Surgical Outcomes of Medial Versus Lateral Multiligament-Injured, Dislocated Knees

Abstract

Purpose: To compare clinical and functional outcomes of surgically treated medial and lateral knee dislocations.

Methods: A retrospective review of the medical records of patients who presented with knee dislocations was conducted. We identified patients who underwent surgical treatment of KDIII-M (anterior cruciate ligament/posterior cruciate ligament/medial collateral ligament) or KDIII-L (anterior cruciate ligament/posterior cruciate ligament/lateral collateral ligament) knee dislocation as documented by the Schenck classification. Minimum 2-year follow-up with Lysholm and International Knee Documentation Committee (IKDC) outcome scores was required for inclusion. Postoperative range of motion, ligamentous examination, and conversion to total knee arthroplasty were also collected. Data were analyzed using univariate and multivariate statistical models with P < .05 considered significant.

Results: A total of 56 patients met the inclusion criteria, 24 with the KDIII-M injury pattern (43%) and 32 with the KDIII-L injury pattern (57%), with a mean age of 34 years (range, 16 to 62 years) and a mean follow-up of 6.5 years (range, 2 to 20 years). Patients undergoing medial repairs had worse outcomes for both the Lysholm score (P = .008) and IKDC score (P = .003). In addition, female sex was linked to worse outcomes (Lysholm score, 58.8 ± 21.5 v 77.8 ± 21.1, P < .01; IKDC score, 54.9 ± 23.7 v 75.2 ± 20.2, P < .01). No differences in outcome were found between patients with and patients without peroneal nerve injury (Lysholm score, P = .81; IKDC score, P = .77). No difference in laxity testing was found between the 2 groups.

Conclusions: In patients undergoing multiligament knee reconstruction, our data suggest that those who undergo medial repair for knee dislocations are not as likely to achieve positive results as those who undergo reconstruction or lateral reconstruction/repair, regardless of the status of the peroneal nerve. In addition, medial reconstruction had comparable outcomes to those in patients treated with lateral reconstruction/repair. Lastly, female patients showed less favorable clinical outcomes than male patients.

Level of evidence: Level III, retrospective comparative study.