title: Primary ligament sutures as a treatment option of knee dislocations: a meta-analysis.
abstract: OBJECTIVE
  Treatment of knee dislocation is still controversial. There is no evidence to favour ligament suture or reconstruction. Until now, no meta-analyses have examined suture versus reconstruction of cruciate ligaments in knee dislocations with respect to injury pattern and rupture classification.
  
  
  METHODS
  We searched Medline, the Cochrane Controlled Trial Database, and EMBASE for studies on surgical treatment for 'knee dislocation' and 'multiple ligament injured knee'. A meta-analysis was performed using individual patient data.
  
  
  RESULTS
  Nine studies including 195 patients (200 knees) with a mean age of 31.4 (±13) years fulfilled the study requirements. Thirteen cases of type II dislocations, 63 cases of type III medial, 84 cases of type III lateral, and 40 cases of type IV dislocations, according to Schenck's classification, were found. Poor or moderate results were found in 70 % of patients without surgical treatment of ACL or PCL (n = 27). Patients (n = 40) treated by sutures of the ACL and PCL demonstrated a significantly greater proportion of excellent or good results (40 and 37.5 %, respectively) (p < 0.001). Patients who underwent reconstruction of the ACL and PCL (n = 75) showed excellent or good results (28 and 45 %, respectively). No significant difference was found when comparing suture versus reconstruction of the ACL and PCL (n.s.). The outcome depends considerably on Schenck's injury pattern classification.
  
  
  CONCLUSIONS
  Conservative treatment after knee dislocation yields poor clinical results. Suture repair of cruciate ligaments can still serve as an alternative option for multiligament injuries of the knee and achieve good clinical results, which are comparable to those of ligament reconstruction. The data provided by this meta-analysis should be reinforced by a prospective study, in which suture repair and ligament reconstruction are compared.
  
  
  METHODS
  IV.
authors.affiliation: Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany. k.frosch@asklepios.com
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Frosch
authors.forename: Achim
authors.initials: A
authors.lastname: Preiss
authors.forename: Saskia
authors.initials: S
authors.lastname: Heider
authors.forename: Dirk
authors.initials: D
authors.lastname: Stengel
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlmuth
authors.forename: Martin F
authors.initials: MF
authors.lastname: Hoffmann
authors.forename: Helmut
authors.initials: H
authors.lastname: Lill
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D001182:Arthroscopy; D006801:Humans; D031221:Knee Dislocation / Q000601:surgery*; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery*; D013536:Suture Techniques