Nonoperative Management

Historically, nonsurgical management of knee dislocations was standard.25-27 Treatment typically consisted of cast immobilization for 4 to 12 weeks. Selecting duration of treatment represented a compromise between stability and motion. Knee stability generally improved while knee motion declined with longer periods of immobilization. Given the results of modern reconstruction techniques, nonoperative management should probably be reserved for those patients who are elderly or very sedentary or have significant medical comorbidities.

Nonoperative treatment consists of 6 weeks of immobilization in extension using a cast, brace, or external fixation. The form of immobilization depends on the patient's habitus, energy level of the injury, and associated soft-tissue, vascular, or systemic injuries. Typically, obese patients, high-energy injuries, and injuries requiring soft-tissue or vascular surgery are best served by treatment in an across-knee external fixator. During the initial period of immobilization, regular radiographs should be obtained to confirm reduction. Initial immobilization is followed by progressive motion and strengthening in a brace.

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