Multi-ligament injuries (Knee dislocation)

A rare but limb threatening injury called a knee dislocation occurs from a violent injury to the knee most commonly in motor vehicle or motorcycle accidents, falls from height, or even during athletic sport. These are serious injuries as oftentimes the main artery that provides blood supply to the lower leg can be damaged, which can lead to amputation. Nerve injuries also conduct here, resulting in significant lower extremity foot and ankle weakness, as well as sensory loss.

Typically, these injuries require emergency assessment and treatment. The ligaments that are frequently involved include the ACL, PCL, MCL, and posteromedial corner, as well as the LCL and posterolateral corner.

In the emergency room, X-rays are obtained to rule out fracture and ensure that the knee joint is in proper position. Sometimes a reduction of the knee dislocation is necessary. Neurovascular assessment is performed and oftentimes requires a CT angiogram to assess if appropriate blood flow is maintained in the limb. If the artery is damaged or clotted, then a vascular surgeon would perform emergency surgery to reconstitute blood flow to the limb. Oftentimes these patients are treated with a spanning joint external fixator to stabilize the knee.

From a purely orthopedic standpoint, experts in knee ligament reconstruction can repair all of the damaged ligaments. Often this is performed in one operation but, at times, numerous surgical procedures are required to repair and or reconstruct all of the ligaments damaged. These surgeries can take numerous hours and are quite extensive. Postoperatively, these patients require significant rehabilitation of their knee to regain range of motion, muscle strength, and agility.

Mayo Clinic surgeons have been instrumental in advancing the treatment of the multiple ligament injured/dislocated knee by developing ligament specific surgical instrumentation and new minimally invasive surgical techniques that have led to improved patient outcomes. Currently Mayo Clinic Sports Medicine is involved in the star trial, which is the largest multi-center research trial ever performed on these injuries. This trial is funded by the Department of Defense and the results of this trial will help dictate optimum treatment strategies to help future patients worldwide.

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