Knee dislocation

Not to be confused with Patellar dislocation.

Knee dislocation
Plain lateral X-ray of the left knee showing a posterior knee dislocation[1]
SpecialtyOrthopedic surgery 
SymptomsKnee pain, knee deformity[2]
ComplicationsInjury to the artery behind the knee, compartment syndrome[3][4]
TypesAnterior, posterior, lateral, medial, rotatory[4]
CausesTrauma[3]
Diagnostic methodBased on history of the injury and physical examination, supported by medical imaging[5][2]
Differential diagnosisFemur fracture, tibial fracture, patellar dislocation, ACL tear[6]
TreatmentReduction, splinting, surgery[4]
Prognosis10% risk of amputation[4]
Frequency1 per 100,000 per year[3]

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

About half of cases are the result of major trauma and about half as a result of minor trauma.[3] About 50% of the time, the joint spontaneously reduces before arrival at hospital.[3] Typically there is a tear 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] More recently, the FAST-D protocol, assessing the posterior tibial and dorsalis pedis arteries for a ‘tri-phasic wave pattern’ with ultrasound, has been shown to be reliable in ruling out significant arterial injury.[8]

If the joint remains dislocated, reduction and splinting is indicated;[4] this is typically carried out under procedural sedation.[2] If signs of arterial injury are present, immediate surgery is generally recommended.[3] Multiple surgeries may be required.[4] In just over 10% of cases, an amputation of part of the leg is required.[4]

Knee dislocations are rare, occurring in about 1 per 100,000 people per year.[3] Males are more often affected than females.[2] Younger adults are most often affected.[2] Descriptions of this injury date back to at least 20 BC by Meges of Sidon.[9]

  1. ^ Duprey K, Lin M (February 2010). "Posterior knee dislocation". The Western Journal of Emergency Medicine. 11 (1): 103–4. PMC 2850837. PMID 20411095.
  2. ^ a b c d e f g Boyce RH, Singh K, Obremskey WT (December 2015). "Acute Management of Traumatic Knee Dislocations for the Generalist". The Journal of the American Academy of Orthopaedic Surgeons. 23 (12): 761–8. doi:10.5435/JAAOS-D-14-00349. PMID 26493970. S2CID 10713473.
  3. ^ a b c d e f g h i j k Maslaris A, Brinkmann O, Bungartz M, Krettek C, Jagodzinski M, Liodakis E (August 2018). "Management of knee dislocation prior to ligament reconstruction: What is the current evidence? Update of a universal treatment algorithm". European Journal of Orthopaedic Surgery & Traumatology. 28 (6): 1001–1015. doi:10.1007/s00590-018-2148-4. PMID 29470650. S2CID 3482099.
  4. ^ a b c d e f g h i Bryant B, Musahl V, Harner CD (2011). "59. The Dislocated Knee". In W. Norman Scott (ed.). Insall & Scott Surgery of the Knee E-Book (5th ed.). Elsevier Churchill Livingstone. p. 565. ISBN 978-1-4377-1503-3.
  5. ^ Cite error: The named reference Lac2015 was invoked but never defined (see the help page).
  6. ^ Eiff MP, Hatch RL (2011). Fracture Management for Primary Care E-Book. Elsevier Health Sciences. p. ix. ISBN 978-1455725021.
  7. ^ Medina O, Arom GA, Yeranosian MG, Petrigliano FA, McAllister DR (September 2014). "Vascular and nerve injury after knee dislocation: a systematic review". Clinical Orthopaedics and Related Research. 472 (9): 2621–9. doi:10.1007/s11999-014-3511-3. PMC 4117866. PMID 24554457.
  8. ^ Montorfano, Miguel Angel; Montorfano, Lisandro Miguel; Perez Quirante, Federico; Rodríguez, Federico; Vera, Leonardo; Neri, Luca (December 2017). "The FAST D protocol: a simple method to rule out traumatic vascular injuries of the lower extremities". Critical Ultrasound Journal. 9 (1): 8. doi:10.1186/s13089-017-0063-2. PMC 5360748. PMID 28324353.
  9. ^ Elliott JS (1914). Outlines of Greek and Roman Medicine. Creatikron Company. p. 76. ISBN 9781449985219. {{cite book}}: ISBN / Date incompatibility (help)
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