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BACKGROUND: The evaluation and management of knee dislocations remain variable and controversial. The purpose of this study was to describe our method of surgical treatment of knee dislocations with use of a standardized protocol and to report the clinical results. METHODS: Forty-seven consecutive patients presented with an occult (reduced) or grossly dislocated knee. Fourteen of these patients were not included in this series because of confounding variables: four had an open knee dislocation, five had vascular injury requiring repair, three were treated with external fixation, and two had associated injury. The remaining thirty-three patients underwent surgical treatment for the knee dislocation with our standard approach. Anatomical repair and/or replacement was performed with fresh-frozen allograft tissue. Thirty-one of the thirty-three patients returned for subjective and objective evaluation with use of four different knee-rating scales at a minimum of twenty-four months after the operation. RESULTS: Nineteen of the thirty-one patients were treated acutely (less than three weeks after the injury) and twelve, chronically. The mean Lysholm score was 91 points for the acutely reconstructed knees and 80 points for the chronically reconstructed knees. The Knee Outcome Survey Activities of Daily Living scores averaged 91 points for the acutely reconstructed knees and 84 points for the chronically reconstructed knees. The Knee Outcome Survey Sports Activity scores averaged 89 points for the acutely reconstructed knees and 69 points for the chronically reconstructed knees. According to the Meyers ratings, twenty-three patients had an excellent or good score and eight had a fair or poor score. Sixteen of the nineteen acutely reconstructed knees and seven of the twelve chronically reconstructed knees were given an excellent or good Meyers score. The average loss of extension was 1°, and the average loss of flexion was 12°. There was no difference in the range of motion between the acutely and chronically treated patients. Four acutely reconstructed knees required manipulation because of loss of flexion. Laxity tests demonstrated consistently improved stability in all patients, with more predictable results in the acutely treated patients. CONCLUSIONS: Surgical treatment of the knee dislocations in our series provided satisfactory subjective and objective outcomes at two to six years postoperatively. The patients who were treated acutely had higher subjective scores and better objective restoration of knee stability than did patients treated three weeks or more after the injury. Nearly all patients were able to perform daily activities with few problems. However, the ability of patients to return to high-demand sports and strenuous manual labor was less predictable.

Over the past thirty years, the subspecialty of sports medicine has evolved into a major component of the practice of orthopaedic surgery. Since its genesis in the early 1970s, sports medicine has evolved from the province of a small group of orthopaedists covering athletic teams into a major body of knowledge fueled by clinicians, scientists, and industry. Well-established educational curricula defining and prioritizing all areas of sports medicine now exist at the resident, fellowship, and subspecialty-society levels. The purpose of this article is to review and to put into perspective recent scientific and educational advancements in sports medicine. This overview is based on papers presented in 2000 at both the annual and subspecialty meetings of the American Orthopaedic Society for Sports Medicine (AOSSM), the Arthroscopy Association of North America (AANA), the Orthopaedic Research Society (ORS), and the American Academy of Orthopaedic Surgeons (AAOS). Papers published from September 1999 through August 2000 in the American Journal of Sports Medicine (six volumes), Arthroscopy (twelve volumes), and The Journal of Bone and Joint Surgery (twelve volumes) are reviewed, and their major contributions to orthopaedic sports medicine are summarized. This general overview of papers and presentations is followed by a summary of new developments in the study of the knee and shoulder as well as in other aspects of sports medicine, a discussion of emerging technologies in basic-science research, and an update on educational and socioeconomic issues. Between September 1999 and August 2000, research in orthopaedic sports medicine was featured in over 250 oral presentations at the annual and Specialty Day meetings of the American Orthopaedic Society for Sports Medicine, the Arthroscopy Association of North America, the Orthopaedic Research Society, and the American Academy of Orthopaedic Surgeons. Almost two-thirds of the studies focused on surgical techniques or clinical outcomes data, with just over a …

Question: In asymptomatic patients, what is the clinical course of meniscal lesions diagnosed by magnetic resonance imaging? Design: Inception cohort study with follow-up of ≥2 years (mean, 30 mo). Setting: An orthopaedic hospital in Zurich, Switzerland. Patients: 100 patients who were referred for magnetic resonance imaging for suspected meniscal lesions in one knee and no symptoms in the other were followed. Patients were ≥18 years of age, had no pain in the asymptomatic knee before presenting for magnetic resonance imaging, had not experienced disruptions of work or sports activity because of knee problems, and had not had knee surgery. 84 patients (mean age, 44 y; 57% men) completed the study. Assessment of prognostic factors: Magnetic resonance imaging was used to assess meniscal lesions of the asymptomatic knee. 53 knees had normal menisci, 26 had horizontal or oblique partial-thickness tears, 1 had a radial tear, 2 had vertical or full-thickness tears, and 2 had tears with displaced meniscal fragments. Main outcome measure: The adapted Knee Injury and Osteoarthritis Outcome Score (KOOS), which assessed pain, stiffness, and function with use of visual analogue scales (VAS). Main results: More patients with meniscal tears than those without meniscal tears reported having some pain, stiffness, and impaired daily function; however, the mean VAS scores for these outcomes did not differ between patients with and without meniscal tears (Table). None of the initially asymptomatic knees underwent surgery during follow-up.

The objectives of this study were to determine the effects of hamstrings and quadriceps muscle loads on knee kinematics and in situ forces in the posterior cruciate ligament of the knee and to evaluate how the effects of these muscle loads change with knee flexion. Nine human cadaveric knees were studied with a robotic manipulator/universal force-moment sensor testing system. The knees were subjected to an isolated hamstrings load (40 N to both the biceps and the semimembranosus), a combined hamstrings and quadriceps load (the hamstrings load and a 200-N quadriceps load), and an isolated quadriceps load of 200 N. Each load was applied with the knee at full extension and at 30, 60, 90, and 120 degrees of flexion. Without muscle loads, in situ forces in the posterior cruciate ligament were small, ranging from 6+/-5 N at 30 degrees of flexion to 15+/-3 N at 90 degrees. Under an isolated hamstrings load, the in situ force in the posterior cruciate ligament increased significantly throughout all angles of knee flexion, from 13+/-6 N at full extension to 86+/-19 N at 90 degrees. A posterior tibial translation ranging from 1.3+/-0.6 to 2.5+/-0.5 mm was also observed from full extension to 30 degrees of flexion under the hamstrings load. With a combined hamstrings and quadriceps load, tibial translation was 2.2+/-0.7 mm posteriorly at 120 degrees of flexion ut was as high as 4.6+/-1.7 mm anteriorly at 30 degrees. The in situ force in the posterior cruciate ligament decreased significantly under this loading condition compared with under an isolated hamstrings load, ranging from 6+/-7 to 58+/-13 N from 30 to 120 degrees of flexion. With an isolated quadriceps load of 200 N, the in situ forces in the posterior cruciate ligament ranged from 4+/-3 N at 60 degrees of flexion to 34+/-12 N at 120 degrees. Our findings support the notion that, compared with an isolated hamstrings load, combined hamstrings and quadriceps loads significantly reduce the in situ force in the posterior cruciate ligament. These data are in direct contrast to those for the anterior cruciate ligament. Furthermore, we have demonstrated that the effects of muscle loads depend significantly on the angle of knee flexion.