Open, Combat-Related Loss, or Disruption of the Knee Extensor Mechanism: Treatment Strategies, Classification, and Outcomes
OBJECTIVE:To report the outcomes of repair or reconstruction of high-energy, open knee extensor disruption or loss due to combat-related injuries. DESIGN:Retrospective review. SETTING:Tertiary (Level/Role V) Military Treatment Facility. PATIENTS:Fourteen consecutive patients who sustained 17 complex...
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| Veröffentlicht in: | Journal of orthopaedic trauma 2014-11, Vol.28 (11), p.e250-e257 |
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| container_title | Journal of orthopaedic trauma |
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| creator | Andersen, Romney C Wilson, Kevin W Bojescul, John A Mickel, Timothy J Gordon, Wade T Potter, Benjamin K |
| description | OBJECTIVE:To report the outcomes of repair or reconstruction of high-energy, open knee extensor disruption or loss due to combat-related injuries.
DESIGN:Retrospective review.
SETTING:Tertiary (Level/Role V) Military Treatment Facility.
PATIENTS:Fourteen consecutive patients who sustained 17 complex, open knee extensor mechanism injuries during combat operations between March 2003 and May 2012.
INTERVENTION:Primary repair or staged allograft extensor reconstruction after serial debridement and closure or soft tissue coverage.
MAIN OUTCOME MEASURES:Final knee range of motion, extensor lag, ambulatory ability and assist devices, and complications requiring reoperation or salvage procedure.
RESULTS:The open knee extensor mechanism injuries required a mean of 11 procedures per injury. At a mean final follow-up of 39 months (range, 12–89 months), all patients achieved regular community ambulation, with 36% requiring assist devices due to concomitant or bilateral injuries. Average knee flexion was 92 degrees, and 35% of extremities had an extensor lag >10 degrees; however, 6 of 9 extremities with allograft reconstructions had extensor lags of |
| doi_str_mv | 10.1097/BOT.0000000000000121 |
| format | Article |
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DESIGN:Retrospective review.
SETTING:Tertiary (Level/Role V) Military Treatment Facility.
PATIENTS:Fourteen consecutive patients who sustained 17 complex, open knee extensor mechanism injuries during combat operations between March 2003 and May 2012.
INTERVENTION:Primary repair or staged allograft extensor reconstruction after serial debridement and closure or soft tissue coverage.
MAIN OUTCOME MEASURES:Final knee range of motion, extensor lag, ambulatory ability and assist devices, and complications requiring reoperation or salvage procedure.
RESULTS:The open knee extensor mechanism injuries required a mean of 11 procedures per injury. At a mean final follow-up of 39 months (range, 12–89 months), all patients achieved regular community ambulation, with 36% requiring assist devices due to concomitant or bilateral injuries. Average knee flexion was 92 degrees, and 35% of extremities had an extensor lag >10 degrees; however, 6 of 9 extremities with allograft reconstructions had extensor lags of <10 degrees, and 5 had no extensor lag. The presence of a major periarticular or patellar fracture was significantly associated with the knee requiring a subsequent extensor mechanism allograft reconstruction procedure. One extremity each underwent knee arthrodesis or transfemoral amputation due to severe infection.
CONCLUSIONS:High-energy, open knee extensor mechanism injuries are severe and rarely occur in isolation, but limb salvage is generally successful after multiple procedures. Patients who required staged allograft reconstruction, despite high complication rates, generally had favorable results.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</description><identifier>ISSN: 0890-5339</identifier><identifier>EISSN: 1531-2291</identifier><identifier>DOI: 10.1097/BOT.0000000000000121</identifier><identifier>PMID: 24694556</identifier><language>eng</language><publisher>United States: by Lippincott Williams & Wilkins</publisher><subject>Adult ; Amputation - methods ; Amputation, Traumatic - surgery ; Arthroplasty - methods ; Blast Injuries - diagnosis ; Blast Injuries - surgery ; Female ; Fractures, Open ; Humans ; Knee Injuries - diagnosis ; Knee Injuries - surgery ; Male ; Military Personnel ; Multiple Trauma - surgery ; Reconstructive Surgical Procedures - methods ; Recovery of Function ; Retrospective Studies ; Salvage Therapy - methods ; Soft Tissue Injuries - surgery ; Treatment Outcome ; Warfare ; Young Adult</subject><ispartof>Journal of orthopaedic trauma, 2014-11, Vol.28 (11), p.e250-e257</ispartof><rights>2014 by Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3710-749180740d7846f484267b2d7f46537bae3848579a93282a9fba1ebff44dcac43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24694556$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Andersen, Romney C</creatorcontrib><creatorcontrib>Wilson, Kevin W</creatorcontrib><creatorcontrib>Bojescul, John A</creatorcontrib><creatorcontrib>Mickel, Timothy J</creatorcontrib><creatorcontrib>Gordon, Wade T</creatorcontrib><creatorcontrib>Potter, Benjamin K</creatorcontrib><title>Open, Combat-Related Loss, or Disruption of the Knee Extensor Mechanism: Treatment Strategies, Classification, and Outcomes</title><title>Journal of orthopaedic trauma</title><addtitle>J Orthop Trauma</addtitle><description>OBJECTIVE:To report the outcomes of repair or reconstruction of high-energy, open knee extensor disruption or loss due to combat-related injuries.
DESIGN:Retrospective review.
SETTING:Tertiary (Level/Role V) Military Treatment Facility.
PATIENTS:Fourteen consecutive patients who sustained 17 complex, open knee extensor mechanism injuries during combat operations between March 2003 and May 2012.
INTERVENTION:Primary repair or staged allograft extensor reconstruction after serial debridement and closure or soft tissue coverage.
MAIN OUTCOME MEASURES:Final knee range of motion, extensor lag, ambulatory ability and assist devices, and complications requiring reoperation or salvage procedure.
RESULTS:The open knee extensor mechanism injuries required a mean of 11 procedures per injury. At a mean final follow-up of 39 months (range, 12–89 months), all patients achieved regular community ambulation, with 36% requiring assist devices due to concomitant or bilateral injuries. Average knee flexion was 92 degrees, and 35% of extremities had an extensor lag >10 degrees; however, 6 of 9 extremities with allograft reconstructions had extensor lags of <10 degrees, and 5 had no extensor lag. The presence of a major periarticular or patellar fracture was significantly associated with the knee requiring a subsequent extensor mechanism allograft reconstruction procedure. One extremity each underwent knee arthrodesis or transfemoral amputation due to severe infection.
CONCLUSIONS:High-energy, open knee extensor mechanism injuries are severe and rarely occur in isolation, but limb salvage is generally successful after multiple procedures. Patients who required staged allograft reconstruction, despite high complication rates, generally had favorable results.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</description><subject>Adult</subject><subject>Amputation - methods</subject><subject>Amputation, Traumatic - surgery</subject><subject>Arthroplasty - methods</subject><subject>Blast Injuries - diagnosis</subject><subject>Blast Injuries - surgery</subject><subject>Female</subject><subject>Fractures, Open</subject><subject>Humans</subject><subject>Knee Injuries - diagnosis</subject><subject>Knee Injuries - surgery</subject><subject>Male</subject><subject>Military Personnel</subject><subject>Multiple Trauma - surgery</subject><subject>Reconstructive Surgical Procedures - methods</subject><subject>Recovery of Function</subject><subject>Retrospective Studies</subject><subject>Salvage Therapy - methods</subject><subject>Soft Tissue Injuries - surgery</subject><subject>Treatment Outcome</subject><subject>Warfare</subject><subject>Young Adult</subject><issn>0890-5339</issn><issn>1531-2291</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc1u1DAURq0K1A6lb1AhL1lMiq_txDY7GMqPGDQSDOvISa6ZtEk82I4K4uXx0AJVvbGs-33nSseEnAO7AGbUi9eb7QW7f4DDEVlAKaDg3MAjsmDasKIUwpyQJzFe5YxmnB-TEy4rI8uyWpBfmz1OS7ryY2NT8RkHm7Cjax_jkvpA3_QxzPvU-4l6R9MO6ccJkV7-SDjFPP-E7c5OfRxf0m1Am0acEv2SQqZ86zEzVoONsXd9aw-QJbVTRzdzav2I8Sl57OwQ8ezuPiVf315uV--L9ebdh9WrddEKBaxQ0oBmSrJOaVk5qSWvVMM75WRVCtVYFFrqUhlrBNfcGtdYwMY5KbvWtlKckue33H3w32eMqR772OIw2An9HGuooJKq0qrMUXkbbUNWENDV-9CPNvysgdUH7XXWXj_UnmvP7jbMzYjdv9Jfz_-5N35IGOL1MN9gqHdoh7T7wyvh8G8MJEB-FQcwE78Ba6-Mmg</recordid><startdate>201411</startdate><enddate>201411</enddate><creator>Andersen, Romney C</creator><creator>Wilson, Kevin W</creator><creator>Bojescul, John A</creator><creator>Mickel, Timothy J</creator><creator>Gordon, Wade T</creator><creator>Potter, Benjamin K</creator><general>by Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201411</creationdate><title>Open, Combat-Related Loss, or Disruption of the Knee Extensor Mechanism: Treatment Strategies, Classification, and Outcomes</title><author>Andersen, Romney C ; Wilson, Kevin W ; Bojescul, John A ; Mickel, Timothy J ; Gordon, Wade T ; Potter, Benjamin K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3710-749180740d7846f484267b2d7f46537bae3848579a93282a9fba1ebff44dcac43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Amputation - methods</topic><topic>Amputation, Traumatic - surgery</topic><topic>Arthroplasty - methods</topic><topic>Blast Injuries - diagnosis</topic><topic>Blast Injuries - surgery</topic><topic>Female</topic><topic>Fractures, Open</topic><topic>Humans</topic><topic>Knee Injuries - diagnosis</topic><topic>Knee Injuries - surgery</topic><topic>Male</topic><topic>Military Personnel</topic><topic>Multiple Trauma - surgery</topic><topic>Reconstructive Surgical Procedures - methods</topic><topic>Recovery of Function</topic><topic>Retrospective Studies</topic><topic>Salvage Therapy - methods</topic><topic>Soft Tissue Injuries - surgery</topic><topic>Treatment Outcome</topic><topic>Warfare</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Andersen, Romney C</creatorcontrib><creatorcontrib>Wilson, Kevin W</creatorcontrib><creatorcontrib>Bojescul, John A</creatorcontrib><creatorcontrib>Mickel, Timothy J</creatorcontrib><creatorcontrib>Gordon, Wade T</creatorcontrib><creatorcontrib>Potter, Benjamin K</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of orthopaedic trauma</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Andersen, Romney C</au><au>Wilson, Kevin W</au><au>Bojescul, John A</au><au>Mickel, Timothy J</au><au>Gordon, Wade T</au><au>Potter, Benjamin K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Open, Combat-Related Loss, or Disruption of the Knee Extensor Mechanism: Treatment Strategies, Classification, and Outcomes</atitle><jtitle>Journal of orthopaedic trauma</jtitle><addtitle>J Orthop Trauma</addtitle><date>2014-11</date><risdate>2014</risdate><volume>28</volume><issue>11</issue><spage>e250</spage><epage>e257</epage><pages>e250-e257</pages><issn>0890-5339</issn><eissn>1531-2291</eissn><abstract>OBJECTIVE:To report the outcomes of repair or reconstruction of high-energy, open knee extensor disruption or loss due to combat-related injuries.
DESIGN:Retrospective review.
SETTING:Tertiary (Level/Role V) Military Treatment Facility.
PATIENTS:Fourteen consecutive patients who sustained 17 complex, open knee extensor mechanism injuries during combat operations between March 2003 and May 2012.
INTERVENTION:Primary repair or staged allograft extensor reconstruction after serial debridement and closure or soft tissue coverage.
MAIN OUTCOME MEASURES:Final knee range of motion, extensor lag, ambulatory ability and assist devices, and complications requiring reoperation or salvage procedure.
RESULTS:The open knee extensor mechanism injuries required a mean of 11 procedures per injury. At a mean final follow-up of 39 months (range, 12–89 months), all patients achieved regular community ambulation, with 36% requiring assist devices due to concomitant or bilateral injuries. Average knee flexion was 92 degrees, and 35% of extremities had an extensor lag >10 degrees; however, 6 of 9 extremities with allograft reconstructions had extensor lags of <10 degrees, and 5 had no extensor lag. The presence of a major periarticular or patellar fracture was significantly associated with the knee requiring a subsequent extensor mechanism allograft reconstruction procedure. One extremity each underwent knee arthrodesis or transfemoral amputation due to severe infection.
CONCLUSIONS:High-energy, open knee extensor mechanism injuries are severe and rarely occur in isolation, but limb salvage is generally successful after multiple procedures. Patients who required staged allograft reconstruction, despite high complication rates, generally had favorable results.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</abstract><cop>United States</cop><pub>by Lippincott Williams & Wilkins</pub><pmid>24694556</pmid><doi>10.1097/BOT.0000000000000121</doi></addata></record> |
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| subjects | Adult Amputation - methods Amputation, Traumatic - surgery Arthroplasty - methods Blast Injuries - diagnosis Blast Injuries - surgery Female Fractures, Open Humans Knee Injuries - diagnosis Knee Injuries - surgery Male Military Personnel Multiple Trauma - surgery Reconstructive Surgical Procedures - methods Recovery of Function Retrospective Studies Salvage Therapy - methods Soft Tissue Injuries - surgery Treatment Outcome Warfare Young Adult |
| title | Open, Combat-Related Loss, or Disruption of the Knee Extensor Mechanism: Treatment Strategies, Classification, and Outcomes |
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