Imaging Studies

Plain radiographs are recommended post reduction and prior to any provocative ligamentous stressing.^[7]

Briefly, the ankle-brachial index compares the Doppler pressure of an arm to a leg to screen for lower limb ischemia. This straightforward measurement is performed by recording the highest Doppler sound of the brachial pulse and comparing it to the highest Doppler sound of the posterior tibial or dorsalis pedis artery. The ankle Doppler pressure is then divided by the brachial Doppler pressure to calculate the index. Indexes less than 0.9 indicate an abnormal result and should prompt further vascular imaging/assessment.

Duplex ultrasonography is a reliable, noninvasive, low-risk, low-cost option. Duplex ultrasonography appears to be an excellent modality for vascular injury assessment.^{[27, 30, 31]} Fry et al reported 100% sensitivity and 97% specificity for clinically significant arterial injury.^[27]This modality only incurs about 10% of the cost of arteriography with little to no risk profile.^[32]

CT angiography is another reliable alternative to arteriography without the risk of direct arterial injury. It does require additional contrast beyond that used for chest/abdomen/pelvis body CTs that are often also indicated in these types of trauma cases; thus, it may have added risk of nephropathy or contrast reactions over arteriography, which uses less contrast. Inaba et al reported 100% sensitivity and 100% specificity for lower extremity arterial injury of significance.^[28]Soto et al reported 95% sensitivity and 98.7% specificity.^{[7, 29]}

Direct arteriography is the criterion standard but carries risk of arterial injury from direct catheterization of the artery while also requiring specialist involvement to perform (ie, interventional radiologist or vascular surgeon).

Treatment & Management

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Media Gallery

Types of knee dislocation.
Posterior knee dislocation.
Lateral knee dislocation (before reduction).
Open knee dislocation.
Lateral knee dislocation after reduction.

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Author

H Brendan Kelleher, MD Assistant Professor of Clinical Emergency Medicine, University of Southern California Keck School of Medicine; Assistant Residency Director, Department of Emergency Medicine, University of Southern California Los Angeles County Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Diku Mandavia, MD, FACEP, FRCPC Attending Staff Physician, Department of Emergency Medicine, Cedars-Sinai Medical Center; Clinical Associate Professor of Emergency Medicine, Los Angeles County-USC Medical Center; Co-Editor, Color Atlas of Emergency Trauma

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Program Director, Emergency Medicine, Einstein Medical Center Montgomery

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

James E Keany, MD, FACEP Associate Medical Director, Emergency Services, Mission Hospital Regional Medical Center, Children's Hospital of Orange County at Mission

James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, California Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Tom Scaletta, MD President, Smart-ER (http://smart-er.net); Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Knee Dislocation Workup

Imaging Studies

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