Skip to main content
SpringerLink
Log in

Kniegelenkluxation – multiligamentäre Kniegelenkverletzung im Sport

Operative Strategie – Outcome – Rehabilitation

Knee dislocation – multiligament knee injuries in sports

Operative strategy, outcome and rehabilitation

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die multiligamentäre Verletzung eines Kniegelenkes nach Kniegelenkluxation stellt ein seltenes, jedoch sehr schweres Verletzungsmuster dar. Neben der ligamentären Verletzung besteht zusätzlich ein nicht unerhebliches Risiko, eine begleitende neurovaskuläre Verletzung zu erleiden. Die Erstmaßnahmen müssen zügig und standardisiert erfolgen, wobei dem Gefäßmonitoring eine wichtige Rolle zukommt. Die operative Stabilisierung stellt die Methode der ersten Wahl dar. Der Rehabilitationsprozess ist langwierig, wobei die gute Kommunikation der betreuenden Physio- und Ergotherapeuten mit dem Operateur den essenziellen Grundstein für das ehrgeizige Ziel Return-to-Play oder gar Return-to-Competition darstellt.

Abstract

Multiple ligament injuries of the knee following knee dislocation are rare but very severe injury patterns. In addition to the ligament injuries there is also a substantial risk of suffering from concomitant neurovascular injuries. The initial treatment measures must be standardized and carried out rapidly, whereby vascular monitoring plays an important role. The method of choice is surgical stabilization. The rehabilitation process is tedious, whereby good communication between the physiotherapist, occupational therapist and surgeon represents the essential foundation for the ambitious target of return to play or even return to competition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Cooper, A (1824) A treatise on dislocations and on fractures of the joints. 1st American edition, p. 198. Boston: Lilly, Wait, Carter and Hendee

  2. Brautigan B, Johnson DL (2000) The epidemiology of knee dislocations. Clin Sports Med 19(3):387–397

    Article  CAS  PubMed  Google Scholar 

  3. Levy BA, Marx RG (2009) Outcome after knee dislocation. Knee Surg Sports Traumatol Arthrosc 17(9):1011–1012

    Article  PubMed  Google Scholar 

  4. Wascher DC (2000) High-velocity knee dislocation with vascular injury. Treatment principles. Clin Sports Med 19(3):457–477

    Article  CAS  PubMed  Google Scholar 

  5. Howells NR et al (2011) Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee. Injury 42(11):1198–1204

    Article  PubMed  Google Scholar 

  6. Bratt HD, Newman AP (1993) Complete dislocation of the knee without disruption of both cruciate ligaments. J Trauma 34(3):383–389

    Article  CAS  PubMed  Google Scholar 

  7. Cooper DE et al (1992) Complete knee dislocation without posterior cruciate ligament disruption. A report of four cases and review of the literature. Clin Orthop Relat Res 284:228–233

    Google Scholar 

  8. Yeh WL et al (1999) Knee dislocation: treatment of high-velocity knee dislocation. J Trauma 46(4):693–701

    Article  CAS  PubMed  Google Scholar 

  9. Hoover NW (1961) Injuries of the popliteal artery associated with fractures and dislocations. Surg Clin North Am 41:1099–1112

    Article  CAS  PubMed  Google Scholar 

  10. Jones RE, Smith EC, Bone GE (1979) Vascular and orthopedic complications of knee dislocation. Surg Gynecol Obstet 149(4):554–558

    CAS  PubMed  Google Scholar 

  11. Boisgard S et al (2009) Bicruciate ligament lesions and dislocation of the knee: mechanisms and classification. Orthop Traumatol Surg Res 95(8):627–631

    Article  CAS  PubMed  Google Scholar 

  12. Harner CD et al (2004) Surgical management of knee dislocations. J Bone Joint Surg Am 86-A(2):262–273

    Article  PubMed  Google Scholar 

  13. Ríos A et al (2003) Results after treatment of traumatic knee dislocations: a report of 26 cases. J Trauma 55(3):489–494

    Article  PubMed  Google Scholar 

  14. Nicandri GT, Chamberlain AM, Wahl CJ (2009) Practical management of knee dislocations: a selective angiography protocol to detect limb-threatening vascular injuries. Clin J Sport Med 19(2):125–129

    Article  PubMed  Google Scholar 

  15. Alberty RE, Goodfried G, Boyden AM (1981) Popliteal artery injury with fractural dislocation of the knee. Am J Surg 142(1):36–40

    Article  CAS  PubMed  Google Scholar 

  16. Dart CH, Braitman HE (1977) Popliteal artery injury following fracture or dislocation at the knee. Diagnosis and management. Arch Surg 112(8):969–973

    Article  PubMed  Google Scholar 

  17. Gable DR, Allen JW, Richardson JD (1997) Blunt popliteal artery injury: is physical examination alone enough for evaluation? J Trauma 43(3):541–544

    Article  CAS  PubMed  Google Scholar 

  18. Abou-Sayed H, Berger DL (2002) Blunt lower-extremity trauma and popliteal artery injuries: revisiting the case for selective arteriography. Arch Surg 137(5):585–589

    Article  PubMed  Google Scholar 

  19. Miranda FE et al (2002) Confirmation of the safety and accuracy of physical examination in the evaluation of knee dislocation for injury of the popliteal artery: a prospective study. J Trauma 52(2):247–251 (discussion 251–2)

    PubMed  Google Scholar 

  20. Boisrenoult P et al (2009) Vascular lesions associated with bicruciate and knee dislocation ligamentous injury. Orthop Traumatol Surg Res 95(8):621–626

    Article  CAS  PubMed  Google Scholar 

  21. Gakhal MS, Sartip KA (2009) CT angiography signs of lower extremity vascular trauma. AJR Am J Roentgenol 193(1):W49–W57

    Article  PubMed  Google Scholar 

  22. Peng PD et al (2008) CT angiography effectively evaluates extremity vascular trauma. Am Surg 74(2):103–107

    PubMed  Google Scholar 

  23. Redmond JM et al (2008) Detecting vascular injury in lower-extremity orthopedic trauma: the role of CT angiography. Orthopedics 31(8):761–767

    Article  PubMed  Google Scholar 

  24. Green NE, Allen BL (1977) Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am 59(2):236–239

    Article  PubMed  Google Scholar 

  25. Niall DM, Nutton RW, Keating JF (2005) Palsy of the common peroneal nerve after traumatic dislocation of the knee. J Bone Joint Surg Br 87(5):664–667

    Article  CAS  PubMed  Google Scholar 

  26. White J (1968) The results of traction injuries to the common peroneal nerve. J Bone Joint Surg Br 50(2):346–350

    CAS  PubMed  Google Scholar 

  27. Wood MB (1991) Peroneal nerve repair. Surgical results. Clin Orthop Relat Res 267:206–210

    Google Scholar 

  28. Sedel L, Nizard RS (1993) Nerve grafting for traction injuries of the common peroneal nerve. A report of 17 cases. J Bone Joint Surg Br 75(5):772–774

    CAS  PubMed  Google Scholar 

  29. Dedmond BT, Almekinders LC (2001) Operative versus nonoperative treatment of knee dislocations: a meta-analysis. Am J Knee Surg 14(1):33–38

    CAS  PubMed  Google Scholar 

  30. Fanelli GC, Edson CJ (2002) Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2‑ to 10-year follow-up. Arthroscopy 18(7):703–714

    Article  PubMed  Google Scholar 

  31. Engebretsen L et al (2009) Outcome after knee dislocations: a 2–9 years follow-up of 85 consecutive patients. Knee Surg Sports Traumatol Arthrosc 17(9):1013–1026

    Article  PubMed  Google Scholar 

  32. Gaski IA et al (2004) Knee luxation-follow-up after surgery. Tidsskr Nor Laegeforening 124(8):1078–1080

    Google Scholar 

  33. Levy BA et al (2009) Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy 25(4):430–438

    Article  PubMed  Google Scholar 

  34. Robertson A, Nutton RW, Keating JF (2006) Dislocation of the knee. J Bone Joint Surg Br 88(6):706–711

    Article  CAS  PubMed  Google Scholar 

  35. Frosch KH et al (2016) Arthroscopic popliteus bypass graft for posterolateral instabilities of the knee: a new surgical technique. Oper Orthop Traumatol 28(3):193–203

    Article  PubMed  Google Scholar 

  36. Heitmann M et al (2014) Ligament bracing – augmented primary suture repair in multiligamentous knee injuries. Oper Orthop Traumatol 26(1):19–29

    Article  CAS  PubMed  Google Scholar 

  37. Eggli S et al (2015) Dynamic intraligamentary stabilization: novel technique for preserving the ruptured ACL. Knee Surg Sports Traumatol Arthrosc 23(4):1215–1221

    Article  CAS  PubMed  Google Scholar 

  38. Eggli S et al (2016) Five year results of the first ten ACL patients treated with dynamic intraligamentary stabilisation. BMC Musculoskelet Disord 17:105

    Article  PubMed  PubMed Central  Google Scholar 

  39. Larson RL (1980) Combined instabilities of the knee. Clin Orthop Relat Res 147:68–75

    Google Scholar 

  40. Ateschrang A et al (2016) Acute MCL and ACL injuries: first results of minimal-invasive MCL ligament bracing with combined ACL single-bundle reconstruction. Arch Orthop Trauma Surg 136(9):1265–1272

    Article  CAS  PubMed  Google Scholar 

  41. Kovachevich R et al (2009) Operative management of the medial collateral ligament in the multi-ligament injured knee: an evidence-based systematic review. Knee Surg Sports Traumatol Arthrosc 17(7):823–829

    Article  PubMed  Google Scholar 

  42. LaPrade RF (2005) Anatomic reconstruction of the posterolateral aspect of the knee. J Knee Surg 18(2):167–171

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sektion für Sporttraumatologie und arthroskopische Chirurgie, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland

    A. Ateschrang, S. Döbele, S. Schröter, M. Baumann, U. Stöckle & T. M. Kraus

Authors
  1. A. Ateschrang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Döbele
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Schröter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Baumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U. Stöckle
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. M. Kraus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Ateschrang.

Ethics declarations

Interessenkonflikt

A. Ateschrang, S. Döbele, S. Schröter, M. Baumann, U. Stöckle und T.M. Kraus geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ateschrang, A., Döbele, S., Schröter, S. et al. Kniegelenkluxation – multiligamentäre Kniegelenkverletzung im Sport. Trauma Berufskrankh 19, 20–25 (2017). https://doi.org/10.1007/s10039-017-0235-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-017-0235-0

Schlüsselwörter

Keywords

Search

Navigation