Knee Joint Dislocation in a Difficult, Low-Resource Himalayan Setting: A Longitudinal Functional Outcome Study

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Introduction: Knee joint dislocation is a rare and limb-threatening injury, which is often missed due to its association with other life-threatening injuries and is particularly challenging to manage in a low-resource setting. Our study is a longitudinal observational study evaluating the functional recovery trends following knee joint dislocation in a tertiary care hospital in the Himalayan Region of India. Materials and Methods: This was a longitudinal study conducted from September 2022 to June 2024. It included a total of 28 patients who presented to the hospital with a dislocated knee joint, of which half were managed surgically, while the other half were managed conservatively post-reduction. Functional outcomes were assessed using the Lysholm Knee Scoring Scale, International Knee Documentation Committee (IKDC) subjective score, and EQ-5D-5L at 6 weeks, 3 months, and 6 months. Statistical analyses were performed using the Statistical Package for the Social Sciences version 29. Results: Of the 28 patients (22 males and 6 females; mean age 39.3 ± 13.4 years), exactly half were managed conservatively, and the other 14 operatively. Kennedy type A (75%), and Schenck KD I (36%) injuries predominated. Functional scores improved gradually across time points. At 6 months, mean Lysholm scores (conservative 61.7 ± 11.3 versus operative 64.3 ± 10.8, P = 0.53, Cohen's d = -0.24) and IKDC scores (61.2 ± 3.3 versus 54.1 ± 9.4, P = 0.63, d = 0.19) were statistically comparable. EQ-5D-5L indices (0.75 ± 0.09 versus 0.78 ± 0.08, P = 0.40) paralleled these findings. Repeated-measures analysis of variance revealed significant within-group improvement (F = 12.4, P < 0.001) but no group-time interaction (P = 0.72). Sensitivity analysis excluding vascular cases confirmed robustness (adjusted P = 0.61). Conclusion: Both management modalities yielded equivalent short-term recovery. Conservative management, when feasible and with preserved vascular integrity, can achieve satisfactory functional outcomes along with reduced cost (approximately 40% lower than operative management) in low- and middle-income resource settings such as the Himalayan region. Enhanced rehabilitation access remains essential for recovery and better functional outcomes. Long-term, multicentric research is needed to provide more robust data on this topic.

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