Total Knee Arthroplasty for Chronic Anterior Knee Dislocatio
The present case series has been published in the
Clinical Medicine Insights: Case Reports. The occurrence of chronic knee dislocation is rare. To the best of authors' knowledge, total knee arthroplasty for treatment of chronic anterior knee dislocation has not been reported.

Case 1
A 48-year-old woman presented with a history of right knee dislocation resulting from an automobile accident in 2007. As shown in her records and based on the Schenck et al3 classification, she had experienced spontaneously reduced KD3M (i.e. ACL, PCL and MCL injured) knee dislocation. One year later, she was treated by anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction at another centre.

The knee range of motion (ROM) decreased over time and the joint became deformed. On admission in 2013, she presented with fixed anterior knee dislocation in which the tibia was anterior to the femur (Figure 1A). Passive ROM was between 10° of hyperextension and 60° of flexion.

The knee was unstable and painful. After discussion about the risks and benefits, a total knee arthroplasty (TKA) with a constrained hinge prosthesis was performed in 2015. Two years after the TKA, the patient reported a pain-free knee with a ROM of 0° to 110° (Figure 1B). Her Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score4 was 94.7. The patient was satisfied with this functional outcome.

Case 2
A 40-year-old woman presented with a history of a Schenck et al KD4 (i.e. ACL, PCL, PLC and MCL injured) left knee dislocation after an automobile accident in 2006. Her records showed that a popliteal vascular injury was treated by bypass grafting and the knee was fixed with an external fixator (Figure 2A). After 3 weeks, the posterolateral complex injury was treated by direct repair.

Four years after the trauma, PCL and ACL reconstructions were performed in 2 stages at another centre (Figure 2B). On admission in 2014, she had a fixed anteriorly dislocated knee (Figure 2C). After accepting the risks and benefits of surgery, TKA with a constrained hinge prosthesis was performed in February 2016 (Figure 2D). At the 15-month follow-up, she had a painless stable knee with a ROM of 0° to 95° and a WOMAC score of 88.6. She was satisfied with this functional outcome.

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