BACKGROUND Congenital knee dislocation(CKD)is a rare condition,which accounts for 1%of congenital hip dislocations.It can present as an isolated condition or coexist with other genetic disorders.Treatment options incl...BACKGROUND Congenital knee dislocation(CKD)is a rare condition,which accounts for 1%of congenital hip dislocations.It can present as an isolated condition or coexist with other genetic disorders.Treatment options include serial casting,percutaneous quadriceps recession,and V-Y quadricepsplasty(VYQ).The pathogenesis and hereditary patterns of CKD are not fully understood,with most cases being familial.CKD is usually managed immediately after birth.However,in this report,the patient was neglected for 2 years.CASE SUMMARY A 2-year-old girl with bilateral CKD after birth presented to our hospital after failed serial casting;the patient had seizures and limited access to healthcare because of her family’s low socioeconomic status.Her birth was noted for a breech presentation accompanied by oligohydramnios.The delivery took a long time,requiring immediate medical interventions.As an infant,she had chronic diseases,including a small patent ductus arteriole,multicystic dysplastic kidney disease,and epilepsy.She was found to have a bilateral knee dislocation of approximately-90°on hyperextension.A multidisciplinary team was involved,and medical care was optimized.She underwent VYQ plus semitendinosus and sartorius transfer.After four postoperative follow-ups,her knees were regaining mobility,and she could walk for 2-3 steps without assistance.CONCLUSION This report highlights the importance of early intervention and recommends extensive studies of the management in similar cases.展开更多
Introduction: Neglected knee dislocation is an unusual injury, only a few cases have been reported in the literature. The circumstances of onset are generally an unnoticed knee dislocation in a polytrauma context or a...Introduction: Neglected knee dislocation is an unusual injury, only a few cases have been reported in the literature. The circumstances of onset are generally an unnoticed knee dislocation in a polytrauma context or a delay in consultation after the initial trauma. Presentation of case: We report the case of a 48-year-old female patient who sustained a knee injury during a domestic accident. Initial treatment was traditional and was followed for 3 years. She then consulted hospital, where a neglected knee dislocation was identified and treated with femorotibial arthrodesis. Discussion and conclusion: The treatment options of neglected knee dislocation include open reduction and fixation, arthrodesis and total knee arthroplasty. That the choice depends on the old unreduced of dislocation.展开更多
Knee dislocations frequently involve vascular injuries that demand early diagnosis and timely intervention. Time of ischemia is pivotal in determining the outcome for the limb, delays in treatment beyond 8 hours signi...Knee dislocations frequently involve vascular injuries that demand early diagnosis and timely intervention. Time of ischemia is pivotal in determining the outcome for the limb, delays in treatment beyond 8 hours significantly increase the risk of limb loss. Unfortunately, this critical window is often missed in resource-limited settings. Here we report a 25-year-old female sustained a left knee injury after falling into a trench. She was diagnosed with an open knee dislocation accompanied by a popliteal artery injury. However, revascularization was delayed for 18 hours due to limited resources, including the unavailability of a thrombectomy catheter. Postoperatively, the patient received anticoagulation therapy with serial limb assessments and after 3 weeks the laceration healed and the limb was still viable. Knee dislocations frequently result in vascular injury (popliteal artery most common), making prompt diagnosis and intervention essential for limb preservation. In settings with limited resources, like ours, delayed presentation and transfer to specialized centers contribute to prolonged ischemic times. Nonetheless, viable limbs should be revascularized in stable patients, even with prolonged ischemia. This case highlights the importance of limb revascularization despite delay. Efforts should be made to improve prompt diagnosis, timely referral, and availability of necessary equipment for vascular repair to optimize outcomes in similar cases.展开更多
Rotatory instability of the knee represents the main reason for failure and poor clinical outcomes regarding anterior cruciate ligament(ACL)reconstruction techniques.It is now clear that the anterolateral complex(ALC)...Rotatory instability of the knee represents the main reason for failure and poor clinical outcomes regarding anterior cruciate ligament(ACL)reconstruction techniques.It is now clear that the anterolateral complex(ALC)of the knee possesses a fundamental role,in association with the ACL,in controlling internal rotation.Over the past decade,ever since the anterolateral ligament has been identified and described as a distinct structure,there has been a renewed interest in the scientific community about the whole ALC:Lateral extra-articular tenodesis have made a comeback in association with ACL reconstructions to improve functional outcomes,reducing the risks of graft failure and associated injuries.Modern ACL reconstruction surgery must therefore investigate residual instability and proceed,when necessary,to extra-articular techniques,whether functional tenodesis or anatomical reconstruction.This review aims to investigate the latest anatomical and histological descriptions,and the role in rotational control and knee biomechanics of the ALC and its components.The diagnostic tools for its identification,different reconstruction techniques,and possible surgical indications are described..In addition,clinical and functional results available in the literature are reported.展开更多
This paper discussed the injury mechanism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fractu...This paper discussed the injury mechanism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fracturedislocations of the left hip （Pipkin＇s type IV） and knee （Moore II）joints and contralateral open fracture of the leg bones after a car accident. After emergency resuscitative measures, the hip joint was reduced and Pipkin＇s fracture was fixed using Ganz approach with lag screws; knee joint was reduced closely and tibial plateau fracture was stabilized with lateral buttress plate and a transarticular spanning fixator. The open fracture on the other leg was debrided and fixed with an external fixator. There was no insta-bility in both joints after fixation when he was examined under anesthesia. The fractures united after 3 months and the patient had no residual instability of hip and knee. There was no clinical or radiological evidence of osteonecrosis in the hip joint after 6 months. At one-year follow-up, he had satisfactory functional outcome with almost normal range of motion at both joints. Ipsilateral hip and knee dislocations are rare injuries and more caution is needed for early diagnosis. A timely appropriate intervention can provide good functional outcome to the patient in this situation.展开更多
Anterior tibiofemoral dislocation after total knee arthroplasty is an extremely rare and serious event.Amongst English-published papers,we found only 15 relevant cases,3 of which presented vascular complications.This ...Anterior tibiofemoral dislocation after total knee arthroplasty is an extremely rare and serious event.Amongst English-published papers,we found only 15 relevant cases,3 of which presented vascular complications.This manuscript aims to present a 77-year-old woman with a TC-Plus(Smith&Nephew)cruciate-retaining type in first time of knee prosthesis,who suffered an anterior tibiofemoral dislocation and were admitted to our hospital.The clinical management and outcome were evaluated.Furthermore,a review of literature was performed.We concluded that early detection and surgical intervention of vascular injury is the key in the survival of the limbs.If there is still knee instability after acute recovery,it seems that revision surgery with constrained total knee arthroplasty can bring about good clinical and functional results.展开更多
Constrained total knee prostheses are used in knees with severe deformities and insufficiency of collaterals to provide stable and mobile knees. Dislocation after constrained knee prosthesis is an extremely rare and d...Constrained total knee prostheses are used in knees with severe deformities and insufficiency of collaterals to provide stable and mobile knees. Dislocation after constrained knee prosthesis is an extremely rare and dreaded complication. When dislocation is associated with patellar tendon rupture, the management includes restoration of the extensor apparatus along with a stable knee. Repair of the patellar tendon is challenging due to poor soft tissue coverage in the area and a bulky repair can put tension on the wound closure. Ideal method of restoration of the extensor apparatus is a matter of debate. There are various modalities used ranging from primary end-to-end repair, augmentation by medial gastrocnemius flap, semitendinosus and synthetic implants and allograft tendoachilles. We report a rare case of a posterior dislocation of a constrained total knee arthroplasty in association with patellar tendon rupture due to a minor fall after a few weeks of surgery. The first episode was managed by reposition of the dislocation and V-Y plasty of the quadriceps and primary repair. The second episode of dislocation with re-rupture needed augmentation by semitendinosus along with the insertion of the thicker insert. The management of this complex problem along with the review of literature is discussed in this case reoort.展开更多
文摘BACKGROUND Congenital knee dislocation(CKD)is a rare condition,which accounts for 1%of congenital hip dislocations.It can present as an isolated condition or coexist with other genetic disorders.Treatment options include serial casting,percutaneous quadriceps recession,and V-Y quadricepsplasty(VYQ).The pathogenesis and hereditary patterns of CKD are not fully understood,with most cases being familial.CKD is usually managed immediately after birth.However,in this report,the patient was neglected for 2 years.CASE SUMMARY A 2-year-old girl with bilateral CKD after birth presented to our hospital after failed serial casting;the patient had seizures and limited access to healthcare because of her family’s low socioeconomic status.Her birth was noted for a breech presentation accompanied by oligohydramnios.The delivery took a long time,requiring immediate medical interventions.As an infant,she had chronic diseases,including a small patent ductus arteriole,multicystic dysplastic kidney disease,and epilepsy.She was found to have a bilateral knee dislocation of approximately-90°on hyperextension.A multidisciplinary team was involved,and medical care was optimized.She underwent VYQ plus semitendinosus and sartorius transfer.After four postoperative follow-ups,her knees were regaining mobility,and she could walk for 2-3 steps without assistance.CONCLUSION This report highlights the importance of early intervention and recommends extensive studies of the management in similar cases.
文摘Introduction: Neglected knee dislocation is an unusual injury, only a few cases have been reported in the literature. The circumstances of onset are generally an unnoticed knee dislocation in a polytrauma context or a delay in consultation after the initial trauma. Presentation of case: We report the case of a 48-year-old female patient who sustained a knee injury during a domestic accident. Initial treatment was traditional and was followed for 3 years. She then consulted hospital, where a neglected knee dislocation was identified and treated with femorotibial arthrodesis. Discussion and conclusion: The treatment options of neglected knee dislocation include open reduction and fixation, arthrodesis and total knee arthroplasty. That the choice depends on the old unreduced of dislocation.
文摘Knee dislocations frequently involve vascular injuries that demand early diagnosis and timely intervention. Time of ischemia is pivotal in determining the outcome for the limb, delays in treatment beyond 8 hours significantly increase the risk of limb loss. Unfortunately, this critical window is often missed in resource-limited settings. Here we report a 25-year-old female sustained a left knee injury after falling into a trench. She was diagnosed with an open knee dislocation accompanied by a popliteal artery injury. However, revascularization was delayed for 18 hours due to limited resources, including the unavailability of a thrombectomy catheter. Postoperatively, the patient received anticoagulation therapy with serial limb assessments and after 3 weeks the laceration healed and the limb was still viable. Knee dislocations frequently result in vascular injury (popliteal artery most common), making prompt diagnosis and intervention essential for limb preservation. In settings with limited resources, like ours, delayed presentation and transfer to specialized centers contribute to prolonged ischemic times. Nonetheless, viable limbs should be revascularized in stable patients, even with prolonged ischemia. This case highlights the importance of limb revascularization despite delay. Efforts should be made to improve prompt diagnosis, timely referral, and availability of necessary equipment for vascular repair to optimize outcomes in similar cases.
文摘Rotatory instability of the knee represents the main reason for failure and poor clinical outcomes regarding anterior cruciate ligament(ACL)reconstruction techniques.It is now clear that the anterolateral complex(ALC)of the knee possesses a fundamental role,in association with the ACL,in controlling internal rotation.Over the past decade,ever since the anterolateral ligament has been identified and described as a distinct structure,there has been a renewed interest in the scientific community about the whole ALC:Lateral extra-articular tenodesis have made a comeback in association with ACL reconstructions to improve functional outcomes,reducing the risks of graft failure and associated injuries.Modern ACL reconstruction surgery must therefore investigate residual instability and proceed,when necessary,to extra-articular techniques,whether functional tenodesis or anatomical reconstruction.This review aims to investigate the latest anatomical and histological descriptions,and the role in rotational control and knee biomechanics of the ALC and its components.The diagnostic tools for its identification,different reconstruction techniques,and possible surgical indications are described..In addition,clinical and functional results available in the literature are reported.
文摘This paper discussed the injury mechanism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fracturedislocations of the left hip （Pipkin＇s type IV） and knee （Moore II）joints and contralateral open fracture of the leg bones after a car accident. After emergency resuscitative measures, the hip joint was reduced and Pipkin＇s fracture was fixed using Ganz approach with lag screws; knee joint was reduced closely and tibial plateau fracture was stabilized with lateral buttress plate and a transarticular spanning fixator. The open fracture on the other leg was debrided and fixed with an external fixator. There was no insta-bility in both joints after fixation when he was examined under anesthesia. The fractures united after 3 months and the patient had no residual instability of hip and knee. There was no clinical or radiological evidence of osteonecrosis in the hip joint after 6 months. At one-year follow-up, he had satisfactory functional outcome with almost normal range of motion at both joints. Ipsilateral hip and knee dislocations are rare injuries and more caution is needed for early diagnosis. A timely appropriate intervention can provide good functional outcome to the patient in this situation.
文摘Anterior tibiofemoral dislocation after total knee arthroplasty is an extremely rare and serious event.Amongst English-published papers,we found only 15 relevant cases,3 of which presented vascular complications.This manuscript aims to present a 77-year-old woman with a TC-Plus(Smith&Nephew)cruciate-retaining type in first time of knee prosthesis,who suffered an anterior tibiofemoral dislocation and were admitted to our hospital.The clinical management and outcome were evaluated.Furthermore,a review of literature was performed.We concluded that early detection and surgical intervention of vascular injury is the key in the survival of the limbs.If there is still knee instability after acute recovery,it seems that revision surgery with constrained total knee arthroplasty can bring about good clinical and functional results.
文摘Constrained total knee prostheses are used in knees with severe deformities and insufficiency of collaterals to provide stable and mobile knees. Dislocation after constrained knee prosthesis is an extremely rare and dreaded complication. When dislocation is associated with patellar tendon rupture, the management includes restoration of the extensor apparatus along with a stable knee. Repair of the patellar tendon is challenging due to poor soft tissue coverage in the area and a bulky repair can put tension on the wound closure. Ideal method of restoration of the extensor apparatus is a matter of debate. There are various modalities used ranging from primary end-to-end repair, augmentation by medial gastrocnemius flap, semitendinosus and synthetic implants and allograft tendoachilles. We report a rare case of a posterior dislocation of a constrained total knee arthroplasty in association with patellar tendon rupture due to a minor fall after a few weeks of surgery. The first episode was managed by reposition of the dislocation and V-Y plasty of the quadriceps and primary repair. The second episode of dislocation with re-rupture needed augmentation by semitendinosus along with the insertion of the thicker insert. The management of this complex problem along with the review of literature is discussed in this case reoort.
