Knee > Knee Dislocation > Treatments

   Closed Reduction and Ligament Surgery

Surgery Procedure

Despite the variations in severity of knee dislocations, the general procedure can be broken into two basic parts: closed reduction and ligament surgery.

Your physician helps relax your thigh muscles and calm you down. You are usually given narcotic painkillers, and possibly muscle relaxants, when the knee is put back in place. In some cases, general anesthesia may be required. With the appropriate combination of pulling and rotating, your knee essentially pops back into place. The reduction should only be done by a highly trained physician, as complications of a knee dislocation can be very serious.

LIGAMENT SURGERY

Your ACL, MCL, LCL, and PCL can be treated in a number of ways, depending on your orthopedic surgeon's diagnosis of your knee injury. Damaged ligaments may heal with immobilization or may require surgery. If surgery is required, ligaments are repaired if possible, or they are reconstructed using other tissues. Some surgery may be done during the initial hospitalization, but it is common to wait up to several weeks before certain ligament reconstructions are performed. You will be given either regional or general anesthesia as required by the complexity of your injury. The more ligaments you have damaged, the longer the surgery will take to perform and the longer you will have to be under anesthesia. When surgery is required, the PCL and the ACL can usually be repaired arthroscopically, with small incisions and tiny surgical instruments. But the LCL and the MCL may require open surgery.

Depending on the type of surgery that was performed, your knee will have a different appearance when you wake up. Open surgery leaves you with a surgical incision with multiple staples or stitches. Arthroscopic surgery usually requires two or more punctures with one or two stitches in each. Your knee may be in a cast or immobilizer, depending on the severity of your injury and the preference of your surgeon. You may receive a brace for your knee before leaving the hospital. You may spend two to five hours in the recovery room, during which time your knee will be elevated. An ice pack may be used to reduce pain and swelling, and pain medication may be administered orally or through an IV (intravenous) line. You should try to move your feet while you are in the recovery room to improve circulation. You will probably be unable to put much weight on your leg. Your surgeon may suggest that you use crutches for at least one week. If you damaged multiple ligaments you may be asked to use crutches for four to six weeks. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who with the assistance of the doctor, will determine when you can prepare to go home. You will usually spend at least one night in the hospital after ligament surgery for a knee dislocation.

Most patients stay in the hospital for at least 24 hours after a knee dislocation. If your leg is not in a cast, it may be flexed and extended to keep the knee joint from becoming stiff. This can be done using a continuous passive motion (CPM) machine. The CPM is attached to your bed and then your leg is placed in it. When turned on, it takes your leg through a continuous range of motion. There will likely be pain and you can expect to be given pain medication as needed. Be sure to ask for medication as soon as you feel pain coming on, because pain medication works best on pain that is building rather than on pain that is already present. The nurses will not give you more than your doctor has prescribed and what is considered to be safe. Ice also helps control pain and swelling. You will be unable to drive yourself home so be sure to arrange for someone to give you a ride.

After ligament surgery to repair your dislocated knee, you will need to take steps to reduce the pain and inflammation in the knee. Rest, icing, elevation, and painkillers such as ibuprofen or narcotics can ease pain and swelling. To immobilize the knee, your physician may recommend that you wear a cast or a lightweight brace. The type and duration of immobilization depend upon the severity of the injury and the surgical procedures performed. The cast or brace may be designed so that you cannot bend your knee. If this is the case, you will need to modify your behavior so that you can avoid having to squat, kneel down, or bend over. You should try to keep your leg elevated even if you are sitting in a chair to minimize swelling of the knee joint. Depending on the success in reducing pain and swelling, you may be able to start on a rehabilitative program after a few days. In general, physicians have started recommending aggressive rehab programs that get you out of bed and moving as soon as possible. Patients can usually start walking with crutches right away. Many patients progress from crutches to a cane before walking unassisted. The length of time spent on crutches varies greatly depending on the amount of damage to your knee. Most people can count on taking at least six weeks off from work after a knee dislocation and ligament surgery. However, a patient may return to a sedentary job sooner.

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Complete healing of your knee structure may take several months, depending on the severity of the injury. Physicians may suggest you begin early passive movement of the knee, either with the aid of a physical therapist or by taking home a CPM (continuous passive motion) machine. In most cases, your rehabilitation will be supervised by a physical therapist who is trained in dealing with knee injuries. Strengthening exercises focus on the quadriceps and hamstrings - the main stabilizing muscles for your knee. Physicians suggest you gradually increase the amount of weight as your leg muscles get stronger. Strengthening exercises require dedication because it may take months for a patient to see results. Once the muscles of your injured leg are about as strong as the uninjured leg, the focus of rehab turns to increasing your coordination. At this point, physical therapy tends to become activity oriented as you regain the ability to perform complicated movements. Recreational and sports activities may be delayed up to a year or more depending on the injury. In severe cases, patients may never return to sports.

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Prevention

Strength, endurance, flexibility, and generalized fitness are the keys to avoiding re-injury after a knee dislocation. Your main prevention goal should be to strengthen your quadriceps and hamstring muscles so they are stronger than before the dislocation. You should try to feel comfortable that your leg muscles are powerful enough to snugly keep your knee in a normal alignment. Making the strengthening exercises you learned in rehab part of your regular conditioning routine is the best way to prevent future knee dislocations. While a repeat dislocation is rare, other knee injuries may be more likely to occur as a result of damage sustained in the original dislocation. Depending on the severity of your dislocation and the success of your rehab program, your physician may recommend that you avoid contact sports or risky, high-speed activities. Your physician can recommend the best types of protective gear for your knees.

Treatment Introduction

Knee dislocations usually disrupt or tear the main ligaments stabilizing your knee. The ACL (anterior cruciate ligament), PCL (posterior cruciate ligament), MCL (medial collateral ligament), and LCL (lateral collateral ligament) are all at risk of injury during a dislocation. An orthopedic surgeon will be consulted to ensure your knee dislocation and related ligament damage is managed properly.