The Value of the Ankle???Brachial Index for Diagnosing Arterial Injury After Knee Dislocation: A Prospective Study

Mills, W. J.; Barei, David P.; McNair, Patrick

doi:10.1097/01.ta.0000068995.63201.0b

Cited by 268 publications

(132 citation statements)

References 13 publications

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“…However, they also state that all knee dislocation patients presenting to their institution since 2005 are now assessed with Ankle Brachial Indices (ABI), with an ABI of less than 0.8 necessitating further work up with angiogram. Mills et al [3] showed that an ABI \ 0.9 is highly predictive of major vascular injury, so we caution the reader that 0.9 should be used as a cut off, not 0.8. When indicated, we currently use CT-angiogram (CTA) as opposed to conventional angiogram as CTA has been shown to be highly sensitive and specific; it uses the anticubital fossa as opposed to the groin for injection site, and uses one-fourth the radiation [4].…”

mentioning

confidence: 99%

Outcome after knee dislocation

Levy

Marx

2009

Knee Surg Sports Traumatol Arthrosc

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mentioning

confidence: 99%

Outcome after knee dislocation

Levy

Marx

2009

Knee Surg Sports Traumatol Arthrosc

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“…As they explained, many of the patients included in their meta-analysis had injuries that occurred more than 30 years ago, and when interpreted in the context of the changing demographics of modern society, it would seem valuable to continue reporting the diagnostic utility of various physical examination maneuvers. Although some authors [18,21,24] agree that knee dislocations are best diagnosed and managed through a systematic approach, the specifics of such have been heavily debated [12,13,24]. Levy et al [10] reported a shortage of high-quality evidence from which to base diagnosis and treatment decisions, specifically those related to vascular injury.…”

Section: Discussionmentioning

confidence: 99%

“…Levy et al [10] reported a shortage of high-quality evidence from which to base diagnosis and treatment decisions, specifically those related to vascular injury. Routine arteriography has been advocated by some [1,13], although there has been a gradual shift in opinion toward more selective use of angiography [6,9,16]. We therefore performed a review of a large trauma database and asked the following questions: (1) What patient factors are predictors of vascular injury after knee dislocation?…”

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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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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“…An anklebrachial index (ABI) should be performed if any concern of arterial injury arises following physical examination. Mills et al reported a 100 % sensitivity and specificity with ABIs <0.9 for patients with a clinically significant arterial injury [27]. If the vascular physical examination is normal the patient should be admitted and observed for at least 48 hours to make certain a late vascular occlusion does not occur [25].…”

Section: Diagnosismentioning

confidence: 99%

“…Isolated edema medially is often indicative of an isolated MCL injury. An effusion of the knee often results from intra-articular pathology, such as injury to the cruciate ligaments, or meniscus [10,13] [25][26][27][28]. Injury to the popliteal artery can be limb threatening and should be addressed promptly.…”

Section: Diagnosismentioning

confidence: 99%

Surgical approach to the posteromedial corner: indications, technique, outcomes

Bauer

Stannard

2013

Curr Rev Musculoskelet Med

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Injuries to the medial side of the knee can occur in isolation or in conjunction with multiple other ligaments about the knee. In addition, medial knee injuries can involve isolated injury to the medial collateral ligament or include the posteromedial structures of the knee. Treatment strategies differ greatly depending on injury pattern. In order to select an appropriate treatment strategy, one must accurately diagnose the injury pattern based on clinical examination and the use of appropriate imaging studies. The fundamental basis for diagnosis of a medial sided knee injury stems from understanding the static and dynamic stabilizing structures that compose the medial side of the knee. It is our aim to define the anatomic roles of medial sided structures, their importance in protecting the biomechanical stability of the knee, as well as provide indications and our preferred procedures for surgical management of these complex injuries.

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The Value of the Ankle???Brachial Index for Diagnosing Arterial Injury After Knee Dislocation: A Prospective Study

Abstract: The ABI is a rapid, reliable, noninvasive tool for diagnosing vascular injury associated with knee dislocation. Routine arteriography for all patients with knee dislocation is not supported.

Cited by 268 publications

References 13 publications

Outcome after knee dislocation

Outcome after knee dislocation

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

Surgical approach to the posteromedial corner: indications, technique, outcomes

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