Epidemiology, Diagnostic Modalities, Treatment Options and Outcomes of Open Knee Dislocations: A Systematic Review.

Abstract

An open knee dislocation (OKD) is a severe injury associated with significant intra- and extra-articular injuries. Given the lack of consensus with existing literature, this study aims to systematically review the associated injuries, diagnostic and treatment approaches for OKDs. Three databases (PubMed, Embase, Scopus) were searched in accordance with Preferred Reporting for Systematic Reviews and Meta-analysis (PRISMA) guidelines in April 2025. Studies involving case(s) of OKD with details of demographic, diagnostic and/or management approach were included. The search strategy yielded 20 studies (five case studies and 15 case reports), with a mean MINOR score of 9.9. Across all studies, there were 87 patients with a mean age of 38.5 (range 18-70) years. Male proportion was 73% and mechanism of action was high-energy trauma in all cases. The severity of ligamentous injury amongst 20 cases that were reported across 13 studies as classified by the Schenck Knee Dislocation (KD) classification was: 20% (4/20) KD-I, 10% (2/20) KD-II, 30% (6/20) KD-III and 40% (8/20) KD-IV. The proportion with associated meniscal injury, fracture, vascular compromise, neurological deficit, and post-injury infection was 67% (12/18), 60% (25/42), 31% (27/87), 39% (12/41) and 28% (22/78) respectively. An average of 1.58 debridements (range 1-11) was performed, with external fixation performed in 62% (23/37) cases after initial debridement. Outcomes remain heterogenous when compared against various factors. OKD represents a severe injury associated with KDIII-IV ligamentous injuries. Prompt and thorough initial debridement plays a critical role in mitigating the risk of subsequent infection. Outcomes are variable due to heterogeneity in presentation. Additional studies are necessary to determine the optimal management approach. Systematic review; Level of evidence, 4.