Prioritised challenges in the management of acute knee dislocations are stiffness, obesity, treatment delays and associated limb-threatening injuries: a global consensus study. Issue 4 (5th March 2021)

• Record Type: Journal Article
• Authors: Held, Michael; Schenck, Robert C; Khanduja, Vikas; Campos, Túlio Vinícius de Oliveira; Tapasvi, Sachin; Williams, Andy; Yau, Wai Pan; Harner, Christopher
• Other Names: author non-byline.; Bormann Richard von author non-byline.; North David author non-byline.; Richter Dustin author non-byline.; Alizayagam Hasan author non-byline.; Mourao Carlos author non-byline.; Mesquita Diogo author non-byline.; Arojuraye Soliudeen author non-byline.; Freitas Ednei author non-byline.; Patel Rtesh author non-byline.; Deepak S author non-byline.; Nahas Fernanda author non-byline.; Fontes Paulo author non-byline.; Miura Gabriel M author non-byline.; Preez Gian Du author non-byline.; Simoes Guilherme F author non-byline.; Marinho Leandro author non-byline.; Luciano Roberto Cunha author non-byline.; Gowda Yogesh author non-byline.; Ribeiro Bernardo author non-byline.; Calapodopulos Constantino author non-byline.; Coutinho Ennio author non-byline.; Fu Weili author non-byline.; Ferreira Frederico author non-byline.; Passos Clauco author non-byline.; Jonker Hannes author non-byline.; Hobbs Hayden author non-byline.; Grant John author non-byline.; Magobotha Sebastian author non-byline.; Alves Marcos author non-byline.; Amorim Marcelo author non-byline.; Denaro Marcelo author non-byline.; Safran Marc author non-byline.; Moraes Marcelo author non-byline.; Pardiwala Dinshaw author non-byline.; Lazzarini Rodrigo author non-byline.; Sherman Seth author non-byline.; Shanmugasundaram Saseendar author non-byline.; Silvampatti Sundararajan author non-byline.; Lemos Wagner author non-byline.;
• Is Part Of: Journal of ISAKOS. Volume 6:Issue 4(2021)
• Page Start: 193
• Page End: 198
• Publication Date: 2021-03-05
• Subjects: knee injuries -- joint dislocations; Joints -- Endoscopic surgery -- Periodicals; Osteoarthritis -- Periodicals; Joints -- Diseases -- Periodicals; Total knee replacement -- Periodicals; Sports injuries -- Surgery -- Periodicals; Sports medicine -- Periodicals; 617.472059705
• DOI: 10.1136/jisakos-2020-000565
• Languages: English
• ISSNs: 2059-7754

Abstract

Abstract : Objectives: Heterogeneous patient factors and injury mechanisms result in a great variety of injury patterns encountered in knee dislocations (KD). Attempts to improve outcome can focus on a wide range of challenges. The aim of this study was to establish and prioritise a list of challenges encountered when treating patients with acute KD. Methods: A modified Delphi consensus study was conducted with international knee specialists who generated a prioritised list of challenges. Selected priorities were limited to half of the possible items. Agreement of more than 70% was defined as consensus on each of these items a priori. Results: Ninety-one international surgeons participated in the first round. The majority worked in public hospitals and treated patients from low-income and middle-income households. Their propositions were prioritised by 27 knee surgeons from Europe, Africa, Asia, as well as North and South America, with a mean of 15.3 years of experience in knee surgery (SD 17.8). Consensus was reached for postoperative stiffness, obesity, delay to presentation and associated common peroneal nerve injuries. Challenges such as vascular injuries, ipsilateral fractures, open injuries as well as residual laxity were also rated high. Most of these topics with high priority are key during the initial management of a patient with KD, at presentation. Topics with lower priority were postsurgical challenges, such as patient insight, expectations and compliance, rehabilitation programme, and pain management. Conclusion: This consensus study has a wide geographical footprint of experts around the world practising in various settings. These participants prioritised stiffness, obesity, treatment delays and associated limb-threatening injuries as the most important challenges when managing a patient with acute KD. This list calls for applicable and feasible solutions for these challenges in a global setting. It should be used to prioritise research efforts and discuss treatment guidelines. Level of evidence: V.