Knee dislocations—a retrospective study comparing operative versus closed immobilization treatment outcomes

Controversies over operative versus closed immobilization of traumatic complex multiple ligamentous knee injury are still debated. The aim of our study is to evaluate the outcome of reconstructive vs non-reconstructive (closed immobilization) treatment outcomes. This is a retrospective review of cases seen at our institution. All cases admitted with a diagnosis of knee dislocation, defined as patients with multidirectional knee instability in the setting of trauma, were reviewed. Twenty-nine consecutive patients from January of 1996 to June of 2002 were reviewed. Twenty-six patients (89.7%) were successfully recalled and their functional outcome analyzed. Comparing the operated group (n=15, 57.7%) with closed immobilized patients (n=11, 42.3%), there was no statistical difference in the range of motion (mean difference 8.55°, p=0.202). While the operated group had more flexion contracture (mean difference 3.9°, p=0.002), they had better stability and better overall knee function as measured by the International Knee Documentation Committee (IKDC) score (the mean difference of IKDC score was 12.13, p=0.005). In the operated group of 15 patients, we compared partial repair (n=7) with complete repair of all torn ligaments (n=8). Superior results were noted in the group with complete repair of all structures, with comparable range of motion (mean difference 0.6°, p=0.861) and flexion contractures (mean difference 1.0°, p=0.795) but better stability and IKDC score (mean difference of IKDC score 13.6, p=0.003). Our conclusion is that operative treatment with complete repair of all torn structures produces the best overall knee function with better knee stability and patient satisfaction.