The timing of surgical treatment of knee dislocations: a systematic review.

Abstract

Traumatic knee dislocations (KDs) are unusual yet limb-threatening injuries; the timing of surgical intervention is still debated. A systematic review was performed to determine the optimal timing of surgery with respect to injury pattern. A comprehensive search of Medline, EMBASE, and Cochrane Central Register of Controlled Trials was performed for studies published between 1 January 1974 and 20 April 2014 on the surgical management of "knee dislocation" and "multiligament knee injuries". Surgical timing was classified as acute, chronic, or staged. A systematic review was performed for patients with KD-III according to Schenck's classification using individual patient data. Twelve studies including 150 patients (153 knees) with KDs fulfilled the study requirements. Sixty-nine cases with KD-IIIM and 84 cases with KD-IIIL were identified. Excellent or good results were demonstrated in 79.1 % (34 cases) of cases managed with staged treatment versus 58.4 % (45 cases) of cases undergoing acute surgery (p = 0.02), and versus 45.5 % (15 cases) of cases undergoing chronic surgery (p = 0.002). No statistically significant difference was found in the percentage of excellent or good results between the acute and chronic surgery groups (n.s.), or between the KD-IIIM and KD-IIIL groups (n.s.). Staged treatment yields the best clinical results for patients with KD-III. No statistically significant difference was shown in the clinical results between acute surgery and chronic surgery groups. IV.