The management of acute knee dislocations: A global survey of orthopaedic surgeons’ strategies
Purpose: Great variety and controversies surround the management strategies of acute multiligament knee injuries (aMKLIs) and no established guidelines exist for resource-limited practices. The aim of this study was to compare the management approach of acute knee dislocations (AKDs) by orthopedic s...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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EDP Sciences
2021-01-01
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| Series: | SICOT-J |
| Subjects: | |
| Online Access: | https://www.sicot-j.org/articles/sicotj/full_html/2021/01/sicotj200115/sicotj200115.html |
| _version_ | 1818591583754256384 |
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| author | Venter Santa-Marie Dey Roopam Khanduja Vikas von Bormann Richard PB Held Michael |
| author_facet | Venter Santa-Marie Dey Roopam Khanduja Vikas von Bormann Richard PB Held Michael |
| author_sort | Venter Santa-Marie |
| collection | DOAJ |
| description | Purpose: Great variety and controversies surround the management strategies of acute multiligament knee injuries (aMKLIs) and no established guidelines exist for resource-limited practices. The aim of this study was to compare the management approach of acute knee dislocations (AKDs) by orthopedic surgeons from nations with different economic status. Methods: This descriptive cross-sectional scenario-based survey compares different management strategies for aMLKIs of surgeons in developed economic nations (DEN) and emerging markets and developing nations (EMDN). The main areas of focus were operative versus non-operative management, timing and staging of surgery, graft choice and vascular assessment strategies. The members of the Societe Internationale de Chirurgie Orthopedique et de Traumatologie (SICOT) were approached to participate and information was collected regarding their demographics, experience, hospital setting and management strategies of aMLKIs. These were analyzed after categorizing participants into DEN and EMDN based on the gross domestic product (GDP) per capita. Results: One-hundred and thirty-eight orthopedic surgeons from 47 countries participated in this study, 67 from DEN and 71 (51.4%) from EMDN. DEN surgeons had more years of experience and were older (p < 0.05). Surgeons from EMDN mostly worked in public sector hospitals, were general orthopedic surgeons and treated patients from a low-income background. They preferred conservative management and delayed reconstruction with autograft (p < 0.05) if surgery was necessary. Surgeons from DEN favored early, single stage arthroscopic ligament reconstruction. Selective Computerized Tomography Angiography (CTA) was the most preferred choice of arterial examination for both groups. 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 vary significantly based on the economic status of the country. Surgeons from DEN prefer early, single stage arthroscopic ligament reconstruction, while conservative management is favored in EMDN. Ligament surgery in EMDN is often delayed and staged. EMDN respondents utilize duplex doppler scanning and clinical examination more readily in their vascular assessment of aMLKIs. These findings highlight very distinct approaches to MLKIs in low-resource settings which are often neglected when guidelines are generated. |
| first_indexed | 2024-12-16T10:14:45Z |
| format | Article |
| id | doaj.art-a3e3078054004ee6b5729a954134e669 |
| institution | Directory Open Access Journal |
| issn | 2426-8887 |
| language | English |
| last_indexed | 2024-12-16T10:14:45Z |
| publishDate | 2021-01-01 |
| publisher | EDP Sciences |
| record_format | Article |
| series | SICOT-J |
| spelling | doaj.art-a3e3078054004ee6b5729a954134e6692022-12-21T22:35:29ZengEDP SciencesSICOT-J2426-88872021-01-0172110.1051/sicotj/2021017sicotj200115The management of acute knee dislocations: A global survey of orthopaedic surgeons’ strategiesVenter Santa-Marie0https://orcid.org/0000-0001-7009-1970Dey RoopamKhanduja Vikas1von Bormann Richard PB2Held Michael3Department of Orthopedic Surgery, Groote Schuur Hospital, Orthopedic Research Unit, University of Cape TownConsultant Orthopedic Surgeon, Addenbrooke’s Hospital, Cambridge, University of CambridgeCape Town Sports and Orthopaedic Clinic, Christian Barnard Memorial HospitalDepartment of Orthopedic Surgery, Groote Schuur Hospital, Orthopedic Research Unit, University of Cape TownPurpose: Great variety and controversies surround the management strategies of acute multiligament knee injuries (aMKLIs) and no established guidelines exist for resource-limited practices. The aim of this study was to compare the management approach of acute knee dislocations (AKDs) by orthopedic surgeons from nations with different economic status. Methods: This descriptive cross-sectional scenario-based survey compares different management strategies for aMLKIs of surgeons in developed economic nations (DEN) and emerging markets and developing nations (EMDN). The main areas of focus were operative versus non-operative management, timing and staging of surgery, graft choice and vascular assessment strategies. The members of the Societe Internationale de Chirurgie Orthopedique et de Traumatologie (SICOT) were approached to participate and information was collected regarding their demographics, experience, hospital setting and management strategies of aMLKIs. These were analyzed after categorizing participants into DEN and EMDN based on the gross domestic product (GDP) per capita. Results: One-hundred and thirty-eight orthopedic surgeons from 47 countries participated in this study, 67 from DEN and 71 (51.4%) from EMDN. DEN surgeons had more years of experience and were older (p < 0.05). Surgeons from EMDN mostly worked in public sector hospitals, were general orthopedic surgeons and treated patients from a low-income background. They preferred conservative management and delayed reconstruction with autograft (p < 0.05) if surgery was necessary. Surgeons from DEN favored early, single stage arthroscopic ligament reconstruction. Selective Computerized Tomography Angiography (CTA) was the most preferred choice of arterial examination for both groups. 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 vary significantly based on the economic status of the country. Surgeons from DEN prefer early, single stage arthroscopic ligament reconstruction, while conservative management is favored in EMDN. Ligament surgery in EMDN is often delayed and staged. EMDN respondents utilize duplex doppler scanning and clinical examination more readily in their vascular assessment of aMLKIs. These findings highlight very distinct approaches to MLKIs in low-resource settings which are often neglected when guidelines are generated.https://www.sicot-j.org/articles/sicotj/full_html/2021/01/sicotj200115/sicotj200115.htmlmultiligament knee injuryacute knee dislocationmanagement knee dislocation |
| spellingShingle | Venter Santa-Marie Dey Roopam Khanduja Vikas von Bormann Richard PB Held Michael The management of acute knee dislocations: A global survey of orthopaedic surgeons’ strategies SICOT-J multiligament knee injury acute knee dislocation management knee dislocation |
| title | The management of acute knee dislocations: A global survey of orthopaedic surgeons’ strategies |
| title_full | The management of acute knee dislocations: A global survey of orthopaedic surgeons’ strategies |
| title_fullStr | The management of acute knee dislocations: A global survey of orthopaedic surgeons’ strategies |
| title_full_unstemmed | The management of acute knee dislocations: A global survey of orthopaedic surgeons’ strategies |
| title_short | The management of acute knee dislocations: A global survey of orthopaedic surgeons’ strategies |
| title_sort | management of acute knee dislocations a global survey of orthopaedic surgeons strategies |
| topic | multiligament knee injury acute knee dislocation management knee dislocation |
| url | https://www.sicot-j.org/articles/sicotj/full_html/2021/01/sicotj200115/sicotj200115.html |
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