2021 ISAKOS Biennial Congress Paper
Management Of Acute Knee Dislocations: A Global Survey Of Orthopaedic Surgeons’ Strategies
Santa-Marie Venter, MMED(Ortho), MSc, MBChB, LLB, BA, Cape Town SOUTH AFRICA
Roopam Dey, PhD, Cape Town, Western Cape SOUTH AFRICA
Vikas Khanduja, MA(Cantab), MBBS, MSc, FRCS, FRCS(Orth), PhD, Cambridge, Cambrideshire UNITED KINGDOM
Richard P. von Bormann, MD, Cape Town, Western Province SOUTH AFRICA
Michael Held, MD, PhD, Cape Town SOUTH AFRICA
University of Cape Town, Cape Town, Western Cape, SOUTH AFRICA
FDA Status Not Applicable
Summary
This questionnaire based study shows that treatment of knee dislocations varied significantly based on the economic status of the country.
Abstract
Purpose
The aim of this study was to compare the management approach of acute knee
dislocations (AKDs) by orthopaedic surgeons from nations with different economic status.
Methods
A survey sent to members of the Societe Internationale de Chirurgie Orthopedique et de Traumatologie (SICOT) compared different management strategies for acute multiligament knee injuries (aMLKIs). These were compared after categorising surgeons into developed economic nations (DEN) and emerging markets and developing nations (EMDN) based on the gross domestic product (GDP) per capita.
Results
138 orthopaedic surgeons from 47 countries participated in this study. DEN surgeons had more years of experience and were older (p<0.05). Surgeons from EMDN preferred conservative management and delayed reconstruction with autograft (p<0.05) if surgery was necessary. Surgeons from DEN favoured early, single stage arthroscopic ligament reconstruction. Significantly more EMDN surgeons preferred clinical examination (p<0.05) and duplex doppler scanning (p<0.05) compared to DEN surgeons. More surgeons from EMDN did not have access to a physiotherapist for their patients.
Conclusions
Treatment of aMLKIs varied significantly based on the economic status of the country. In EMDN, aMLKIs are often treated conservatively, ligament surgery is often delayed and staged, alternative vascular assessment methods are more commonly used, and access to physiotherapy is challenging. This calls for adjusted guidelines when treating patients in areas of low resource setting.