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PubMed1980

Popliteal artery injury associated with knee dislocation: improved outlook?

Popliteal artery injury due to knee dislocation is an injury complex that is being reported with increasing frequency. A review of the literature from 1974 to 1978 reveals 40 new cases. Of these cases, 85 per cent underwent successful arterial repair, an encouraging figure. although few, large individual series exist, it is felt that an improved prognosis may be expected. Four case reports from the last year at the author's institution are presented. Various aspects of diagnosis and treatment are analyzed and recommended.

Adolescent↗
PubMed2004

The role of arteriography in assessing popliteal artery injury in knee dislocations.

BACKGROUND: This study aimed to review the need for angiography among patients with traumatic knee dislocations, and to evaluate any adverse consequences associated with the clinical decision to pursue or defer angiography. METHODS: A retrospective analysis was performed for 55 patients (57 knees) with traumatic knee dislocation during a 7-year period. The presence or absence of arterial injury was assessed via physical examination (to determine presence of foot pulses and ankle-brachial index > or = 0.80) and, in selected cases, via angiography. RESULTS: At the vascular examination, 32 knees (56%) were found to be normal and 25 (44%) to be abnormal. None of the 32 knees with normal examination results had substantial vascular injuries, as determined by angiography in 13 cases (41%) or by clinical follow-up assessment in 19 cases (59%). All 25 patients with abnormal vascular examination results underwent angiography, with 12 patients (48%) demonstrating vascular injury (7 major and 5 minor injury). Seven patients (6 with major and 1 with minor injury) underwent surgical repair with reverse saphenous vein grafting. CONCLUSIONS: No limb with initial normal vascular examination results was found to have a vascular injury that required treatment. Routine screening angiography may not be necessary for all patients with traumatic knee dislocations.

Adolescent↗
PubMed2001

Operative versus nonoperative treatment of knee dislocations: a meta-analysis.

Although several studies have investigated the optimal treatment of knee dislocations, all have been composed of a small number of patients and therefore have made it difficult to draw definitive conclusions. The literature on knee dislocation was reviewed to allow a meta-analysis and determine whether operative or nonoperative treatment had better outcomes. Range of motion, flexion contracture, Lysholm score, instability, ability to return to preinjury employment, and ability to return to preinjury athletic activities were compared using statistical methods. A total of 132 knee dislocations treated surgically and 74 treated nonoperatively were included. Average range of motion was 123 degrees in the surgical group and 108 degrees in the nonoperative group (P<.001). Flexion contracture averaged 0.5 degrees for the surgical group and 3.5 degrees for the nonoperative group (P<.05). A significant difference (P<.001) also was found in the Lysholm scores, with a surgical group mean of 85.2 and a nonoperative group mean of 66.5. There was no significant difference in the ability to return to preinjury employment or athletic activity or in the amount of instability between the two groups. Surgical treatment appears to be associated with improved outcomes, although significant disability is still possible after successful surgical treatment.

Activities of Daily Living↗
PubMed2004

Knee dislocations: an evaluation of surgical and conservative treatment.

BACKGROUND: We evaluated the results of surgical or non-operative treatment of knee dislocations and the effect of associated soft tissue injuries on the planning of treatment. METHODS: The study included 12 patients (10 males, 2 females; mean age 34 years; range 17 to 75 years). Knee dislocations were caused by low-energy injuries in five patients, and by high-energy injuries in seven patients. All the knees were dislocated posteriorly. Three dislocations were open. Three patients had popliteal artery injuries and three patients had peroneal nerve injuries. Dislocations affecting the anterior and/or posterior cruciate ligaments were treated surgically (n=6), whereas the medial collateral ligament and lateral ligament injuries were treated non-operatively (n=6). The Lysholm scores and the range of motion of the knees were compared between surgically and conservatively treated groups. The mean follow-up period was 46 months (range 26 to 82 months). RESULTS: The mean range of motion of the knees (116 degrees versus 72 degrees ; p<0.01) and the mean Lysholm scores (84.6 versus 74; p<0.01) differed significantly between patients undergoing surgical and non-operative treatment. Chronic laxity occurred in two knees (one with surgical, one with conservative treatment). Arthrofibrosis developed in four patients (one with surgical, three with conservative treatment). There were no deep infections. Superficial infections occurred in two open dislocations. CONCLUSION: Knee dislocations should be regarded as significant limb-threatening injuries. Evaluation and immediate treatment of vascular insufficiency is of primary importance. Then, treatment depending on the presence and severity of ligamentous injuries is essential to provide a stable and functional extremity.

Adolescent↗
PubMed1992

Complete knee dislocation without posterior cruciate ligament disruption. A report of four cases and review of the literature.

Complete knee dislocation usually causes disruption of both the anterior and posterior cruciate ligaments. Four cases of complete knee dislocation without posterior cruciate ligament (PCL) disruption are reported. All cases involved either anterior or anteromedial dislocation with anterior cruciate ligament disruption and collateral ligament injury, but without posterior cruciate disruption. This is an uncommon finding in complete dislocation of the knee. The PCL may occasionally be spared significant injury in anterior type dislocations, however, thus favorably affecting treatment options.

Adolescent↗
PubMed2003

Treatment of the multiple ligament injured knee and knee dislocations: a trauma perspective.

A complete understanding of traumatic knee dislocations begins with a review of their definition, classification, initial examination, and management options. Special emphasis is placed on associated injuries and their early detection and treatment. Decision making regarding ligament reconstruction must only be made in the context of the associated injuries or "personality" of the injury and are secondary to decisions regarding vascular compromise. These injuries can be limb threatening and deserve special respect and prompt attention when recognized.

Algorithms↗
PubMed1999

A non-contact complete knee dislocation with popliteal artery disruption, a rare martial arts injury.

Complete knee dislocation is a rare injury and an associated incidence of popliteal artery damage ranges from 16-60% of cases. It occurs commonly in road traffic accidents and in high velocity trauma where significant contact remains as the usual mode of injury. We describe a rare case of non-contact knee dislocation with popliteal artery injury sustained while practising Aikido, a type of martial art. This patient successfully underwent closed reduction of the knee with an emergency vein bypass graft. Similar injury in association with Aikido has not been described in the English literature previously. Various martial art injuries are briefly discussed and safety recommendations made.

Adult↗
PubMed2001

Irreducible knee dislocation treated by arthroscopic debridement.

This case report introduces arthroscopic debridement as a new method of treating an irreducible knee dislocation. The clinical presentation of 2 patients with irreducible knee dislocations, including history, physical examination, a clinical photograph, radiographs, and magnetic resonance images, is presented. As well, intraoperative arthroscopic photographs are included that show the effectiveness of the treatment. A review of the literature reveals that irreducible knee dislocations are rare. The finding of a skin furrow along the joint line was present in all cases. Past treatment usually involved an open procedure to remove the capsuloligamentous structures from the joint. We show that arthroscopy with debridement of these structures resulted in reduction of the joint. Follow-up arthroscopy in 1 patient showed healing of the previously debrided ligament. The ability to debride the interposed soft tissue through the arthroscope allows for reduction of the joint without the need for an open procedure.

Journal Article↗
PubMed1992

Examination of the patient with a knee dislocation. The case for selective arteriography.

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.

Adolescent↗
PubMed2005

Periprosthetic patellar fracture after an open knee dislocation.

We present a patient who sustained an open knee dislocation with a periprosthetic fracture of the patella and who was treated satisfactorily with tension band wiring and a conservative rehabilitation program. In addition to describing this unique combination of injuries, we review the literature on the treatment of periprosthetic patellar fractures. Although internal fixation of these fractures historically has provided unpredictable results, we think that it is warranted if the patella has adequate bone stock.

Bone Wires↗
PubMed2002

Does the pulse examination in patients with traumatic knee dislocation predict a surgical arterial injury? A meta-analysis.

BACKGROUND: This systematic review aimed at evaluating the diagnostic accuracy of pulse examination in detecting surgical arterial lesions associated with knee dislocation. METHODS: MEDLINE, CINAHL, and SportDiscus databases were searched in all languages to review articles concerning human knee dislocation and associated vascular injuries. RESULTS: We reviewed 116 articles. Seven met our inclusion criteria, providing detailed data on 284 injuries. Pooled data demonstrated that abnormal pedal pulses present a sensitivity of 0.79 (95% confidence interval [CI], 0.64-0.89), a specificity of 0.91 (95% CI 0.78-0.96), a positive predictive value of 0.75 (95% CI, 0.61-0.83), and a negative predictive value of 0.93 (95% CI, 0.85-.96). CONCLUSION: Our findings suggest that the isolated presence of abnormal pedal pulses on initial examination of patients with knee dislocations is not sensitive enough to detect a surgical vascular injury. On the basis of this meta-analysis, an algorithm for the evaluation of these patients is presented.

Adult↗
PubMed1993

Reassessing the role of arteriograms in the management of posterior knee dislocations.

Vascular injury has been reported in up to one third of patients with posterior knee dislocations, which has led to the routine use of arteriograms in the management of these injuries. Recent studies have shown physical examination (PE) is reliable in detecting significant vascular injuries requiring surgery from other mechanisms. We hypothesized that PE would be similarly sufficient to assess popliteal injury in patients with posterior knee dislocations. To test this, we reviewed the records of all 37 patients with 38 such injuries at our institution over the past 5 years. The average age was 29.5 years, and 31 patients (81.5%) had other associated injuries. All dislocations were the result of blunt trauma. Two patients (5.3%) had hard signs (distal ischemia and no pulses) that clearly indicated vascular injury. Total occlusions of the popliteal artery were seen on arteriograms in both cases and these were successfully treated surgically with reversed saphenous vein bypass grafts. The remaining 36 dislocations manifested no hard signs of vascular injury (absent pulses, distal ischemia, active bleeding, bruit/thrill). Nineteen patients (50.0%) had normal vascular examination results, did not receive arteriograms, and had no adverse sequelae, with a mean follow-up of 9.3 months (range 1 day-43 months). Sixteen patients with 17 dislocations (44.7%) underwent arteriography and the findings appeared normal in ten extremities; nine of these extremities had normal pulses and one had a diminished but palpable pulse. A minimal injury (intimal defect, 3; narrowing, 4) was demonstrated in seven extremities, five with normal pulses and two with diminished pulses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

Fresh meniscal allograft transplantation and autologous ACL/PCL reconstruction in a patient with complex knee trauma following knee dislocation--a case report.

Instability of the knee joint, particularly in combination with the loss of one meniscus, regularly leads to the early development of arthritis. This paper describes the case of a 19-year-old male with ruptures of the anterior (ACL) and posterior cruciate ligament (PCL) along with the loss of the medial meniscus due to knee dislocation. Combined, time-delayed reconstruction of both the ACL and PCL and the allogenic fresh meniscal transplantation of the medial meniscus without bone plugs were performed. The control arthroscopy performed 6 months post-transplantation revealed good vitality and integration of the grafts as assessed both macroscopically and histologically. A small portion of the posterior horn had to be refixated, and the anterior horn was atrophic. At 24 months after trauma and 13 months following meniscal transplantation, the patient achieved a Lysholm score of 88 points and clinical examination indicated a stable knee. Fresh meniscal allograft transplantation, in combination with autologous ACL and PCL reconstruction, constitutes--in specialized centers--an alternative treatment option for complex trauma of the knee joint with loss of a meniscus.

Accidents, Traffic↗
PubMed2003

Heterotopic ossification after knee dislocation: the predictive value of the injury severity score.

OBJECTIVE: To determine the relationship of multiple variables, including the Injury Severity Score (ISS), closed head injury (CHI), and timing and type of surgery to formation of motion-limiting heterotopic ossification (HO) following knee dislocation. DESIGN: Longitudinal observational study. SETTING: University level 1 trauma center. PATIENTS/PARTICIPANTS: Thirty-five consecutive patients with 36 knee dislocations (OTA fracture and dislocation classification 40-D) admitted over a 26-month period. MAIN OUTCOME MEASUREMENTS: Admission ISS, Glasgow Coma scale (GCS) scores, CHI, timing (> or < 3 weeks from injury) and type (open or arthroscopic) of surgery, number of cruciate ligaments reconstructed, medial surgical procedure, and eventual presence or absence of motion-limiting HO. RESULTS: A classification system for HO was developed ranging from none (type 0) to ankylosing (type IV) HO. Twenty-nine patients with type 0-III HO recovered an average range of motion of 126 degrees at an average of 14 months (group A). Six patients formed ankylosing type IV HO (group B). The ISS in group A ranged from 9 to 26. ISS in group B ranged from 26 to 50 (P < 0.001). Regarding the formation of type IV HO, the sensitivity of an ISS >/=26 was 100%, the specificity was 97%, and the positive predictive value was 86%. Patients in group B had a greater incidence of documented CHI (P < 0.025). Timing and type of surgery, number of ligaments reconstructed, and whether or not the patient had a medial surgical procedure had no statistical influence on degree of HO formation. CONCLUSIONS: An ISS of 26 seems to be a discrete boundary above which patients with knee dislocation are at extremely high risk for type IV HO formation if undergoing surgical reconstruction and below which patients are likely spared this complication. The presence of a CHI is a significant factor in type IV HO formation, although harder to quantify. None of the remaining independent variables studied were significantly related to ankylosing type IV HO formation.

Anterior Cruciate Ligament Injuries↗
PubMed1992

Two cases of irreducible knee dislocation occurring simultaneously in two patients and a review of the literature.

Knee dislocations normally respond to closed reduction; however, a small percentage must be reduced by open operations. A 24-year-old man exhibited typical medial joint-line puckering during repeated reduction attempts and a mild lateral displacement on roentgenograms. A 31-year-old woman had a complete dislocation of her knee, with the femur "buttonholed" through medial soft tissue and entrapped by the joint capsule. Longitudinal incision of the medial joint capsule was the method of reduction. The lateral collateral ligament and both lateral and medial menisci were intact in both cases. However, the medial collateral ligament and the anterior and posterior cruciate ligaments were avulsed from the femur and required fixation.

Adult↗
PubMed2004

Knee dislocations: experience at the Hôpital du Sacré-Coeur de Montréal.

INTRODUCTION: Although many options exist for ligament reconstruction in knee dislocations, the optimal treatment remains controversial. Allografts and autografts have both been used to reconstruct the cruciate ligaments. We present the results of reconstruction using artificial ligaments at Hôpital du Sacré-Coeur in Montréal. METHODS: We reviewed the treatment of all patients with knee dislocations seen between June 1996 and October 1999. The Lysholm score, ACL-quality of life (QoL) questionnaire, physical examination and Telos instrumented laxity measurement were used to evaluate the results. RESULTS: Twenty patients (21 knees) participated in the study. The mean (and standard deviation [SD]) Lysholm score was 71.7 (18). Results from the ACL-QoL questionnaire showed a global impairment in QoL. Mean (and SD) range of motion and flexion were 118 degrees (10.9 degrees) and 2 degrees (2.9 degrees) respectively. Mean (and SD) radiologic laxity evaluated with Telos for the anterior and posterior cruciate ligaments were 6.1 (5.7) mm and 7.3 (4.5) mm respectively. CONCLUSIONS: Knee reconstruction with artificial ligaments shows promise, but further studies are necessary before it can be recommended for widespread use. This is the first study to show specifically a severe impairment in QoL in this patient population.

Adolescent↗