Objectives Heterogeneous patient factors and injury mechanisms result in a great variety of injury patterns encountered in knee dislocations (KD). Attempts to improve outcome can focus on a wide range of challenges. The aim of this study was to establish and prioritise a list of challenges encountered when treating patients with acute KD. Methods A modified Delphi consensus study was conducted with international knee specialists who generated a prioritised list of challenges. Selected priorities were limited to half of the possible items. Agreement of more than 70% was defined as consensus on each of these items a priori. Results Ninety-one international surgeons participated in the first round. The majority worked in public hospitals and treated patients from low-income and middle-income households. Their propositions were prioritised by 27 knee surgeons from Europe, Africa, Asia, as well as North and South America, with a mean of 15.3 years of experience in knee surgery (SD 17.8). Consensus was reached for postoperative stiffness, obesity, delay to presentation and associated common peroneal nerve injuries. Challenges such as vascular injuries, ipsilateral fractures, open injuries as well as residual laxity were also rated high. Most of these topics with high priority are key during the initial management of a patient with KD, at presentation. Topics with lower priority were postsurgical challenges, such as patient insight, expectations and compliance, rehabilitation programme, and pain management. Conclusion This consensus study has a wide geographical footprint of experts around the world practising in various settings. These participants prioritised stiffness, obesity, treatment delays and associated limb-threatening injuries as the most important challenges when managing a patient with acute KD. This list calls for applicable and feasible solutions for these challenges in a global setting. It should be used to prioritise research efforts and discuss treatment guidelines. Level of evidence V. De-identified participant data are available upon reasonable request from the authors (ORCID identifier: 0000-0002-0671-0439).

中文翻译：

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急性膝关节脱位管理中的优先挑战是僵硬、肥胖、治疗延迟和相关的肢体威胁：一项全球共识研究

目的 异质的患者因素和损伤机制导致膝关节脱位 (KD) 中遇到的损伤模式多种多样。改善结果的尝试可以集中在广泛的挑战上。本研究的目的是建立和优先考虑治疗急性 KD 患者时遇到的挑战列表。方法 修改后的德尔菲共识研究是与国际膝关节专家进行的，他们生成了一个优先挑战列表。选定的优先事项仅限于可能项目的一半。超过 70% 的同意被定义为事先就这些项目中的每一个达成共识。结果 91名国际外科医生参加了第一轮比赛。大多数人在公立医院工作，治疗来自中低收入家庭的患者。他们的提议得到了来自欧洲、非洲、亚洲以及北美和南美的 27 名膝关节外科医生的优先考虑，他们的膝关节手术经验平均为 15.3 年 (SD 17.8)。就术后僵硬、肥胖、延迟就诊和相关的腓总神经损伤达成共识。血管损伤、同侧骨折、开放性损伤以及残余松弛等挑战也被评为高。这些具有高优先级的主题中的大多数是 KD 患者初始治疗期间的关键。优先级较低的主题是术后挑战，例如患者洞察力、期望和依从性、康复计划和疼痛管理。结论 这项共识研究具有广泛的地理足迹，涵盖了世界各地在各种环境中执业的专家。这些参与者将僵硬、肥胖、治疗延迟和相关的肢体威胁性损伤列为治疗急性 KD 患者时最重要的挑战。该清单呼吁在全球范围内针对这些挑战提出适用和可行的解决方案。它应该用于优先考虑研究工作和讨论治疗指南。证据级别 V. 可根据作者的合理要求（ORCID 标识符：0000-0002-0671-0439）提供去标识化参与者数据。