The management of unreduced knee dislocations who present late is challenging. The aim of this study was to determine the clinical, radiological, and functional outcomes following open reduction and reconstructive surgery for chronic irreducible knee dislocations. This retrospective study analyzed prospectively collected data of patients with an unreduced fixed anterior or posterior knee dislocation of 1 to 6 months' duration, treated with open reduction, hinged external fixator application, and ligament reconstruction who had a minimum 2-year follow-up. Patients were classified based on presence of prior periarticular surgery and direction of dislocation. Data on pre- and posttreatment clinical, radiological, and functional scores were analyzed. A total of 21 patients (age range: 19–43 years) fulfilled all inclusion criteria. These included 13 missed dislocations and 8 neglected postoperative dislocations. There were 18 posterior and 3 anterior dislocations. The mean follow-up was 6.9 years (range: 2.7–16.2 years). On final follow-up, all 21 patients were independently ambulatory with mean knee range of motion 127 degrees. No patient had symptomatic knee instability at final follow-up, despite four having isolated grade-III posterior cruciate ligament (PCL) laxity. Anatomical reduction was achieved in 19 patients, whereas 2 patients had incomplete joint reduction with a persistent grade-II fixed posterior subluxation. Scanograms revealed coronal alignment within 5 degrees of the opposite unaffected limb in 17 patients. Mean functional scores improved from preoperative 9.4 ± 4.7 (range: 2–19) to postoperative 75.9 ± 8.0 (range: 64–95) for Lysholm's and preoperative 10.7 ± 1.8 (range: 8.3–13.7) to postoperative 73.5 ± 6.7 (range: 66.7–88.7) for knee injury and osteoarthritis outcome score (KOOS) scores. Prior periarticular surgery was associated with significantly inferior Lysholm's scores (p < 0.04). Although 23.8% knees developed posttraumatic knee arthritis, no patient had undergone conversion to knee arthroplasty or arthrodesis. The study concludes that open reduction and reconstructive surgery is an effective surgical treatment for chronic irreducible knee dislocations of up to 6 months duration. An individualized, often staged approach that prioritizes joint reduction, early knee mobilization, and knee stability, ensures satisfactory clinical, radiological, and functional outcomes in the medium term. This is a clinical case series and reflects level of evidence IV.

对于晚期就诊的未复位膝关节脱位的治疗具有挑战性。本研究的目的是确定慢性不可复位膝关节脱位切开复位和重建手术后的临床、放射学和功能结果。这项回顾性研究前瞻性地分析了持续 1 至 6 个月的未复位固定膝关节前或后脱位患者的数据，这些患者接受切开复位、铰接外固定器应用和韧带重建治疗，并进行了至少 2 年的随访。根据先前是否进行过关节周围手术和脱位方向对患者进行分类。分析治疗前和治疗后临床、放射学和功能评分的数据。共有 21 名患者（年龄范围：19-43 岁）满足所有纳入标准。其中包括 13 例遗漏脱位和 8 例被忽视的术后脱位。后脱位 18 例，前脱位 3 例。平均随访时间为 6.9 年（范围：2.7-16.2 年）。最终随访时，所有 21 名患者均可独立行走，膝关节平均活动范​​围为 127 度。尽管有四名患者出现孤立的 III 级后十字韧带 (PCL) 松弛，但在最终随访时，没有患者出现膝关节不稳定症状。19 名患者实现了解剖复位，而 2 名患者关节复位不完全，伴有持续性 II 级固定后半脱位。扫描图显示 17 名患者的冠状排列与另一侧未受影响肢体的误差在 5 度以内。Lysholm 病的平均功能评分从术前 9.4 ± 4.7（范围：2-19）改善到术后 75.9 ± 8.0（范围：64-95），术前 10.7 ± 1.8（范围：8.3-13.7）改善到术后 73.5 ± 6.7（范围：64-95）。 66.7–88.7) 膝损伤和骨关节炎结果评分 (KOOS) 评分。既往关节周围手术与 Lysholm 评分显着较差相关 ( p  < 0.04)。尽管 23.8% 的膝盖出现了创伤后膝关节炎，但没有患者接受膝关节置换术或关节固定术。该研究得出的结论是，切开复位重建手术是治疗长达 6 个月的慢性不可复位膝关节脱位的有效手术方法。个体化、通常分阶段的方法优先考虑关节复位、早期膝关节活动和膝关节稳定性，可确保中期获得满意的临床、放射学和功能结果。这是一个临床病例系列，反映了证据级别 IV。