Knee Dislocation: Initial Assessment and Implications for Treatment

Wascher, Daniel C.; Dvirnak, Paul; DeCoster, Thomas A.

doi:10.1097/00005131-199710000-00011

Cited by 331 publications

(237 citation statements)

References 19 publications

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“…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].…”

Section: Discussionmentioning

confidence: 55%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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What Is the Frequency of Vascular Injury After Knee Dislocation?

Natsuhara

Yeranosian

Cohen

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Vascular injury secondary to an acute knee dislocation is a known complication. However, there exist wide discrepancies in the reported rate of vascular injury in this setting. Questions/purposes Using a large private insurance database, we determined the frequency of vascular injury in knee dislocations across year of diagnosis, age, sex, and US geographic region and the proportion of these injuries requiring surgical repair. MethodsThe PearlDiver database, which contains records from 11 million orthopaedic patients, was searched using ICD-9 diagnostic codes for all knee dislocation events from 2004 to 2009. Within this subset, we identified which knee dislocations had an associated vascular injury ICD-9 code. Patients were stratified by year of diagnosis, age, sex, and US geographic region, and Current Procedural Terminology codes were used to identify the subset of patients with vascular injury requiring surgical repair. Differences in frequency across demographic groups and over time were analyzed with Poisson regression analysis. Results Among the 8050 limbs with knee dislocation identified over the study period, 267 had a concomitant vascular injury for an overall frequency of 3.3%. Males were found to have an increased risk of vascular injury compared to females (odds ratio = 2.59, p \ 0.001). Additionally, patients aged 20 to 39 years had a higher risk of vascular injury when compared to those aged 0 to 19 years (odds ratio = 1.93, p = 0.001), 40 to 59 years (odds ratio = 1.57, p = 0.014), and 60 years or older (odds ratio = 2.81, p = 0.036). There were no differences in vascular injury frequency across US geographic regions or diagnosis year. Thirty-four of the 267 cases of vascular injury (13%) underwent surgical treatment. Conclusions This is the largest study, to our knowledge, that analyzes the proportion of knee dislocations that result in vascular injury. Our data suggest that there is a lower frequency of vascular injury associated with knee

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Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

What Is the Frequency of Vascular Injury After Knee Dislocation?

Natsuhara

Yeranosian

Cohen

et al. 2014

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…These injuries were then classified according to the system described by Wascher, which is a modification to the original KD (knee dislocation) classification system proposed by Schenck (Fig. 1) [36,42,51].…”

Section: Methodsmentioning

confidence: 99%

Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Born¹,

Engasser

King

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Reconstruction of the multiligament-injured knee often involves extended surgical and tourniquet use times and often is performed in patients who have sustained concomitant fractures as well as vascular injuries, all of which would appear to predispose the patient to the potentially serious complications of deep vein thrombosis and perhaps pulmonary embolism, yet little is known about the frequency of venous thromboembolic (VTE) events after multiligamentous knee reconstruction. Questions/purposes The purposes of this study were to (1) determine the frequency of symptomatic VTE after multiligamentous knee reconstruction at a single institution; and (2) to determine associated risk factors for VTE in these patients. Methods The records of 134 (63% of the 213 consented individuals in our longitudinal database) patients who underwent primary (129 [96%]) or revision (five [4%]) multiligamentous knee reconstruction at a single institution between 1992 and 2013 were retrospectively reviewed. With two patients undergoing procedures bilaterally, this resulted in a total of 136 multiligamentous knee reconstructions. VTE for which clinical symptoms were evident and confirmed by imaging within 3 months after the reconstructive procedure was noted. Pre-and perioperative data were collected with respect to demographics, associated injuries, medical history, smoking status, and surgical data. Standard rehabilitation and thromboprophylaxis protocols were used in all patients. Results Three cases of symptomatic VTE (three deep vein thromboses) occurred after the 136 reconstructions (2%; 95% confidence interval, 0.53%-7.3%). Two of the three patients were obese and the remaining patient smoked and abused alcohol. However, as a result of a low frequency of VTE, no risk factors could be identified in this series. Conclusions Symptomatic VTE occurred in 2% of multiligamentous knee reconstructions at our institution while receiving thromboprophylaxis. This is similar to rates documented after anterior cruciate ligament reconstruction without thromboprophylaxis. Further multicenter research is required to identify the true frequency of and risk factors for developing VTE in patients undergoing multiligamentous knee reconstruction after knee dislocation. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…3 of the patients are polytraumatized [29], and the amputation rate after knee dislocation is approximately 10% [23]. 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].…”

Section: Introductionmentioning

confidence: 99%