| Background: Dislocation of knee joints is a kind of serious injury which usually caused by high energy injury,and induces multiple tissue damage around knee joints.Dislocation of knee joints is rare in the trauma department of orthopedics,most of it can be closed the reduction by themselves or manipulative reduction.Irreducible knee dislocation(IKD)is a special type of dislocation of knee joints,which is extremely rare in the trauma department of orthopedics and with characters of can not be closed reduction by themselves or manipulative reduction and relatively difficult treatment.In the early nineteenth century,amputation was the only treatment option for IKD.In 1951,Griswold reported 4 cases of IKD,in which skin depression sign was found in the medial compartment of the knee joint.Four patients were treated with open surgery for reduction,followed by exercise of the musculi quadriceps femoris as soon as possible after postoperative knee joints fixation for 6~10 weeks.In 1958,Quinlan and Sharrar described 5 cases of IKD,in which skin depression sign was found in the medial compartment of the knee joint as well.During the surgery for reduction,medial collateral ligament,medial capsule and musculi quadriceps femoris were found incarcerated in the gap of medial knee joint,which caused difficult reduction of IKD.Mild instability of joint was left after postoperative knee joints fixation for 6~10 weeks and rehabilitation therapy.IKD usually accompanied by injury of knee joints’ anterior cruciate ligament and medial collateral ligament,which are critical for stability of knee joints.With the acquaintance of anatomic structure of knee joints and development of knee arthroscopic technology,repairment of damaged ligament can obviously improve the stability and recovery of knee joint function after surgery in IKD patients.In recent years,treatment of patients with IKD is mainly through the medial knee joint incision in the emergency operation and then cleared the tissue incarcerated in the gap of medial knee joint,which can make the knee joint replacement easily and repair the medial collateral ligament and joint capsule injuries at the meanwhile.And then according to the postoperative stability of the knee joints to decide whether operate two times arthroscopic cruciate ligament reconstruction surgery or not.Objective: In this paper,we reported a case of a patient with irreducible posterolateral dislocation of the knee joint,which was treated with knee arthroscopy assisted reduction and reconstruction of cruciate ligament and medial collateral ligament of knee joint,and achieved remarkable effect.And reviewed the relevant literature to improve the understanding of IKD damage mechanism,clinical manifestations,diagnosis,therapeutic regimen,postoperative rehabilitation and other aspects.Case report: Patient is male,46 years old.He was hospitalized as a result of traumatic right knee joint pain and swelling with limitation of activity for 7 hours.7 hours before,he fell carelessly from bike,which caused right knee joint pain,swelling and autonomic activity incapable.Patient’s right knee joint showed slight flexion and valgus fixation,prompting the presence of knee join dislocation.The local hospital failed to closed the reduction by themselves or manipulative reduction and suggested the patient to transfer to upper hospitals.Then he consulted in our hospital.The physical examination,T37.2℃,P80/min,R 18/min,BP130/70 mm Hg,normal development,good nutrition and clear mind.Specialized subjects:the right knee joint showed slight flexion and valgus fixation with obvious swelling and malformation.The right knee joint media skin had visible wrinkles.The right knee joint with touch tenderness positive and increased local skin temperature.The skin of right lower extremity existed normal feeling and without numbness.The right foot dorsal artery and the posterior tibial artery can be touched and the right toe end capillary reaction was good.Because of right knee joint flexed on slight valgus position,the joint fixed on the activities.The stability test of the right knee was unable to check for pain and activities of right ankle and toe were fine.The right knee deformity was 30 degrees of flexion with 10 degrees of valgus position.The muscle strength was not measured due to pain.The right knee joint X-ray examination showed: right tibia moved backward relative to the femur,patellar projection in the lateral femoral condyle,the right knee medial gap increased slightly,fracture sign was not find on bones constituted the right knee joint.MRI examination showed that the right knee medial muscle of femur incarcerated in the right knee medial gap,which formed a binding belt around the right medial femoral condyle leading to posterolateral dislocation of the right knee joint,and this cannot be closed by manual reduction.After hospitalization,the patient was given the right lower limb gypsum plaster fixation and raised the limb.Ice right knee for 24 hours,in order to reduce swelling of the right knee joint.Fifth days after admission,the right knee joint swelling reduced well,then operated "right knee arthroscopic exploration operation",arthroscopic exploration found,rupture of anterior and posterior cruciate ligament,damage of medial articular capsule,medial vastus muscle formed binding band bundled medial condyle of femur and injury of medial meniscus.The knee joint dislocation was restored after the medial vastus medialis muscle was restored under knee arthroscopy,in the meanwhile,operated arthroscopic repair of medial collateral ligament,medial articular capsule and opened the medial side of the knee to repair the medial collateral ligament.Postoperative operated limb fixed at full knee joint extension by braces,the day after the surgery took femoral head four muscle functional exercise and ankle pump motion.1 week later,the patient took knee joint function exercise with the protection of braces,and braces had a fixed extension of not more than 20 degrees,and the buckling is not more than 90 degrees.When 6 weeks,still wearing braces expect walked with cruth allowed with elastic kneecap replaced braces.After 12 weeks,full weight-bearing walking is feasible and avoid physical activity within 6 months.The patients were followed up for 1 and a half years,his right knee joint activity was consistent with the healthy side,and had been engaged in physical labor without symptoms.Tegner exercise level score: 5 points;knee Lysholm score: 94 points.Conclusions: 1.IKD is a special type of dislocation of the knee joint,if not diagnosed timely and correctly,it may be induced increased knee joint injury due to many times of invalid closed manipulative reduction and then delayed its treatment.Therefore,we should deepen the understanding of the clinical manifestations,imaging examination and other characteristics of IKD,so as to avoid missed diagnosis and misdiagnosis.2.The treatment of IKD is usually treated with open reduction,two stage cruciate ligament reconstruction,needs for two surgeries,which caused prolonged hospitalization time and increased cost of hospitalization.In addition,emergency surgery may aggravate swelling of knee joints.However,the use of selective knee arthroscopic surgery can solve the dislocation of the knee joint and the reconstruction of the ligament at one time,and can effectively reduce the trauma,shorten the hospitalization time and save the cost.So it is worth popularizing. |
PDF Full Text Request