Uniplanar Coronal Tibiofemoral Subluxation in Patients Following Multi-Ligament Knee Injuries: A Multi-Center Retrospective Case Series

Document Type

Conference Proceeding

Publication Date

9-2025

Publication Title

Orthopaedic Journal of Sports Medicine

Abstract

Introduction:

Uniplanar coronal tibiofemoral subluxation (UCTFS) in the setting of multiple ligament knee injury (MLKI) or knee dislocation (KD) has rarely been discussed and the potential for missed diagnosis may significantly impact long-term outcomes. While a missed KD is rare, a pure UCTFS could be overlooked, especially in the setting of a patient with multiple traumatic injuries, where more urgent intervention may be necessary or if follow-up imaging is not obtained. In the literature, risk factors, etiology, and treatment recommendations have been described for tibiofemoral subluxation in the sagittal plane, but there is little reported on how to approach tibiofemoral subluxation in the coronal plane following MLKIs. Early management of UCTFS is vital to obtain a more stable joint reduction and avoid long term consequences.

Objective:

To describe the presentation, injury patterns, possible mechanical barriers for reduction, and management for isolated UCTFS following MLKI/KD. This is the only case series so far to describe the etiology and treatment of UCTFS following MLKI and KD. This study aims to enhance early recognition, decision making, and overall management of this rare injury to help avoid long-term complications such as knee instability, arthrofibrosis, and post-traumatic osteoarthritis. This is a multicenter retrospective case series of level of evidence IV.

Methods:

A retrospective chart review was conducted at four institutions to identify patients with KD or MLKI who presented with or developed subsequent UCTFS from Jan 2001 to Jan 2024. UCTFS was defined as medial or lateral translation of the tibial plateau in reference to the femoral condyle as seen on anterior-posterior radiographic imaging, with normal alignment seen on the lateral radiograph. Medical records were reviewed for demographic data, clinical presentation, physical examination, diagnostic imagining, examination under anesthesia, surgical finding and procedures performed.

Results:

A total of 15 cases were included. Of these, 12 patients were subluxed laterally and 3 medially (Figure 1). UCTFS was diagnosed at different time points with 10 patients within one week, 2 patients between 1 to 6 weeks, and 3 patients after 6 weeks from injury. The most common mechanism of injury was a fall (33%) and the most common pattern of injury was a KD-3L (26.6%). A mechanical blockage to reduction was found in 9 cases (60%). These included medial soft tissue sleeve incarceration (4), bucket-handle meniscus tears (3), concomitant patella dislocation (2) and a displaced tibial spine fracture (1). Some patients experienced subluxation due to several sources of mechanical block. Uniplanar external fixation was utilized in 7 patients for management of their initial ligamentous injuries, coronal instability, or a traumatic vascular injury. Hinged external fixation was utilized in 2/15 patients who presented in a chronic fashion to counter the propensity to subluxation while allowing early motion (Figure 2).

Conclusion:

UCTFS is a rare event that has several potential factors contributing to its etiology and one or more of these factors may need to be surgically addressed. Tibiofemoral subluxation can be found in various timepoints from injury and awareness and monitoring for its development should be factored into the clinical decision making. UCTFS is a challenging clinical dilemma that may require multiplanar or hinged external fixation to maintain reduction.

Volume

13

Issue

9 Suppl 3

Comments

American Orthopaedic Society for Sports Medicine Annual Meeting, July 10-13, 2025, Nashville, TN

DOI

10.1177/2325967125S00274

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