eMedicine Specialties > Orthopedic Surgery > Knee

Knee Dislocations: Workup

Author: John R Green III, MD, Associate Professor, Chief of Sports Medicine, Department of Orthopaedics and Sports Medicine, University of Washington Medical Center
Coauthor(s): Cambize Shahrdar, MD, Gratis Professor, Department of Orthopedic Surgery, Louisiana State University Health Sciences Center; Consulting Staff, Department of Orthopedic Surgery, The Orthopedic Clinic; Brett D Owens, MD, Chief, Sports Medicine and Shoulder Service, William Beaumont Army Medical Center
Contributor Information and Disclosures

Updated: Aug 25, 2008

Workup

Imaging Studies

  • Radiographs
    • Standard anteroposterior and lateral radiographs can be used to detect a knee dislocation (see Image 1).
    • After reduction, repeat anteroposterior and lateral radiographs are obtained to confirm reduction.
    • Oblique views after reduction may delineate small avulsion or rim fractures and osteochondral fractures.13
  • The role of noninvasive Doppler studies versus arteriograms in postreduction assessment is controversial (see Future and Controversies). However, the authors strongly recommend arteriograms be performed on all patients with knee dislocations.
  • For ligament injuries of the knee, MRI can be used to determine the extent and location of ligament disruption, meniscal tears, and subtle injuries to the bone, as well as which tears are repairable (see Evaluation of knee ligamentous injury, Medical therapy).9

More on Knee Dislocations

Overview: Knee Dislocations
Workup: Knee Dislocations
Treatment: Knee Dislocations
Follow-up: Knee Dislocations
Multimedia: Knee Dislocations
References
Further Reading
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References

  1. Girgis FG, Marshall JL, Monajem A. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop. Jan-Feb 1975;(106):216-31. [Medline].

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

  3. Frassica FJ, Sim FH, Staeheli JW, Pairolero PC. Dislocation of the knee. Clin Orthop. Feb 1991;(263):200-5. [Medline].

  4. Kennedy JC. Complete Dislocation of the Knee Joint. J Bone Joint Surg. 1963;45(5):889-904.

  5. Taylor AR, Arden GP, Rainey HA. Traumatic dislocation of the knee. A report of forty-three cases with special reference to conservative treatment. J Bone Joint Surg Br. Feb 1972;54(1):96-102. [Medline].

  6. Zoys GN. Knee dislocations. Orthopedics. Mar 2001;24(3):294-9; quiz 300-1. [Medline].

  7. Wood MB. Peroneal nerve repair. Surgical results. Clin Orthop. Jun 1991;(267):206-10. [Medline].

  8. Moore TM. Fracture--dislocation of the knee. Clin Orthop. May 1981;(156):128-40. [Medline].

  9. Bui KL, Ilaslan H, Parker RD, Sundaram M. Knee dislocations: a magnetic resonance imaging study correlated with clinical and operative findings. Skeletal Radiol. Jul 2008;37(7):653-61. [Medline].

  10. Hill JA, Rana NA. Complications of posterolateral dislocation of the knee: case report and literature review. Clin Orthop. Jan-Feb 1981;(154):212-5. [Medline].

  11. Jones RE, Smith EC, Bone GE. Vascular and orthopedic complications of knee dislocation. Surg Gynecol Obstet. Oct 1979;149(4):554-8. [Medline].

  12. McCutchan JD, Gillham NR. Injury to the popliteal artery associated with dislocation of the knee: palpable distal pulses do not negate the requirement for arteriography. Injury. Sep 1989;20(5):307-10. [Medline].

  13. Kaufman SL, Martin LG. Arterial injuries associated with complete dislocation of the knee. Radiology. Jul 1992;184(1):153-5. [Medline].

  14. Treiman GS, Yellin AE, Weaver FA, et al. Examination of the patient with a knee dislocation. The case for selective arteriography. Arch Surg. Sep 1992;127(9):1056-62; discussion 1062-3. [Medline].

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

  16. Kirby L, Abbas J, Brophy C. Recanalization of an occluded popliteal artery following posterior knee dislocation. Ann Vasc Surg. Nov 1999;13(6):622-4. [Medline].

  17. 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. Oct 2007;63(4):855-8. [Medline].

  18. Bonnevialle P, Chaufour X, Loustau O, Mansat P, Pidhorz L, Mansat M. [Traumatic knee dislocation with popliteal vascular disruption: retrospective study of 14 cases]. Rev Chir Orthop Reparatrice Appar Mot. Dec 2006;92(8):768-77. [Medline].

  19. Thomsen PB, Rud B, Jensen UH. Stability and motion after traumatic dislocation of the knee. Acta Orthop Scand. Jun 1984;55(3):278-83. [Medline].

  20. Hughston JC, Jacobson KE. Chronic posterolateral rotatory instability of the knee. J Bone Joint Surg Am. Mar 1985;67(3):351-9. [Medline].

  21. Mariani PP, Santoriello P, Iannone S, et al. Comparison of surgical treatments for knee dislocation. Am J Knee Surg. Fall 1999;12(4):214-21. [Medline].

  22. Shapiro MS, Freedman EL. Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation. Am J Sports Med. Sep-Oct 1995;23(5):580-7. [Medline].

  23. Wascher DC, Becker JR, Dexter JG, Blevins FT. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts. Am J Sports Med. Mar-Apr 1999;27(2):189-96. [Medline].

  24. Yeh WL, Tu YK, Su JY, Hsu RW. Knee dislocation: treatment of high-velocity knee dislocation. J Trauma. Apr 1999;46(4):693-701. [Medline].

  25. Bin SI, Nam TS. Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation. Arthroscopy. Oct 2007;23(10):1066-72. [Medline].

  26. Sisto DJ, Warren RF. Complete knee dislocation. A follow-up study of operative treatment. Clin Orthop. Sep 1985;(198):94-101. [Medline].

  27. Noyes FR, Barber-Westin SD. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Use of early protected postoperative motion to decrease arthrofibrosis. Am J Sports Med. Nov-Dec 1997;25(6):769-78. [Medline].

  28. Applebaum R, Yellin AE, Weaver FA, et al. Role of routine arteriography in blunt lower-extremity trauma. Am J Surg. Aug 1990;160(2):221-4; discussion 224-5. [Medline].

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Further Reading

Acute trauma to the knee.
American College of Radiology - Medical Specialty Society.  1998 (revised 2005).  9 pages.  NGC:004606

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Keywords

knee dislocation, knee injury, traumatic knee dislocation, complex knee dislocation, knee pain, anterior cruciate ligament, posterior cruciate ligament, collateral ligament

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Contributor Information and Disclosures

Author

John R Green III, MD, Associate Professor, Chief of Sports Medicine, Department of Orthopaedics and Sports Medicine, University of Washington Medical Center
John R Green III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American College of Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Southern Medical Association, Southern Orthopaedic Association, and Washington State Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Cambize Shahrdar, MD, Gratis Professor, Department of Orthopedic Surgery, Louisiana State University Health Sciences Center; Consulting Staff, Department of Orthopedic Surgery, The Orthopedic Clinic
Cambize Shahrdar, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Brett D Owens, MD, Chief, Sports Medicine and Shoulder Service, William Beaumont Army Medical Center
Brett D Owens, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Society of Military Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Robert D Bronstein, MD, Associate Professor, Department of Orthopedic Surgery, University of Rochester School of Medicine
Robert D Bronstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Thomas M DeBerardino, MD, Associate Professor of Orthopaedic Surgery, University of Connecticut Health Center
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None; Arthrex, Inc. Consulting fee Speaking and teaching

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

 
 
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