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Prioritized Challenges In The Management Of Acute Knee Dislocations Are Stiffness, Obesity, Treatment Delays, And Associated Limb Threatening Injuries. A Global Consensus Study.

2021 Congress Paper Abstracts

Prioritized Challenges In The Management Of Acute Knee Dislocations Are Stiffness, Obesity, Treatment Delays, And Associated Limb Threatening Injuries. A Global Consensus Study.

Michael Held, MD, PHD, SOUTH AFRICA Robert C. Schenck, Jr., MD, UNITED STATES Sachin Ramchandra Tapasvi, MBBS, MS, DNB, FRCS, INDIA Andy Williams, MBBS, FRCS(Orth), FFSEM(UK), UNITED KINGDOM Wai Pan Yau, MBBS, FRCS, FHKCOS, FHKAM, HONG KONG TĂșlio V.O. Campos, MD, MsC, Prof., BRAZIL Vikas Khanduja, MA(Cantab), MBBS, MSc, FRCS, FRCS(Orth), PhD, UNITED KINGDOM Christopher D. Harner, MD, FAOA, UNITED STATES

University of Cape Town, Cape Town, Western Cape, SOUTH AFRICA


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Summary: A prioritized list of the most important challenges in the management of acute knee dislocations was established through a modified Delphi consensus study and consensus was reached for post-operative stiffness, obesity, delay to presentation, and associated common peroneal nerve injuries.


Heterogeneous patient factors and injury mechanisms result in 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 prioritize a list of challenges encountered when treating patients with acute knee dislocations.

Methods

A modified Delphi consensus study was conducted with international knee specialists who generated a prioritized 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 priory.

Results

Ninety-one international surgeons participated in the first round. The majority worked in public hospitals and treated patients from low- and middle-income households. Their propositions were prioritized 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 post-operative 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 knee dislocations, at presentation. Topics with lower priority were post-surgical challenges, such as patient insight, expectations and compliance, rehabilitation program, and pain management.

Conclusion

This consensus study has a wide geographic footprint of experts around the world practicing in various settings. These participants prioritized 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 prioritize research efforts and discuss treatment guidelines.


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