Download PDF
Z Orthop Unfall 2024; 162(01): 57-62
DOI: 10.1055/a-1884-0240
Leitlinie

S2e-Leitlinie „Kniegelenkluxation“

Article in several languages: deutsch | English
Matthias Krause 
1   Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland (Ringgold ID: RIN37734)
,
Tobias C. Drenck
2   Abteilung Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland (Ringgold ID: RIN14889)
,
Lena Eggeling
2   Abteilung Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland (Ringgold ID: RIN14889)
,
Jannik Frings
1   Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland (Ringgold ID: RIN37734)
,
Ralph Akoto
2   Abteilung Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland (Ringgold ID: RIN14889)
,
Karl-Heinz Frosch
1   Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland (Ringgold ID: RIN37734)
2   Abteilung Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland (Ringgold ID: RIN14889)
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Bei einer Knieluxation handelt es sich um eine besonders schwere Form der Multiligamentverletzung. Aufgrund der häufig hohen Verletzungskomplexität existiert eine Vielfalt unterschiedlicher Diagnostik- und Versorgungsstrategien. Mit dem Ziel evidenzbasierter Therapieempfehlungen richtet sich die S2e-Leitlinie „Knieluxation“ an alle an der Diagnostik und Therapie beteiligten Berufsgruppen (Orthopäden und Unfallchirurgen, Physiotherapeuten, ambulante/stationäre Operateure, Sportmediziner etc.) sowie Betroffene (Patient*innen mit Knieluxation) und Leistungserbringer (Krankenkassen, Rentenversicherungsträger). Diese umfasst neben der Darlegung konzeptioneller Unterschiede zwischen den Verletzungsentitäten die Besonderheiten der Diagnostik, konservativen und operativen Therapieoptionen auch Aspekte der Nachbehandlung vor dem Hintergrund des interdisziplinären Behandlungsansatzes einer schweren Knieverletzung.

Schlüsselwörter

Kniegelenkluxation - vorderes Kreuzband - hinteres Kreuzband - Gefäßverletzung - Nervenverletzung


Publication History

Received: 24 March 2022

Accepted after revision: 22 June 2022

Article published online:
05 September 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Twaddle BC, Bidwell TA, Chapman JR. Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma 2003; 17: 198-202 DOI: 10.1097/00005131-200303000-00008. (PMID: 12621261)
    Google Scholar
  • 2 Lachman JR, Rehman S, Pipitone PS. Traumatic Knee Dislocations: Evaluation, Management, and Surgical Treatment. Orthop Clin North Am 2015; 46: 479-493 DOI: 10.1016/j.ocl.2015.06.004. (PMID: 26410637)
    Google Scholar
  • 3 Chhabra A, Cha PS, Rihn JA. et al. Surgical management of knee dislocations. Surgical technique. J Bone Joint Surg Am 2005; 87 (Suppl. 01) S1-S21 DOI: 10.2106/JBJS.D.02711. (PMID: 15743843)
    Google Scholar
  • 4 Schenck RJ. Classification of knee dislocation. Oper Tech Sports Med 2003; 11: 193-198 DOI: 10.1055/s-0040-1721036. (PMID: 33184799)
    Google Scholar
  • 5 Kennedy JC. Complete Dislocation of the Knee Joint. J Bone Joint Surg Am 1963; 45: 889-904 (PMID: 14046474)
    Google Scholar
  • 6 Brautigan B, Johnson DL. The epidemiology of knee dislocations. Clin Sports Med 2000; 19: 387-397 DOI: 10.1016/s0278-5919(05)70213-1. (PMID: 10918955)
    Google Scholar
  • 7 Natsuhara KM, Yeranosian MG, Cohen JR. et al. What is the frequency of vascular injury after knee dislocation?. Clin Orthop Relat Res 2014; 472: 2615-2620 DOI: 10.1007/s11999-014-3566-1. (PMID: 24658901)
    Google Scholar
  • 8 Moatshe G, Dornan GJ, Loken S. et al. Demographics and Injuries Associated With Knee Dislocation: A Prospective Review of 303 Patients. Orthop J Sports Med 2017; 5: 2325967117706521 DOI: 10.1177/2325967117706521. (PMID: 28589159)
    Google Scholar
  • 9 Maslaris A, Brinkmann O, Bungartz M. et al. Management of knee dislocation prior to ligament reconstruction: What is the current evidence? Update of a universal treatment algorithm. Eur J Orthop Surg Traumatol 2018; 28: 1001-1015 DOI: 10.1007/s00590-018-2148-4. (PMID: 29470650)
    Google Scholar
  • 10 Woodmass JM, Romatowski NP, Esposito JG. et al. A systematic review of peroneal nerve palsy and recovery following traumatic knee dislocation. Knee Surg Sports Traumatol Arthrosc 2015; 23: 2992-3002 DOI: 10.1007/s00167-015-3676-7. (PMID: 26115847)
    Google Scholar
  • 11 Werner BC, Gwathmey FW jr., Higgins ST. et al. Ultra-low velocity knee dislocations: patient characteristics, complications, and outcomes. Am J Sports Med 2014; 42: 358-363 DOI: 10.1177/0363546513508375. (PMID: 24214926)
    Google Scholar
  • 12 Peek RD, Haynes DW. Compartment syndrome as a complication of arthroscopy. A case report and a study of interstitial pressures. Am J Sports Med 1984; 12: 464-468 DOI: 10.1177/036354658401200612. (PMID: 6507718)
    Google Scholar
  • 13 Plancher KD, Siliski J. Long-term functional results and complications in patients with knee dislocations. J Knee Surg 2008; 21: 261-268 DOI: 10.1055/s-0030-1247829. (PMID: 18979926)
    Google Scholar
  • 14 Giannoudis PV, Roberts CS, Parikh AR. et al. Knee dislocation with ipsilateral femoral shaft fracture: a report of five cases. J Orthop Trauma 2005; 19: 205-210
    Google Scholar
  • 15 Azar FM, Brandt JC, Miller 3rd RH. et al. Ultra-low-velocity knee dislocations. Am J Sports Med 2011; 39: 2170-2174 DOI: 10.1177/0363546511414855. (PMID: 21757779)
    Google Scholar
  • 16 Meyers MH, Moore TM, Harvey jr JP. Traumatic dislocation of the knee joint. J Bone Joint Surg Am 1975; 57: 430-433 (PMID: 1123405)
    Google Scholar
  • 17 Sisto DJ, Warren RF. Complete knee dislocation. A follow-up study of operative treatment. Clin Orthop Relat Res 1985; (198) 94-101 (PMID: 4028570)
    Google Scholar
  • 18 Darcy G, Edwards E, Hau R. Epidemiology and outcomes of traumatic knee dislocations: Isolated vs multi-trauma injuries. Injury 2018; 49: 1183-1187 DOI: 10.1016/j.injury.2018.02.016. (PMID: 29576239)
    Google Scholar
  • 19 Harner CD, Waltrip RL, Bennett CH. et al. Surgical management of knee dislocations. J Bone Joint Surg Am 2004; 86: 262-273 DOI: 10.2106/00004623-200402000-00008. (PMID: 15743843)
    Google Scholar
  • 20 Wascher DC, Dvirnak PC, DeCoster TA. Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma 1997; 11: 525-529 DOI: 10.1097/00005131-199710000-00011. (PMID: 9334955)
    Google Scholar
  • 21 Liow RY, McNicholas MJ, Keating JF. et al. Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg Br 2003; 85: 845-851 (PMID: 12931803)
    Google Scholar
  • 22 McCoy GF, Hannon DG, Barr RJ. et al. Vascular injury associated with low-velocity dislocations of the knee. J Bone Joint Surg Br 1987; 69: 285-287 DOI: 10.1302/0301-620X.69B2.3818761. (PMID: 3818761)
    Google Scholar
  • 23 Shelbourne KD, Klootwyk TE. Low-velocity knee dislocation with sports injuries. Treatment principles. Clin Sports Med 2000; 19: 443-456 DOI: 10.1016/s0278-5919(05)70217-9. (PMID: 10918959)
    Google Scholar
  • 24 Shelbourne KD, Porter DA, Clingman JA. et al. Low-velocity knee dislocation. Orthop Rev 1991; 20: 995-1004 (PMID: 1749665)
    Google Scholar
  • 25 Vaidya R, Roth M, Nanavati D. et al. Low-Velocity Knee Dislocations in Obese and Morbidly Obese Patients. Orthop J Sports Med 2015; 3: 2325967115575719 DOI: 10.1177/2325967115575719. (PMID: 26665048)
    Google Scholar
  • 26 Georgiadis AG, Guthrie ST, Shepard AD. Beware of ultra-low-velocity knee dislocation. Orthopedics 2014; 37: 656-658 DOI: 10.3928/01477447-20140924-03. (PMID: 25272276)
    Google Scholar
  • 27 Frosch KH, Preiss A, Heider S. et al. Primary ligament sutures as a treatment option of knee dislocations: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2013; 21: 1502-1509 DOI: 10.1007/s00167-012-2154-8. (PMID: 22868350)
    Google Scholar
  • 28 Xu B, Xu H, Tu J. et al. Initial Assessment and Implications for Surgery: The Missed Diagnosis of Irreducible Knee Dislocation. J Knee Surg 2018; 31: 254-263 DOI: 10.1055/s-0037-1602135. (PMID: 28460411)
    Google Scholar
  • 29 Medina O, Arom GA, Yeranosian MG. et al. Vascular and nerve injury after knee dislocation: a systematic review. Clin Orthop Relat Res 2014; 472: 2621-2629 DOI: 10.1007/s11999-014-3511-3. (PMID: 24554457)
    Google Scholar
  • 30 Darabos N, Gusic N, Vlahovic T. et al. Staged management of knee dislocation in polytrauma injured patients. Injury 2013; 44 (Suppl. 03) S40-S45 DOI: 10.1016/S0020-1383(13)70196-7. (PMID: 24060017)
    Google Scholar
  • 31 D’Alleyrand JC, O’Toole RV. The evolution of damage control orthopedics: current evidence and practical applications of early appropriate care. Orthop Clin North Am 2013; 44: 499-507 DOI: 10.1016/j.ocl.2013.06.004. (PMID: 24095066)
    Google Scholar
  • 32 Bouillon B, Rixen D, Maegele M. et al. Damage Control Orthopedics. What is the current situation?. Unfallchirurg 2009; 112: 860-869 DOI: 10.1007/s00113-009-1598-x. (PMID: 19756456)
    Google Scholar
  • 33 Howells NR, Brunton LR, Robinson J. et al. Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee. Injury 2011; 42: 1198-1204 DOI: 10.1016/j.injury.2010.11.018. (PMID: 21156317)
    Google Scholar
  • 34 Barnes CJ, Pietrobon R, Higgins LD. Does the pulse examination in patients with traumatic knee dislocation predict a surgical arterial injury? A meta-analysis. J Trauma 2002; 53: 1109-1114 DOI: 10.1097/01.TA.0000025792.36332.D7. (PMID: 12478036)
    Google Scholar
  • 35 Fortuna G, DuBose JJ, Mendelsberg R. et al. Contemporary outcomes of lower extremity vascular repairs extending below the knee: A multicenter retrospective study. J Trauma Acute Care Surg 2016; 81: 63-70 DOI: 10.1097/TA.0000000000000996. (PMID: 26885995)
    Google Scholar
  • 36 Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma 2004; 56: 1261-1265 DOI: 10.1097/01.ta.0000068995.63201.0b. (PMID: 15211135)
    Google Scholar
  • 37 King 3rd JJ, Cerynik DL, Blair JA. et al. Surgical outcomes after traumatic open knee dislocation. Knee Surg Sports Traumatol Arthrosc 2009; 17: 1027-1032 DOI: 10.1007/s00167-009-0721-4. (PMID: 19205664)
    Google Scholar
  • 38 Kannus P, Jarvinen M. Nonoperative treatment of acute knee ligament injuries. A review with special reference to indications and methods. Sports Med 1990; 9: 244-260 DOI: 10.2165/00007256-199009040-00005. (PMID: 2183332)
    Google Scholar
  • 39 Dedmond BT, Almekinders LC. Operative versus nonoperative treatment of knee dislocations: a meta-analysis. Am J Knee Surg 2001; 14: 33-38 (PMID: 11216717)
    Google Scholar
  • 40 Levy BA, Dajani KA, Whelan DB. et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy 2009; 25: 430-438 DOI: 10.1016/j.arthro.2009.01.008. (PMID: 19341932)
    Google Scholar
  • 41 Montgomery TJ, Savoie FH, White JL. et al. Orthopedic management of knee dislocations. Comparison of surgical reconstruction and immobilization. Am J Knee Surg 1995; 8: 97-103 (PMID: 7552613)
    Google Scholar
  • 42 O’Malley MP, Pareek A, Reardon P. et al. Treatment of Peroneal Nerve Injuries in the Multiligament Injured/Dislocated Knee. J Knee Surg 2016; 29: 287-292 DOI: 10.1055/s-0035-1570019. (PMID: 26683981)
    Google Scholar
  • 43 Bonnevialle P, Dubrana F, Galau B. et al. Common peroneal nerve palsy complicating knee dislocation and bicruciate ligaments tears. Orthop Traumatol Surg Res 2010; 96: 64-69 DOI: 10.1016/j.rcot.2009.12.004. (PMID: 20170859)
    Google Scholar
  • 44 Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction. Arthroscopy 1996; 12: 521-530 DOI: 10.1016/s0749-8063(96)90189-9. (PMID: 8902124)
    Google Scholar
  • 45 Smyth MP, Koh JL. A review of surgical and nonsurgical outcomes of medial knee injuries. Sports Med Arthrosc Rev 2015; 23: e15-e22 DOI: 10.1097/JSA.0000000000000063. (PMID: 25932882)
    Google Scholar
  • 46 Hegyes MS, Richardson MW, Miller MD. Knee dislocation. Complications of nonoperative and operative management. Clin Sports Med 2000; 19: 519-543 DOI: 10.1016/s0278-5919(05)70222-2. (PMID: 10918964)
    Google Scholar
  • 47 Schenck jr RC. , Richter DL, Wascher DC. Knee Dislocations: Lessons Learned From 20-Year Follow-up. Orthop J Sports Med 2014; 2: 2325967114534387 DOI: 10.1177/2325967114534387. (PMID: 26535332)
    Google Scholar
  • 48 Freychet B, Kennedy NI, Sanders TL. et al. No difference between single and staged posterolateral corner surgical procedures in the multiligament injured/dislocated knee. Knee Surg Sports Traumatol Arthrosc 2020; 28: 2170-2176 DOI: 10.1007/s00167-019-05759-x. (PMID: 31912165)
    Google Scholar
  • 49 Heitmann M, Akoto R, Krause M. et al. Management of acute knee dislocations: anatomic repair and ligament bracing as a new treatment option-results of a multicentre study. Knee Surg Sports Traumatol Arthrosc 2019; 27: 2710-2718 DOI: 10.1007/s00167-018-5317-4. (PMID: 30631909)
    Google Scholar
  • 50 Otto A, Helal A, Imhoff FB. et al. Promising clinical and magnetic resonance imaging results after internal bracing of acute posterior cruciate ligament lesions in multiple injured knees. Knee Surg Sports Traumatol Arthrosc 2020; 28: 2543-2550 DOI: 10.1007/s00167-020-05852-6. (PMID: 32047998)
    Google Scholar
  • 51 Richter M, Bosch U, Wippermann B. et al. Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med 2002; 30: 718-727 DOI: 10.1177/03635465020300051601. (PMID: 12239009)
    Google Scholar
  • 52 Kovachevich R, Shah JP, Arens AM. et al. Operative management of the medial collateral ligament in the multi-ligament injured knee: an evidence-based systematic review. Knee Surg Sports Traumatol Arthrosc 2009; 17: 823-829 DOI: 10.1007/s00167-009-0810-4. (PMID: 19421735)
    Google Scholar
  • 53 Barrett IJ, Krych AJ, Pareek A. et al. Short- to mid-term outcomes of anatomic MCL reconstruction with Achilles tendon allograft after multiligament knee injury. Knee Surg Sports Traumatol Arthrosc 2018; 26: 2952-2959 DOI: 10.1007/s00167-018-4843-4. (PMID: 29427218)
    Google Scholar
  • 54 Stannard JP, Brown SL, Farris RC. et al. The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med 2005; 33: 881-888 DOI: 10.1177/0363546504271208. (PMID: 15827360)
    Google Scholar
  • 55 LaPrade RF, Johansen S, Agel J. et al. Outcomes of an anatomic posterolateral knee reconstruction. J Bone Joint Surg Am 2010; 92: 16-22 DOI: 10.2106/JBJS.I.00474. (PMID: 20048091)
    Google Scholar
  • 56 Arciero RA. Anatomic posterolateral corner knee reconstruction. Arthroscopy 2005; 21: 1147 DOI: 10.1016/j.arthro.2005.06.008. (PMID: 16171645)
    Google Scholar
  • 57 Miyatake S, Kondo E, Tsai TY. et al. Biomechanical comparisons between 4-strand and modified Larson 2-strand procedures for reconstruction of the posterolateral corner of the knee. Am J Sports Med 2011; 39: 1462-1469 DOI: 10.1177/0363546511404135. (PMID: 21508435)
    Google Scholar
  • 58 Domnick C, Frosch KH, Raschke MJ. et al. Kinematics of Different Components of the Posterolateral Corner of the Knee in the Lateral Collateral Ligament-intact State: A Human Cadaveric Study. Arthroscopy 2017; 33: 1821-1830.e1 DOI: 10.1016/j.arthro.2017.03.035. (PMID: 28615108)
    Google Scholar
  • 59 Feldman V, Biadsi A, Slavin O. et al. Pulmonary Embolism After Application of a Sterile Elastic Exsanguination Tourniquet. Orthopedics 2015; 38: e1160-e1163 DOI: 10.3928/01477447-20151123-08. (PMID: 26652340)
    Google Scholar
  • 60 Raschke MJ, Kittl C, Domnick C. Partial proximal tibia fractures. EFORT Open Rev 2017; 2: 241-249 DOI: 10.1302/2058-5241.2.160067. (PMID: 28630761)
    Google Scholar
  • 61 Wong CH, Tan JL, Chang HC. et al. Knee dislocations-a retrospective study comparing operative versus closed immobilization treatment outcomes. Knee Surg Sports Traumatol Arthrosc 2004; 12: 540-544 DOI: 10.1007/s00167-003-0490-4. (PMID: 14999440)
    Google Scholar
  • 62 Mook WR, Miller MD, Diduch DR. et al. Multiple-ligament knee injuries: a systematic review of the timing of operative intervention and postoperative rehabilitation. J Bone Joint Surg Am 2009; 91: 2946-2957 DOI: 10.2106/JBJS.H.01328. (PMID: 19952260)
    Google Scholar
  • 63 Lynch AD, Chmielewski T, Bailey L. et al. Current Concepts and Controversies in Rehabilitation After Surgery for Multiple Ligament Knee Injury. Curr Rev Musculoskelet Med 2017; 10: 328-345 DOI: 10.1007/s12178-017-9425-4. (PMID: 28779476)
    Google Scholar
  • 64 Richter DL, Bankhead CP, Wascher DC. et al. Knee Dislocation (KD) IV Injuries of the Knee: Presentation, Treatment, and Outcomes. Clin Sports Med 2019; 38: 247-260 DOI: 10.1016/j.csm.2018.11.007. (PMID: 30878047)
    Google Scholar
  • 65 Scarcella NR, Weinberg DS, Bowen S. et al. Clinical and Functional Results of 119 Patients With Knee Dislocations. J Orthop Trauma 2017; 31: 380-386 DOI: 10.1097/BOT.0000000000000839. (PMID: 28633148)
    Google Scholar
  • 66 Savarese E, Bisicchia S, Romeo R. et al. Role of high tibial osteotomy in chronic injuries of posterior cruciate ligament and posterolateral corner. J Orthop Traumatol 2011; 12: 1-17 DOI: 10.1007/s10195-010-0120-0. (PMID: 21107635)
    Google Scholar
  • 67 Stannard JP, Nuelle CW, McGwin G. et al. Hinged external fixation in the treatment of knee dislocations: a prospective randomized study. J Bone Joint Surg Am 2014; 96: 184-191 DOI: 10.2106/JBJS.L.01603. (PMID: 24500579)
    Google Scholar
  • 68 Mariani PP, Santoriello P, Iannone S. et al. Comparison of surgical treatments for knee dislocation. Am J Knee Surg 1999; 12: 214-221 (PMID: 10626912)
    Google Scholar
  • 69 Levy BA, Stuart MJ. Treatment of PCL, ACL, and lateral-side knee injuries: acute and chronic. J Knee Surg 2012; 25: 295-305 DOI: 10.1055/s-0032-1324813. (PMID: 23150157)
    Google Scholar
  • 70 Dwyer T, Marx RG, Whelan D. Outcomes of treatment of multiple ligament knee injuries. J Knee Surg 2012; 25: 317-326 DOI: 10.1055/s-0032-1326999. (PMID: 23150159)
    Google Scholar
  • 71 Johnson ME, Foster L, DeLee JC. Neurologic and vascular injuries associated with knee ligament injuries. Am J Sports Med 2008; 36: 2448-2462 DOI: 10.1177/0363546508325669. (PMID: 19074408)
    Google Scholar
  • 72 Tomaino M, Day C, Papageorgiou C. et al. Peroneal nerve palsy following knee dislocation: pathoanatomy and implications for treatment. Knee Surg Sports Traumatol Arthrosc 2000; 8: 163-165 DOI: 10.1007/s001670050208. (PMID: 10883428)
    Google Scholar
  • 73 Welling RE, Kakkasseril J, Cranley JJ. Complete dislocations of the knee with popliteal vascular injury. J Trauma 1981; 21: 450-453 (PMID: 7230298)
    Google Scholar