Wu Jiang1, Jianhua Yao2, Yuan He3, Wei Sun1, Yan Huang1, Dejia Kong4. 1. Department of Orthopaedics, General Hospital of Beijing Military Command, Dongcheng District, Nanmencang No. 5, Beijing, China. 2. Department of Orthopaedics, General Hospital of Beijing Military Command, Dongcheng District, Nanmencang No. 5, Beijing, China. drjianhuayao@163.com. 3. Department of Oncology, Nanfang Hospital, Baiyun District, Guangzhou Avenue No. 1838, Guangzhou, China. 4. Clinical College of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Shushan District, Meishan Road No. 70, Hefei, China.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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.). CONCLUSION: 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. LEVEL OF EVIDENCE: IV.
PURPOSE: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. METHODS: 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. RESULTS: 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.). CONCLUSION: 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. LEVEL OF EVIDENCE: IV.
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