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At least 19 recordsLinked to original sources
PubMed2000

Historic perspectives of treatment algorithms in knee dislocation.

Knee dislocation remains a devastating injury with many complications. It necessitates prompt diagnosis, reduction if needed, and emergent repair of any vascular injury. Serial physical examinations and frequent use of arteriograms are necessary to avoid late vascular complications. Many authors are concerned that normal pulses, normal Doppler signals, and normal ABIs have preceded late ischemia and documented intimal tear, demonstrated by arteriography. More recently, other authors have challenged the gold standard of mandatory arteriography by describing studies in which physical examination was 100% accurate in diagnosing patients without operative vascular injury. If pedal pulses, Doppler signals, or ABIs are asymmetric before or after reduction then either immediate operative exploration or arteriography should be performed. If the initial physical examination is normal, serial examinations are used in the hospital to check for late artery thrombosis. Opponents of mandatory arteriography point to a 5% false-negative rate, high cost, and an 8% complication rate, such as contrast allergy, pseudoaneurysm, local hematoma, and arteriovenous fistula. Today a consensus is that repair and reconstruction of the PCL and posterolateral corner injuries are the primary concerns in the multiple-ligament injured knee after dislocation. The ACL may be repaired later if instability persists, but some investigators believe it should not be repaired acutely, thereby avoiding increased surgical trauma and possible stiffness. Recently one of the goals of ligamentous repair and reconstruction has been to provide stability with the least invasive surgical technique to avoid postoperative stiffness. Recent treatments have focused on early arthroscopic-assisted allograft reconstruction of the ACL and PCL. Allograft provides a less invasive means of graft support than autograft. Early, limited range of motion in a brace helps to maintain flexion and extension.

Algorithms↗
PubMed2000

The epidemiology of knee dislocations.

The traumatically dislocated knee can be a devastating injury; fortunately, it is uncommon. More attention is being given to the treatment of knee dislocations as the capability of ligamentous reconstruction increases. Great treatment advances are anticipated as this interest grows and outcomes are evaluated. Nonetheless, the complications of this injury, including loss of limb, still occur from the missed diagnosis of a knee dislocation. MR imaging and other technological advances do not relieve the clinician of the responsibility for performing a thorough physical examination. Suspicion of an associated neurovascular injury must always be high. To a certain degree, prevention of this injury may be possible in the high-velocity accidents that occur with motor vehicles and in industry. Advancement in vehicular designs, with specific attention to airbags, dashboards, and firewalls, needs to be made to reduce the incidence and magnitude of lower extremity trauma in motor vehicle accidents. Seat belts remain the most effective restraint in the prevention of lower extremity trauma in the motor vehicle.

Accidents, Traffic↗
PubMed1999

Knee dislocation: treatment of high-velocity knee dislocation.

BACKGROUND: We report the outcomes of patients treated with a new arthroscopic treatment modality for knee dislocation after high-velocity trauma. METHODS: Twenty-three patients (12 men, 11 women; 25 knees) with traumatic knee dislocation were treated with this technique. Under arthroscopy with gravity inflow irrigation, the ruptured posterior cruciate ligament was reconstructed with a patellar bone-tendon-bone graft, and the anterior cruciate ligament was debrided subacutely. The collateral ligament, meniscus, and capsules were repaired through additional incisions. RESULTS: The average interval between injury and surgery was 11.1+/-5 days (range, 5 to 25 days). After a mean follow-up period of 27.2+/-7.86 months, the mean extension was 1+/-2 degrees and the average flexion was 129.6+/-4.91 degrees. The mean Lysholm score was 84. There were no major complications. CONCLUSION: Arthroscopic posterior cruciate ligament reconstruction seems to be an effective treatment for traumatic knee dislocation.

Adolescent↗
PubMed1999

Recanalization of an occluded popliteal artery following posterior knee dislocation.

Posterior knee dislocation results in popliteal artery injury in up to one-third of cases. Prompt recognition and treatment of arterial injury is essential for limb salvage. We report a case of complete occlusion of the popliteal artery following posterior knee dislocation treated with saphenous vein bypass without exclusion of the injured arterial segment. Follow-up duplex scanning demonstrated a patent vein graft and a patent ipsilateral popliteal artery. This report suggests that, in some instances, a traumatically occluded popliteal artery may recanalize, and that revascularization with a bypass graft may be the preferred method of repair, particularly in young patients.

Child↗
PubMed1991

Low-velocity knee dislocation.

Complete knee dislocation is an uncommon but potentially devastating injury with a reported high rate of neurovascular injury. Treatment of this ligamentous injury is controversial. The operative (repair of all ligaments) and nonoperative management of ligament injuries appears to result in a stiff knee (decreased range of motion [ROM]), and/or a significant incidence of clinical instability and pain. We report our data on low-velocity knee dislocations and present a treatment plan of noninvasive assessment of the vascular status, a stabilizing procedure centered on posterior cruciate ligament reconstruction (PCL) and an aggressive rehabilitation program that can result in improved ROM, acceptable stability, and a more optimal functional outcome.

Adolescent↗
PubMed2002

Two-stage reconstruction with autografts for knee dislocations.

Traumatic knee dislocations are severe injuries that involve damage to the anterior cruciate ligament, the posterior cruciate ligament, and the lateral or medial ligamentous structures. There are no established methods of treatment. The objective of the current study was to report the clinical outcome of a two-stage autologous reconstruction on nine knees (eight patients). The mean followup was 40.1 months. The first stage of the reconstruction was done at a mean of 2 weeks after the injury, and the posterior cruciate ligament was reconstructed by an arthroscopically assisted technique using contralateral autogenous hamstring tendon as the graft material. Three months later, the second stage of the reconstruction was done for the ligaments that had not healed with conservative treatment. Arthroscopically assisted anterior cruciate ligament reconstruction was done on all of the knees using the ipsilateral autogenous hamstring tendon or bone-patellar tendon-bone as the graft material. At the same time, a medial collateral ligament reconstruction using an autogenous semitendinosus tendon was done on one knee, and reconstruction of the posterolateral ligamentous structures using a biceps tendon was done on three knees. Each of the knees that was reconstructed was capable of full extension, and the mean degree of passive flexion was 139.5 degrees +/- 5.2 degrees. The mean side-to-side difference in anteroposterior total laxity (KT-1000 arthrometer, manual maximum) was 2.3 +/- 1.9 mm. None of the knees had lateral or medial instability. All of the injured ligaments were able to be reconstructed with autografts, and severe contracture was able to be prevented. A good clinical outcome can be achieved when two-stage reconstruction is used for traumatic knee dislocations.

Adult↗
PubMed1993

Arthroscopic view of an irreducible knee dislocation.

Irreducible knee dislocation is a rare effection of the knee joint; only 23 cases have been reported in the literature. This is a case report of a 35-year-old man who injured his left knee in a motorcycle accident. Dislocation was documented on radiograph. His neurovascular status was intact. Attempts under sedation and anesthesia and even arthroscopy failed to reduce the dislocation. Eventually, the patient had open reduction of the dislocation. An arthroscopy view of the dislocation showed that the medial femoral condyle was buttonholed through the anteromedial capsule and retinaculum. Arthroscopy was an excellent tool for partial lateral meniscectomy and planning the open surgical procedure.

Accidents, Traffic↗
PubMed1995

The Dislocated Knee.

Knee dislocation, although relatively rare, may be the result of high-or low-velocity injuries. Well established is the need for urgent diagnosis and treatment to avoid vascular complications and amputation. The initial evaluation should include objective assessment of arterial circulation by means of Doppler pressure measurements; the finding of any asymmetric pressure warrants an arteriogram. Late arterial occlusion may occur, which mandates careful serial reexamination in all patients, including those with initially symmetric pressure. Injury to the peroneal nerve is also common, and the recovery of neurologic function is unpredictable. An operative approach for the young and otherwise healthy patient is outlined. In the absence of definitive clinical studies, the timing and extent of the repair/reconstruction and the optimum rehabilitation still remain uncertain. Therefore, individual patient management must be dictated by circumstances such as instability, swelling, activity level, and the risk of postoperative joint stiffness.

Journal Article↗
PubMed1994

Ipsilateral hip and knee dislocation.

Hip and knee dislocations individually are two of the relatively limited orthopaedic emergencies. Long-term results of treatment of these two types of injury are associated with avascular necrosis of the femoral head, knee instability, and knee stiffness. Correct early diagnosis, including arteriography in the case of knee dislocation, is crucial. Prompt treatment consisting of closed or open reduction of the dislocations is necessary. Additional treatment involving knee ligament reconstruction is warranted to maximize knee function in healthy, active patients. Simultaneous occurrence of ipsilateral hip and knee dislocations is a particularly morbid injury. We report such a case to emphasize that early, aggressive treatment and extensive physical therapy can result in a functional and painless lower extremity.

Adult↗
PubMed1987

The treatment of congenital knee dislocation. A review of nineteen knees.

The treatment of 19 congenitally dislocated knees in 11 patients is reviewed. The knees were subdivided into genu recurvatum, subluxation and dislocation. Nine knees were treated conservatively and ten surgically. A good result was obtained with conservative treatment if started before the age of three months; after this, surgery was likely to be required and was satisfactory if undertaken before two years of age. A successful surgical result was achieved with quadriceps lengthening. If the quadriceps tendon and the anterior cruciate ligament were divided, then only fair results were achieved. Untreated, patients developed stiff, unstable knees.

Female↗
PubMed2001

Orthopedic pitfalls in the ED: vascular injury associated with knee dislocation.

Tibial femoral knee dislocation is a severe injury, with a real potential for limb-threatening vascular compromise, primarily caused by injury to the popliteal artery. When unrecognized or inadequately evaluated and treated, these injuries often lead to a high incidence of morbidity and potential limb loss. Emergency medicine practitioners should be vigilant for vascular injury associated with knee dislocation. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.

Adult↗
PubMed1994

[Injury of the popliteal artery as a complication of knee dislocation].

Dislocation of the knee is rarely seen. Only 15 patients with a knee dislocation were treated in the surgical department of the university hospital in the last 18 years. One patient had bilateral dislocation of the knee. Injury to the popliteal artery is severe and often endangers the extremity. In seven patients with knee dislocation arterial ischemic was detected. Five patients were treated for arterial damage (31.25%).

Adult↗
PubMed1997

Knee dislocation: initial assessment and implications for treatment.

OBJECTIVE: To evaluate bicruciate knee injuries and determine whether they should be treated as knee dislocations, especially with regard to vascular injuries. DESIGN: Retrospective. SETTING: University hospital, level 1 trauma center. PATIENTS: Fifty patients admitted between 1987 and 1994 who had sustained knee dislocations or bicruciate ligament injuries. MAIN OUTCOME MEASURES: Mechanism of injury, direction of dislocation, knee ligament injury pattern, presence or absence of periarticular fracture, presence of vascular and nerve injuries, and location of associated trauma were measured. RESULTS: Twenty-two knees had classic knee dislocations. Twenty-eight knees presented as "reduced" bicruciate ligament injuries. Vascular injury occurred just as frequently in bicruciate ligament injuries as in knee dislocations. The direction of the knee dislocation did not predict ligament injury pattern or the presence of arterial injury. CONCLUSION: Bicruciate ligament injuries are equivalent to knee dislocations with regard to mechanism of injury, severity of ligamentous injury, and frequency of major arterial injuries.

Adolescent↗
PubMed1994

Delayed presentation: dislocation of the proximal tibiofibular joint after knee dislocation.

Attention is brought to a unique case of an anterior dislocation of the proximal tibiofibular joint detected 1 month following closed reduction of a posterior knee dislocation. Open reduction and internal fixation were necessary to achieve a stable proximal tibiofibular joint. Additional attention should be paid to the proximal tibiofibular joint when evaluating acute or chronic knee dislocation.

Accidents, Traffic↗
PubMed2001

Irreducible knee dislocations secondary to interposed menisci.

Dislocations of the knee are accompanied by a highly variable pattern of osseous and soft tissue injury. While much attention has been directed toward the various combinations of ligament involvement observed in these injuries, the patterns of associated meniscal injury are described less frequently. We report two cases of patients in whom displaced medial meniscal tears prevented closed reduction following knee dislocation. Displaced bucket-handle meniscal tears necessitated open reduction in these patients and should be considered when evaluating patients with knee dislocations.

Accidents, Traffic↗