Current Concepts in Acute Knee Dislocation: The Missed Diagnosis?

Abstract

Traumatic knee dislocation is a serious and potentially limb threatening injury that can be easily missed if meticulous history and examination have not been employed. Neurovascular injuries are common in this condition, and due diligence should be given to their thorough evaluation at time of secondary survey so as to avoid complications such as ischaemia, compartment syndrome and eventual amputation. There is growing evidence in the literature that morbid obesity is associated with low energy knee dislocation, therefore this should be considered when assessing this cohort of patients presenting with an acute knee injury. Early operative intervention especially with multi ligaments involvement is the preferable strategy in the management of this acute injury. Controversy exists whether to reconstruct or repair damaged structures, and whether to adopt a one stage or two stage reconstruction of the cruciate ligaments. Early rehabilitation is important and essential to achieve satisfactory outcomes. This article is an evidence-based overview of this rare but devastating injury.

Vascular Injury in Obese Patients after Ultra-Low-Velocity Trauma

“…Traumatic knee dislocation (KD) is a serious and potentially limb threatening injury, albeit a relatively rare condition [1][2][3][4][5][6]. Knee dislocation, defined as a complete disruption of the integrity of the tibia-femoral articulation [7], is uncommon, representing 0.001% to 0.013% of orthopedic injuries [8].…”

“…These injuries have historically been attributed to High Velocity Impacts (HVKD) however more recently they are being noted in low velocity incidents (LVKD), particularly involving morbidly obese people [6,[11][12][13][14][15]. Incidence of associated vascular lesions is reported in the actual literature with 7.5 up to 14% [16][17][18].…”

“…Natsuhara et al reported an increased risk for males of vascular injury compared to females (OR 2.59, p<0.001) [19]. Knee dislocation often reduces spontaneously, potentially leading to a high rate of delayed presentation or missed diagnosis [6,20,21]. Knee dislocations are traditionally divided epidemiologically into those caused by high velocity trauma such as an MVA (motor vehicle accident) or low velocity trauma such as those sustained in sporting injuries [6,7].…”

“…Knee dislocation often reduces spontaneously, potentially leading to a high rate of delayed presentation or missed diagnosis [6,20,21]. Knee dislocations are traditionally divided epidemiologically into those caused by high velocity trauma such as an MVA (motor vehicle accident) or low velocity trauma such as those sustained in sporting injuries [6,7]. More recently there has been an increasing number of reports of knee dislocations involving morbidly obese patients [6,[22][23][24][25].…”

CORR Insights®: Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?

“…The challenge in the management of traumatic knee dislocation is making a prompt and accurate diagnosis. Dislocations often reduce spontaneously, which can result in delayed or missed diagnoses [2], and these can result in ischemia, permanent nerve damage, compartment syndrome, or even amputation. Although generally a consequence of high-velocity trauma, some research suggests that traumatic knee dislocation can occur following even lowenergy injuries like sprains [1].…”