Confirmation of the Safety and Accuracy of Physical Examination in the Evaluation of Knee Dislocation for Injury of the Popliteal Artery: A Prospective Study

Miranda, Fernando; Dennis, James W.; Veldenz, Henry C.; Dovgan, Peter S.; Frykberg, Eric R.

doi:10.1097/00005373-200202000-00008

Cited by 88 publications

(69 citation statements)

References 16 publications

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“…Sillanpää et al [21] similarly warned increasing body proportions are leading to a changing paradigm in the epidemiology of knee dislocations and associated vascular injuries. Although historical literature suggested that mechanism of injury and the degree of injury severity (ISS) were useful predictors of vascular injury [7,8,10,14,25], this was not the case in our study or others [3,21]. To our knowledge, our study is one of the only studies that investigates open injury as a risk factor for vascular injury after knee dislocation; however, Wright et al [27] reported a series of 19 patients with open knee dislocations and found that nine (47%) had some form of concomitant vascular injury.…”

Section: Discussionmentioning

confidence: 99%

“…A similar concept is used by acute care surgeons during the evaluation of appendicitis, where it has been suggested that a significant false positive rate is necessary to ensure a diagnostic sensitivity of 100% [5]. The absence of pulses alone has been suggested in some studies [7,8,10,11,14,24,25] as being sufficient to detect vascular injury, although each of the studies had limited patient sample size and relied on antiquated technology. Moreover, these studies were limited by their selective use of the ABI, which has been shown to be a valuable adjunct to the vascular examination.…”

Section: Discussionmentioning

confidence: 99%

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Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?

Weinberg

Scarcella

Napora

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Knee dislocations are rare injuries with potentially devastating vascular complications. An expeditious and accurate diagnosis is necessary, as failing to diagnose vascular injury can result in amputation; however, the best diagnostic approach remains controversial. Questions/purposes We asked: (1) What patient factors are predictors of vascular injury after knee dislocation? (2) What are the diagnostic utilities of palpable dorsalis pedis or posterior tibial pulses, and the presence of an anklebrachial index (ABI) of 0.9 or greater?Methods A database at a Level I trauma center was queried for patients with evidence of knee dislocation, demographic information (age at the time of injury, sex, Injury Severity Score, BMI, mechanism of injury), and the presence of open injury were recorded. One-hundred fortyone patients underwent screening at initial presentation, of whom 26 (24%) underwent early vascular exploration based on an abnormal physical examination. One-hundred five (91%) of the remaining 115 patients were available at a minimum followup of 6 months (mean, 19 ± 10 months). In total, 31 unique patients were excluded, including 10 patients (7%) who were lost to followup before 6 months. Among the 110 patients who met inclusion criteria, the mean age and SD was 37 ± 13 years, and the Injury Severity Score was 15 ± 9. There were 71 males (65%). Logistic regression was used to determine independent correlates of vascular injury. The vascular examination was reviewed for the presence of a palpable pulse in the dorsalis pedis artery, the presence of a palpable pulse in the posterior tibial artery, and whether the ABI in the dorsalis pedis was 0.9 or greater. Contingency tables were generated to assess the sensitivity, specificity, and accuracy of physical examination maneuvers. The physical examination was collectively regarded as ''normal'' when both pulses were palpable and the ABI was 0.9 or greater. The initial physical examination as just described was considered the diagnostic test being evaluated in this study; ''positive'' tests were evaluated by and confirmed at vascular surgery, and 6 months clinical followup without symptoms or progressive signs of vascular injury confirmed the absence of injury in the remainder of the patients. Contingency tables were generated again to assess the sensitivity, specificity, and accuracy of the combined physical examination.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity w...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?

Weinberg

Scarcella

Napora

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…If basic physical examination reveals intact peripheral pulses, an arteriography is not necessary. On the other hand, a suspicious peripheral perfusion status should lead to an arteriography at an early stage [13].…”

Section: Discussionmentioning

confidence: 99%

Femoral avulsion fracture of the posterior cruciate ligament in association with a rupture of the popliteal artery in a 9-year-old boy: a case report

Hesse

Bastian

Zeichen

et al. 2005

Knee Surg Sports Traumatol Arthrosc

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Ruptures of the posterior cruciate ligament (PCL) and especially proximal bony avulsion fractures in children are very rare. This in combination with a rupture of the popliteal artery is extremely rare. Thus, an exact incidence is not available from the literature. Overall, these injuries are severe and often lead to chronic knee instability. We report a case of a 9-year-old boy who suffered a traumatic displacement of the left knee with a rupture of the popliteal artery. Prior to transfer to our department, he was treated by a saphenous vein bypass graft and by a transfixation of the knee using two oblique percutaneous pins. We performed magnetic resonance imaging (MRI) scan of the knee which revealed a femoral avulsion fracture of the PCL. Other ligaments and menisci were intact. A transosseous femoral fixation using non-absorbable stitches was carried out. A 1-year follow-up after surgery demonstrates intact peripheral perfusion and sensation, straight axes of both legs and a physiological gait. Minimal differences of the length and circumference of both legs could be measured. The posterior laxity (Lachman-test) was about 5/8 mm (right/left knee) and 2/5 mm (right/left knee) in 90 degrees flexion. The range of motion (extension/flexion) was 5/0/140 degrees -/5/100 degrees (right-left knee). Intact cruciate ligaments were confirmed by MRI. Minimal experience exists in treatment of combined injuries to the PCL and the popliteal artery in children.

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“…In two recent studies [27,28] (Fig. 11) where patients were managed with modern reconstruction techniques, and evaluated using the IKDC [55] score, no patients were rated as normal at the time of review. Overall, 38 % were nearly normal, 40 % were abnormal and 21 % were severely abnormal.…”

Section: Outcome Of Knee Dislocationmentioning

confidence: 99%

Acute Knee Ligament Injuries and Knee Dislocation

Keating

2014

European Surgical Orthopaedics and Traumatology

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Confirmation of the Safety and Accuracy of Physical Examination in the Evaluation of Knee Dislocation for Injury of the Popliteal Artery: A Prospective Study

Cited by 88 publications

References 16 publications

Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?

Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?

Femoral avulsion fracture of the posterior cruciate ligament in association with a rupture of the popliteal artery in a 9-year-old boy: a case report

Acute Knee Ligament Injuries and Knee Dislocation

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