Abstract
Introduction:
Knee dislocation were defined as complete loss of tibiofibular articulation confirmed by radiography. The mean age at injury was 37.8 ± 15.3 years. Of the 303 patients included, 65% were male and 35% were female.
We report a case of 37 years old women who comes to our ER. She complained pain at her right knee since 30 minutes after hit by motorcycle. Internal rotation of tibia could be seen in this patient. There were no damaged found on vascular and additional injuries. Knee radiography were carried out to confirm diagnosis.
Discussion:
According the Good and Johnson, they defined knee dislocation to include the grossly unstable knee, with a minimum of 2 of the 4 major knee ligaments injured.
In this patient we performed operative immediately by closed reduction and cast fixation on knee with guidance of fluoroscopy. During the intraoperative we got the valgus test, varus test, Lachman’s test and anterior drawer test were positive. Every week, we follow up by radiography to check is there any shifting or loss reduction on the cast.
After three weeks, we open the cast and found the negative result on valgus and varus test, but the anterior/posterior drawer test and Lachman’s test still positive. It confirmed by MRI with total tear on ACL, partial tear on PCL and partial tear on lateral meniscus. Then we planned to do two arthroscopy, first is ACL, second is PCL.
During first arthroscopy we found many hematoma, then we performed harvest from the hamstring: semimembranosus and gracilis tendon as graft for ACL reconstruction.
Result:
Three weeks after the external fixation was removed, the result of valgus and varus test were negative.
The outcome of ACL reconstruction is a stable ACL, it confirmed with the negative result of anterior drawer test.
Conclusion:
Delayed reconstruction may resulted resolution of swelling, less stiffness, better ROM of knee and some structures healed by itself, but more hematoma. This also support other studies about delay reconstruction could potentially yield equivalent stability outcomes compared with acute surgery.