Clinical Outcomes of Multiligament Knee Fracture Dislocation at Minimum 2-year Follow-up

Abstract To report clinical and functional outcomes, including patient-reported outcome measures (PROMs), complications, reoperation rates, and arthritic progression in patients who sustained a knee dislocation (KD) type V fracture dislocation at minimum 2-year follow-up. A retrospective review from a prospectively collected database was performed to identify all patients with a KD type V fracture dislocation between 2001 and 2022 at a single institution. Patient demographics, pre- and postoperative clinical examination findings, intraoperative details, and postoperative complication rates were obtained from medical records. PROMs, including Visual Analog Scale (VAS), Tegner Activity Scale, Lysholm score, and International Knee Documentation Committee Subjective (IKDC) score were analyzed. A total of 11 patients (mean age: 33.9 ± 7.6, mean BMI: 33.5 ± 6.4 kg/m2) were included with a mean follow-up of 6.4 ± 5.4 years. Seven patients (64%) had a tibial plateau fracture involving the weight-bearing surface. Four patients (36%) had a concomitant nerve injury, one patient (9%) had a concomitant vascular injury, three patients (27%) had a concomitant cartilage injury (ICRS grade 3 + ), and seven patients (64%) had a concomitant meniscus injury. In all, 10 patients (82%) underwent fracture fixation. The mean postoperative Kellgren-Lawrence (KL) grade was 3.0 ± 1.0. Postoperative PROMs included VAS at rest of 2.0 ± 2.3, VAS with activity of 3.3 ± 3.2, IKDC of 68.3 ± 22.1, Lysholm of 79.0 ± 23.6, and Tegner of 4.3 ± 1.7. Nine patients (83%) experienced a complication, with four (36%) patients requiring a subsequent reoperation. Patients with a KD V fracture dislocation who underwent surgical management demonstrated high complication and reoperation rates with advanced radiographic evidence of osteoarthritis but ultimately satisfactory functional outcomes at mid-term follow-up. These findings underscore the complexity of KD V injuries and the importance of early recognition, multidisciplinary surgical planning, and patient counseling regarding the prolonged recovery and likelihood of residual symptoms. Level of evidence is IV—retrospective case series.