Examination of the Patient With a Knee Dislocation

Abstract

One hundred fifteen patients with a unilateral knee dislocation underwent arteriography to examine the popliteal artery. The incidence of popliteal artery injury was 23% (27 patients). Clinically, 29 (25%) of the 115 patients had an abnormal ipsilateral pedal pulse and 23 (79%) of these 29 patients had an arteriographically identified popliteal artery injury. Twenty-two arteries were surgically repaired and one was treated without surgery. Eight-six patients had normal pulses; the arteriogram showed no abnormalities in 77, demonstrated spasm in five, and revealed an intimal flap in four. All 86 patients were treated without surgery and had no delayed vascular complications. This demonstrates that the vascular examination is an accurate predictor of major popliteal artery injury following knee dislocation. Patients with an abnormal pedal pulse warrant arteriography due to a high incidence (79%) of popliteal artery injury. Patients with normal pulses may be monitored by clinical examination only. Popliteal artery injuries in this group are minor and rarely require intervention.

What Is the Frequency of Vascular Injury After Knee Dislocation?

“…In previous studies, the percentage of vascular injuries diagnosed requiring surgical treatment ranged from 64% to 100% [1,5,10,14,[16][17][18]20]. The lower proportion of vascular injury undergoing surgery from our data is interesting since vascular injury secondary to knee dislocation may be severe with a high potential for limb loss [2,7,9,13,15].…”

“…Therefore, it is important to understand the epidemiology of these events. Previous studies vary widely on the reported frequency of vascular injuries in patients with knee dislocations, ranging from 5% to 64% [5,11,[13][14][15][16][17][18][19]. This can most likely be attributed to the small sample sizes used in the majority of these studies, as knee dislocations are relatively rare.…”

“…High-velocity knee dislocations are more likely to result in vascular injury [19], and therefore a higher incidence of lowvelocity knee dislocations would presumably reduce the frequency of vascular injuries, which is what we observed. Additionally, many of the previous studies were able to identify minor vascular injuries that did not require operative intervention, such as intimal flap tears [17,18]. These minor vascular injuries not requiring surgery were detected via angiography.…”

“…Despite the importance in recognition of vascular injuries in patients with knee dislocation, there is much controversy regarding its true frequency, thereby warranting further examination. The reported frequency of vascular injury associated with knee dislocation varies widely, ranging between 5% and 64% [1,5,7,10,14,[16][17][18]20]. In addition, much of the literature is based on very small sample sizes since knee dislocations are uncommon [1,5,10,14,[16][17][18]20].…”

Posterior Tibial Tendon Transfer Improves Function for Foot Drop After Knee Dislocation

“…Knee dislocation is often associated with additional injuries to the affected leg, such as injury to the popliteal artery (23%-32%) [6,26], compartment syndrome, injury to the tibial nerve [13,25,30], and more often injury to the common peroneal nerve (14%-40%) [3,14,16,21,28].…”