engleski

KNEE DISLOCATION AND SPORT

Management of knee dislocations remains variable and controversial. The purpose of this study is describe our method of surgical treatment of knee dislocations use of standardised protocol. According our experience conservative treatment may result with chronic multidirectional knee instability which is very difficult to treat. As many authors, we favour early surgical treatment, reconstruction of the injured ligamentous structures. As physicians, we must be knowledgeable in the current surgical techniques and rehabilitation protocol used in the treatment of knee dislocation. Because is rear injury, we suggested to do by experienced surgeon and not in every department. In the case of gross knee dislocation, which has not spontaneously reduced, should be reduced gently immediiately. Extremely important is to check possible vesse or nerve injury. After careful physical examination, X-ray, probably MRI we suggest surgical treatment within first three days. This injury need open surgery by long anterior arthrotomy and anatomical repair of all rupturedsoft tissue structures. For that, it is important to carefully check all of them, particularly both meisci, collateral ligaments, crutiate ligaments, but posteromedial and posterolateral corner too. In the case rupture of the posterolateral corner it is usefull check peroneal nerve, biceps tendon and attachment of tractus ileotibialis on the tuberositas Jardy. For that, second posterolateral approach is usefull. All structures have to be carefully repaired. We don’ t use allografts, but anterior crutiate ligament is often augmented with HS tendon. After surgery knee is immobilised with brace for four weeks in full extension. Treatment follow with progerssive flexion, and after eight weeks with full weight bearing. Full sport activity after six months. For last 5 years we follow 8 patients after acute knee dislocation. No vascular injury, but two of them had peroneal palsy, one completely recover after one year. In 3 cases had have hi sport activity level. All of them back to previous level of activity. With modern surgical tecnique and rehabilitation protocol, it is possible to achieve functional range of motion and stability necessary for everyday life and previous sport activity. Despite small number of our cases, we strongly recommend early surgical treatment. Conservative treatment, or delay surgical treatment, result with multidirectional instability which is very difficult to treat.

Knee; Dislocation; Sport; Surgical treatment

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