutures of the ACL and PCL demonstrated a significantly greater proportion of excellent or good results (40 and 37.5 %, respectively) (p < 0.001). Patients who underwent reconstruction of the ACL and PCL (n = 75) showed excellent or good results (28 and 45 %, respectively). No significant difference was found when comparing suture versus reconstruction of the ACL and PCL (n.s.). The outcome depends considerably on Schenck's injury pattern classification.

Conclusion: Conservative treatment after knee dislocation yields poor clinical results. Suture repair of cruciate ligaments can still serve as an alternative option for multiligament injuries of the knee and achieve good clinical results, which are comparable to those of ligament reconstruction. The data provided by this meta-analysis should be reinforced by a prospective study, in which suture repair and ligament reconstruction are compared.

Level of evidence: IV.

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Figures

Fig. 1
Fig. 1
Study selection procedure
Fig. 2
Fig. 2
Mean values and standard deviations of grouped individual patient data are presented. Only patients with Type III and IV injuries were included. Clinical results depending on MCL (medial collateral ligament) and LCL (lateral collateral ligament) treatment. The grades of excellent, good, fair and poor were pooled as results from the Lysholm and/or IKDC Score. Operative treatment of the LCL led to significantly better results than conservative therapy. No significant difference between operative and conservative treatment of MCL could be detected
Fig. 3
Fig. 3
Mean values and standard deviations of grouped individual patient data are presented. Clinical results depending on ACL (anterior cruciate ligament) and PCL (posterior cruciate ligament) treatment. Ligament sutures (repair) and ligament reconstruction are compared with conservative treatment. The grades of excellent, good, fair and poor were pooled as results from the Lysholm and/or IKDC Score. No significant difference between suture repair and reconstruction could be detected. Operative treatment led to significantly better results than conservative therapy
Fig. 4
Fig. 4
Mean values and standard deviations of grouped individual patient data are presented. Clinical results depending on the pattern of the injury according to Schenck’s classification. The grades of excellent, good, fair and poor were pooled as results from the Lysholm and/or IKDC Score. Schenck Type IV injuries had a significantly worse outcome than lesser knee dislocation types
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References

    1. Almekinders LC, Dedmond BT. Outcomes of the operatively treated knee. Clin Sports Med. 2000;19:503–518. doi: 10.1016/S0278-5919(05)70221-0. - DOI - PubMed
    1. Balcarek P, Sawallich T, Walde TA, Ferlemann KG, Wachowski M, Stürmer KM, Frosch KH. Influence of cyclops syndrome after anterior cruciate ligament reconstruction on the functional outcome. Sportverletz Sportschaden. 2008;22(4):220–224. doi: 10.1055/s-2008-1027736. - DOI - PubMed
    1. Barnes CJ, Pietrobon R, Heggins LD. Does the pulse examination in patients with traumatic knee dislocation predict a surgical arterial injury? A meta-analysis. J Trauma. 2002;53:1109–1114. doi: 10.1097/00005373-200212000-00013. - DOI - PubMed
    1. Bin SI, Nam TS. Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation. Arthroscopy. 2007;23:1066–1072. doi: 10.1016/j.arthro.2007.05.008. - DOI - PubMed
    1. Fanelli GC, Edson CJ. Combined posterior cruciate ligament- posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up. Arthroscopy. 2004;20:339–345. doi: 10.1016/j.arthro.2004.01.034. - DOI - PubMed

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