Treatment of acute knee dislocations

Dislocation of the knee is a rare but severe injury. Knee dislocations occur mainly in young active male patients mainly due to high velocity injury mechanisms. Combined injuries of the anterior and posterior cruciate ligaments associated with injuries of the medial or lateral collateral ligaments are typical injury patterns in these cases. The early recognition and treatment of accompanying neurovascular injuries must be carefully considered and are decisive for the prognosis. Computed tomography angiography (CTA), X-radiography, magnetic resonance imaging (MRI) and fluoroscopic examination with the patient under anesthesia indicate the injury pattern and guide the treatment algorithm. According to current data conservative treatment seems to result in less favorable outcomes compared to surgical treatment. The decision-making process is influenced by multiple factors including injury pattern and associated injuries. The main aim of operative approaches is anatomically correct femorotibial alignment and stabilization of the knee joint. In the case of polytrauma or the presence of vascuar injuries, external fixation is recommended. Furthermore, reconstructive operative procedures in the first 14 days have advantages over delayed reconstruction procedures. Reconstruction strategies and techniques must be individually adapted to the injury pattern and are dependent among other things on hospital resources and experience of the surgeon. Despite optimal treatment and follow-up it is not uncommon for residual instability, functional and loading impairments to occur. Increased rates of early onset of arthrosis are to be expected.