Knee Dislocation

Knee Dislocation

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Knee dislocation is a relatively rare injury but an important one to recognize because coexistent vascular injury, if missed, often leads to limb loss. In addition, knee dislocation often presents in the context of multisystem trauma or spontaneous relocation, which makes detection more difficult. [1, 2, 3, 4, 5, 6, 7, 8]

Patients with knee dislocation should undergo radiography and MRI, as well as angiography. The American College of Radiology has published the ACR Appropriateness Criteria for knee trauma to rate the appropriateness of imaging and treatment procedures. [9]

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Georgiadis AG, Mohammad FH, Mizerik KT, Nypaver TJ, Shepard AD. Changing presentation of knee dislocation and vascular injury from high-energy trauma to low-energy falls in the morbidly obese. J Vasc Surg. 2013 May. 57(5):1196-203. [Medline].

Henrichs A. A review of knee dislocations. J Athl Train. 2004 Oct-Dec. 39(4):365-9. [Medline].

McDonough EB Jr, Wojtys EM. Multiligamentous injuries of the knee and associated vascular injuries. Am J Sports Med. 2009 Jan. 37(1):156-9. [Medline].

Patterson BM, Agel J, Swiontkowski MF, Mackenzie EJ, Bosse MJ. Knee dislocations with vascular injury: outcomes in the Lower Extremity Assessment Project (LEAP) Study. J Trauma. 2007 Oct. 63(4):855-8. [Medline].

Stannard JP, Sheils TM, Lopez-Ben RR, McGwin G Jr, Robinson JT, Volgas DA. Vascular injuries in knee dislocations: the role of physical examination in determining the need for arteriography. J Bone Joint Surg Am. 2004 May. 86-A(5):910-5. [Medline].

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Bouaicha S. [The acute knee injury – practical considerations]. Praxis (Bern 1994). 2014 Apr 9. 103 (8):439-44. [Medline].

Tuite MJ, Daffner RH, Weissman BN, Bancroft L, Bennett DL, Blebea JS, et al. ACR appropriateness criteria(®) acute trauma to the knee. J Am Coll Radiol. 2012 Feb. 9 (2):96-103. [Medline].

Seroyer ST, Musahl V, Harner CD. Management of the acute knee dislocation: the Pittsburgh experience. Injury. 2008 Jul. 39(7):710-8. [Medline].

Snyder WH III, Thal ER, Bridges RA, et al. The validity of normal arteriography in penetrating trauma. Archives of Surgery. 1978. 113:424-426.

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Lynch K, Johansen K. Can Doppler pressure measurement replace “exclusion” arteriography in the diagnosis of occult extremity arterial trauma?. Ann Surg. 1991 Dec. 214(6):737-41. [Medline].

Johansen K, Lynch K, Paun M, Copass M. Non-invasive vascular tests reliably exclude occult arterial trauma in injured extremities. J Trauma. 1991 Apr. 31(4):515-9; discussion 519-22. [Medline].

Fry WR, Smith RS, Sayers DV, Henderson VJ, Morabito DJ, Tsoi EK, et al. The success of duplex ultrasonographic scanning in diagnosis of extremity vascular proximity trauma. Arch Surg. 1993 Dec. 128(12):1368-72. [Medline].

Inaba K, Potzman J, Munera F, McKenney M, Munoz R, Rivas L, et al. Multi-slice CT angiography for arterial evaluation in the injured lower extremity. J Trauma. 2006 Mar. 60(3):502-6; discussion 506-7. [Medline].

Soto JA, Munera F, Cardoso N, Guarin O, Medina S. Diagnostic performance of helical CT angiography in trauma to large arteries of the extremities. J Comput Assist Tomogr. 1999 Mar-Apr. 23(2):188-96. [Medline].

Redmond JM, Levy BA, Dajani KA, Cass JR, Cole PA. Detecting vascular injury in lower-extremity orthopedic trauma: the role of CT angiography. Orthopedics. 2008 Aug. 31(8):761-7. [Medline]. [Full Text].

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Zierler RE. Vascular surgery without arteriography: use of Duplex ultrasound. Cardiovasc Surg. 1999 Jan. 7(1):74-82. [Medline].

Barnes CJ, Pietrobon R, Higgins LD. Does the pulse examination in patients with traumatic knee dislocation predict a surgical arterial injury? A meta-analysis. J Trauma. 2002 Dec. 53(6):1109-14. [Medline].

Browner BD, Jupiter JB, Levine AM. Dislocations and soft tissue injuries of the knee. Skeletal Trauma. WB Saunders Co; 1992. Vol 2: 1717-1741.

Chhabra A, Cha PS, Rihn JA, Cole B, Bennett CH, Waltrip RL. Surgical management of knee dislocations. Surgical technique. J Bone Joint Surg Am. 2005 Mar. 87 Suppl 1(Pt 1):1-21. [Medline].

Dennis JW, Jagger C, Butcher JL, et al. Reassessing the role of arteriograms in the management of posterior knee dislocations. J Trauma. 1993 Nov. 35(5):692-5; discussion 695-7. [Medline].

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Klineberg EO, Crites BM, Flinn WR, et al. The role of arteriography in assessing popliteal artery injury in knee dislocations. J Trauma. 2004 Apr. 56(4):786-90. [Medline].

Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy. 2009 Apr. 25(4):430-8. [Medline].

Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma. 2004 Jun. 56(6):1261-5. [Medline].

Nicandri GT, Chamberlain AM, Wahl CJ. Practical management of knee dislocations: a selective angiography protocol to detect limb-threatening vascular injuries. Clin J Sport Med. 2009 Mar. 19(2):125-9. [Medline].

Rihn JA, Groff YJ, Harner CD, Cha PS. The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg. 2004 Sep-Oct. 12(5):334-46. [Medline].

Robertson A, Nutton RW, Keating JF. Dislocation of the knee. J Bone Joint Surg Br. 2006 Jun. 88(6):706-11. [Medline].

Rockwood CA, Green DP, Bucholz RW. Injuries of the knee. Fractures in Adults. Lippincott Williams & Wilkins Publishers; 1996. Vol 2: 2112-2126.

Varnell RM, Coldwell DM, Sangeorzan BJ, Johansen KH. Arterial injury complicating knee disruption. Third place winner: Conrad Jobstaward. Am Surg. 1989 Dec. 55(12):699-704. [Medline].

Welling RE, Kakkasseril J, Cranley JJ. Complete dislocations of the knee with popliteal vascular injury. J Trauma. 1981 Jun. 21(6):450-3. [Medline].

H Brendan Kelleher, MD Assistant Professor of Clinical Emergency Medicine, University of Southern California Keck School of Medicine; Assistant Residency Director, Department of Emergency Medicine, University of Southern California Los Angeles County Medical Center

Disclosure: Nothing to disclose.

Diku Mandavia, MD, FACEP, FRCPC Attending Staff Physician, Department of Emergency Medicine, Cedars-Sinai Medical Center; Clinical Associate Professor of Emergency Medicine, Los Angeles County-USC Medical Center; Co-Editor, Color Atlas of Emergency Trauma

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Sanz Laniado Medical Center, Netanya, Israel

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

James E Keany, MD, FACEP Associate Medical Director, Emergency Services, Mission Hospital Regional Medical Center, Children’s Hospital of Orange County at Mission

James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, California Medical Association

Disclosure: Nothing to disclose.

Tom Scaletta, MD President, Smart-ER (; Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Knee Dislocation

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