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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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I dislocated my knee and had surgery six weeks ago to repair the damage. I've been told to expect additional operations in the future. What can I expect in terms of a final result?

There aren't a lot of studies of patients with this type of injury because fortunately, there aren't large numbers of patients who dislocate their knees. What we do know comes from a recent systematic review of evidence collected since the 1950s. Even with 50 years of data to look at, only 24 studies for a total of 396 knees qualified for inclusion in this review. Results of treatment were assessed using objective measures such as range-of-motion, joint stability, and patients' return-to-work or return-to-sports status. The need for manipulation was another outcome measure reported on. Manipulation refers to an operative procedure under anesthesia. The surgeon moves the joint through its full range of motion, gently breaking any adhesions or scar tissue that are keeping the joint from moving and causing severe stiffness and pain. It was possible to see a pattern of treatment times that results could be based on. These were divided into acute treatment (first three weeks following the injury), chronic treatment (three or more weeks after injury), and staged treatment. Staged repairs often take place throughout the time periods. The first surgery in a staged procedure is done during the acute phase with follow-up operations during the chronic phase. Rehabilitation corresponded with these same time periods and could be divided into two major groups: mobilization (early movement) and immobilization (no movement). Data for all patients was put together and analyzed to compare each treatment option with each phase of treatment. They found that patients who had acute (early) treatment were more likely to end up with knee instability (joint laxity/looseness) or the opposite: joint stiffness requiring manipulation. Acute treatment followed by immobilization had the worst results. These patients were the least likely to get back-to-work or back-to-athletics. Patients in the chronic treatment group (treatment three or more weeks after injury) regained their knee joint motion better than the other two groups and were less likely to need a joint manipulation. But results for this group varied and couldn't be predicted. Staged surgeries seemed to have the best results. Patients who had staged treatment were also more likely to rate their results as good-to-excellent. However, they did have just as much stiffness as the acute group requiring manipulation later. In terms of the rehabilitation programs, getting patients up and moving rather than putting them in an immobilizing splint or brace didn't seem to cause joint instability. In fact, in some cases it prevented instability. But it didn't prevent joint stiffness later. The most significant findings regarding postoperative treatment involved that acute treatment group. Patients treated surgically in the acute phase (within three weeks of the injury) who also had early mobility had fewer problems with joint stability. This combination (acute treatment with early mobilization) was more likely to get patients back to work. The results suggest that early aggressive rehab after acute treatment may be advised. But, in the end, taking it one step at a time seems to work best. Your surgeon will be able to guide you through this process based on your own individual factors.


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