Staged protocol for initial management of the dislocated knee

Purpose: The purpose of this study was (1) to describe a staged protocol for management of the dislocated knee and (2) to describe clinical and functional outcomes for patients who received initial spanning external fixation as part of this protocol. Method: Nine knees in 9 patients, consisting of 6 males and 3 females, mean age 30.4 (range 19-44) years with diagnosis or presumption of knee dislocation were treated with a protocol of stabilization with external fixator. Mean follow-up was 24 (range 13-42) months. Indications for spanning external fixation included significant vascular injury, gross instability on examination with failure to maintain joint reduction, open knee dislocation, inability to tolerate mobilization in a brace. The standard protocol involved vascular examination including ankle-brachial index, ligamentous examination (under anesthesia when applicable), stabilization with temporary joint spanning external fixator, thromboprophylaxis, reconstructive knee surgery, and standard rehabilitation. Results: Mean range of motion (ROM) was 97.4° (range 80°-150°, SD 20.75, median 127.5). Median IKDC score was 80 (range 30-95), and mean Lysholm score was 76.7 (range 46-95). Heterotopic ossification (HO) was noted in 4 knees (44%). Conclusion: The treatment algorithm utilized in this series for management of the dislocated knee demonstrated satisfactory clinical and functional outcomes. This staged protocol provides a management option for those patients who may be best served with initial spanning joint external fixation. Larger prospective studies are needed to fully understand the merit of staged protocols in this setting.