Knee Dislocation Follow-up

Updated: Aug 24, 2015
  • Author: H Brendan Kelleher, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Follow-up

Further Inpatient Care

Historically, conventional arteriography was recommended for all cases of knee dislocation and, though it remains the criterion standard for popliteal artery evaluation, there is growing debate over its universal application.

Vascular assessment with the ankle-brachial index, duplex sonography, and/or CT angiography is changing this paradigm while an increasing number of popliteal injuries are being managed nonsurgically (generally those that show no significant thrombosis at 48-72 h). Many surgeons thus argue that arteriography should not be routine and that case-by-case utilization of other imaging modalities combined with vigilant observation is sufficient.

For the EM physician, it is important to recognize that vascular examination findings may be normal in the presence of significant popliteal artery injury [11, 12] and that some combination of further investigation/observation is warranted in all knee dislocations. This may be different for each institution and/or each surgeon and should be decided on in a case-by-case basis in conjunction with the vascular consult.

Time is of utmost concern, as vascular repair delayed more than 8 hours after injury carries an amputation rate of greater than 80%. In contrast, operative vascular repair within 8 hours of injury yields a limb-salvage rate of 80%.

The repair of coexistent popliteal vein injury is controversial. Fasciotomy is recommended after vascular repair, as severe swelling and development of compartment syndrome are common in the postoperative phase.

Operative repair of nerve injury remains controversial, as a poor prognosis is common with both operative and nonoperative care.

Operative ligamentous repair is recommended by most authors, as functional results are better than those of nonoperative care, but determining the ideal timing of this intervention is complex and is a decision best left to the orthopedist.

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Transfer

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  • Patients considered for transfer should have undergone emergency reduction of the knee dislocation. Since time is crucial in salvaging the limb after a vascular injury, transfer should be initiated only if vascular consultation and/or evaluation are not available at the transferring institution or if an arteriogram has been performed and results are normal.
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Complications

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  • Popliteal artery injury
  • Popliteal vein injury
  • Peroneal nerve injury
  • Ligamentous injury
  • Compartment syndrome
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Prognosis

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  • When treated expeditiously and appropriately, 60-70% of patients will have a painless, stable knee. Of the remaining patients, one half will eventually have reasonable function, while the other half will have a chronically unstable and painful knee.
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Patient Education

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