Knee dislocation

A knee dislocation is a knee injury in which there is a complete

Knee dislocation
disruption of the joint between the tibia and the femur.[3][4] Symptoms
include knee pain and instability of the knee.[2] Complications may
include injury to an artery around the knee, most commonly the artery
behind the knee, or compartment syndrome.[3][4][7]

About half of cases are the result of major trauma and about half occur
as a result of minor trauma.[3] In about half of cases the joint reduces
itself before a person arrives at the hospital.[3] Typically there is a
break of the anterior cruciate ligament, posterior cruciate ligament, and
either the medial collateral ligament or lateral collateral ligament.[3] If
the ankle–brachial pressure index is less than 0.9, CT angiography is
recommended to detect blood vessel injury.[3] Otherwise repeated
physical exams may be sufficient.[2]

If the joint remains dislocated, reduction and splinting is indicated;[4]

this is typically carried out under procedural sedation.[2] In those with
signs of arterial injury, immediate surgery is generally carried out.[3]
Multiple surgeries may be required.[4] In just over 10% of cases, an
amputation of part of the leg is required.[4]
Plain lateral X-ray of the left knee showing a
Knee dislocations are rare, occurring in about 1 per 100,000 people per posterior knee dislocation[1]
year.[3] Males are more often affected than females.[2] Younger adults Symptoms Knee pain, knee deformity[2]
are most often affected.[2] Descriptions of this injury date back to at Complications Injury to the artery behind the
least 20 BC by Meges of Sidon.[8] knee, compartment
syndrome[3][4]
Types Anterior, posterior, lateral,
medial, rotatory[4]
Contents
Causes Trauma[3]
Signs and symptoms
Diagnostic Based on history of the injury
Complications
method and physical examination,
Cause
supported by medical
Diagnosis imaging[5][2]
Classification
Differential Femur fracture, tibial fracture,
Treatment
diagnosis patellar dislocation, ACL tear[6]
Epidemiology
Treatment Reduction, splinting, surgery[4]
References
Prognosis 10% risk of amputation[4]
Frequency 1 per 100,000 per year[3]
Signs and symptoms
Symptoms include knee pain.[2] The joint may also be obviously out of place.[2] A joint effusion is not always present.[2]

Complications
Complications may include injury to the artery behind the knee in about 20% of
cases or compartment syndrome.[3][4] Damage to the common peroneal nerve or
tibial nerve may also occur.[2] Nerve problems if they occur often never fully
heal.[10]

Cause
About half are the result of major trauma and about half occur as a result of minor
trauma.[3] Major trauma may include mechanisms like falls from a significant
height, motor vehicle collisions, or a pedestrian being hit by a motor vehicle.[2] CT angiogram 3D reconstruction,
Cases due to major trauma often have other [5]
injuries. posterior view showing a normal
artery on the left, and occlusion to
Minor trauma may include tripping while walking or while playing sports.[2] Risk right popliteal artery as a result of a
factors include obesity.[2] knee dislocation[9]

The condition may also occur in a number of genetic disorders such as Ellis–van
Creveld syndrome, Larsen syndrome, and Ehlers–Danlos syndrome.[11]

Diagnosis
As the injury may reduce on its own before a person arrives at the hospital, the
diagnosis may be missed.[2] Diagnosis may be suspected based on the history of the
injury and a physical examination.[5] This may include anterior drawer test, valgus
stress test, varus stress test, and posterior sag test.[5] An accurate physical exam can
be difficult due to pain.[5]

Plan X-rays, CT scan, ultrasonography, or MRI may help with the diagnosis.[2][10]
Findings on X-ray that may be useful among those who have already reduced
include a variable joint space,subluxation of the joint, or a Segond fracture.[5]

If the ankle–brachial pressure index (ABI) is less than 0.9, CT angiography is

recommended.[3] Standard angiography may also be used.[2] If the ABI is greater
than 0.9 repeated physical exams over the next 24 hours to verify good blood flow
A Segond fracture seen on X-ray
may be sufficient.[2][10] The ABI is calculated by taking the systolic blood pressure
[2]
at the ankle and dividing it by the systolic blood pressure in the arm.

Classification
They may be divided into five types: anterior, posterior, lateral, medial, and rotatory.[4] This classification is based on the movement
of the tibia with respect to the femur.[10] Anterior dislocations are the most common, followed by posterior dislocations.[2] They may
[2]
also be classified based on what ligaments are damaged.

Treatment
Initial management is often based on Advanced Trauma Life Support.[5] If the joint remains dislocated reduction and splinting is
indicated.[4] Reduction can often be done with simple traction after the person has received procedural sedation.[10] If the joint
cannot be reduced in the emergency department emergent surgery is recommended.[2]

In those with signs of arterial injury immediate surgery is generally carried out.[3] If the joint does not stay reduced external fixation
may be needed.[2] If the nerves and artery are okay the ligaments may be repaired after a few days.[10] Multiple surgeries may be
required.[4] In just over 10% of cases anamputation of part of the leg is required.[4]
Epidemiology
[5] and
Knee dislocations are rare: they represent about 1 in 5,000 orthopedic injuries,
about 1 knee dislocation occurs annually per 100,000 people.[3] Males are more
often affected than females, and young adults aremost often affected.[2]

References
1. Duprey, K; Lin, M (February 2010). "Posteriorknee dislocation". The
western journal of emergency medicine. 11 (1): 103–4. PMID 20411095
(https://www.ncbi.nlm.nih.gov/pubmed/20411095).
2. Boyce, RH; Singh, K; Obremskey, WT (December 2015). "Acute
Management of Traumatic Knee Dislocationsfor the Generalist". The A lateral dislocation of the knee
Journal of the American Academy of Orthopaedic Surgeons. 23 (12):
761–8. doi:10.5435/JAAOS-D-14-00349(https://doi.org/10.5435%2FJA
AOS-D-14-00349). PMID 26493970 (https://www.ncbi.nlm.nih.gov/pubm
ed/26493970).
3. Maslaris, A; Brinkmann, O; Bungartz, M; Krettek, C; Jagodzinski, M;
Liodakis, E (22 February 2018)."Management of knee dislocation prior
to ligament reconstruction: What is the current evidence? Update of a
universal treatment algorithm"(https://link.springer.com/content/pdf/10.1
007%2Fs00590-018-2148-4.pdf)(PDF). European journal of
orthopaedic surgery & traumatology : orthopedie traumatologie .
doi:10.1007/s00590-018-2148-4(https://doi.org/10.1007%2Fs00590-01
8-2148-4). PMID 29470650 (https://www.ncbi.nlm.nih.gov/pubmed/2947
0650).(subscription required)
4. Bryant, Brandon; Musahl, Volkar; Harner, Christopher D. (2011). "59.
The Dislocated Knee". In W. Norman Scott. Insall & Scott Surgery of the
Knee E-Book (https://books.google.com/books?id=ujIUjjqajNEC&pg=P A
565) (5th ed.). Elsevier Churchill Livingstone. p. 565.ISBN 978-1-4377-
1503-3.
5. Lachman, JR; Rehman, S; Pipitone, PS (October 2015)."Traumatic
Knee Dislocations: Evaluation, Management, and Surgical rTeatment" (h
ttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299179). The Orthopedic
clinics of North America. 46 (4): 479–93. doi:10.1016/j.ocl.2015.06.004
(https://doi.org/10.1016%2Fj.ocl.2015.06.004) . PMC 5299179 (https://w
ww.ncbi.nlm.nih.gov/pmc/articles/PMC5299179) . PMID 26410637 (htt
ps://www.ncbi.nlm.nih.gov/pubmed/26410637).
6. Eiff, M. Patrice; Hatch, Robert L. (2011).Fracture Management for
Primary Care E-Book (https://books.google.ca/books?id=zn7Ls4NgKq8
C&pg=PR9). Elsevier Health Sciences. p. ix.ISBN 1455725021.
7. Medina, O; Arom, GA; Yeranosian, MG; Petrigliano, FA; McAllister, DR
(September 2014). "Vascular and nerve injuryafter knee dislocation: a
systematic review". Clinical orthopaedics and related research. 472 (9):
2621–9. doi:10.1007/s11999-014-3511-3(https://doi.org/10.1007%2Fs1
1999-014-3511-3). PMID 24554457 (https://www.ncbi.nlm.nih.gov/pubm
ed/24554457).
8. Elliott, James Sands (1914).Outlines of Greek and Roman Medicine(htt
ps://books.google.ca/books?id=Ne23kERgO1IC&pg=P A76). Creatikron
Company. p. 76. ISBN 9781449985219.
 9. Godfrey, AD; Hindi, F; Ettles, C; Pemberton,M; Grewal, P (2017).
"Acute Thrombotic Occlusion of the Popliteal Artery following Knee
Dislocation: A Case Report of Management, Local Unit Practice, and a
Review of the Literature".Case Reports in Surgery. 2017: 5346457.
doi:10.1155/2017/5346457(https://doi.org/10.1155%2F2017%2F53464
57). PMID 28246569 (https://www.ncbi.nlm.nih.gov/pubmed/28246569).
10. Pallin, Daniel J. (2018). "50. Knee and lower leg". In Ron M. W
alls.
Rosen's Emergency Medicine - Concepts and Clinical Practice E-Book
(https://books.google.com/books?id=OANODgAAQBAJ&pg=P A618).
Robert Hockberger, Marianne Gausche-Hill (9th ed.). Philadelphia:
Elsevier Health Sciences. p. 618.ISBN 978-0-323-35479-0.
11. Graham, John M.; Sanchez-Lara, Pedr A. (2016). "12. Knee dislocation
(Genu Recurvatum)". Smith's Recognizable Patterns of Human
Deformation E-Book (https://books.google.com/books?id=gfD5CQAAQB
AJ&pg=PA81) (4th ed.). Philadelphia: Elsevier. p. 81. ISBN 978-0-323-
29494-2.

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