Association of Injury Energy Level and Neurovascular Injury Following Knee Dislocation

Stewart, Robert; Landy, David C.; Khazai, Ravand S.; Cohen, Joseph; Ho, Sherwin S.W.; Dirschl, Douglas R.

doi:10.1097/bot.0000000000001277

Cited by 14 publications

(19 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this context, the exact role of the injury mechanism for the development of popliteal injuries is not fully clarified. While this and other studies [3,10,30,[41][42][43] mainly observed vascular injuries associated with knee dislocations in high-energy trauma cases, some authors suggest that knee dislocation-associated vascular injuries preferably appear secondary to low energy injuries (21% in ultra-low energy injuries) when compared with high energy injuries mechanisms (13%) [41]. Also patient-and injury-specific risk factors (increased body mass index and open injuries, OR 3.366; 95% CI, 1.008-11.420; p = 0.048) for vascular injuries in case of knee dislocation were identified [42].…”

Section: Associated Neurovascular Injuriesmentioning

confidence: 56%

See 1 more Smart Citation

Which Risk Factors Predict Knee Ligament Injuries in Severely Injured Patients?—Results from an International Multicenter Analysis

Weber

Solomon

Lefering

et al. 2020

JCM

View full text Add to dashboard Cite

Introduction: Ligament injuries around the knee joint and knee dislocations are rare but potentially complex injuries associated with high-energy trauma. Concomitant neurovascular injuries further affect their long-term clinical outcomes. In contrast to isolated ligamentous knee injuries, epidemiologic data and knowledge on predicting knee injuries in severely injured patients is still limited. Methods: The TraumaRegister DGU® (TR-DGU) was queried (01/2009–12/2016). Inclusion criteria for selection from the database: maximum abbreviated injury severity ≥ 3 points (MAIS 3+). Participating countries: Germany, Austria, and Switzerland. The two main groups included a “control” and a “knee injury” group. The injury severity score (ISS) and new ISS (NISS) were used for injury severity classification, and the abbreviated injury scale (AIS) was used to classify the severity of the knee injury. Logistic regression analysis was performed to evaluate various risk factors for knee injuries. Results: The study cohort included 139,462 severely injured trauma patients. We identified 4411 individuals (3.2%) with a ligament injury around the knee joint (“knee injury” group) and 1153 patients with a knee dislocation (0.8%). The risk for associated injuries of the peroneal nerve and popliteal artery were significantly increased in dislocated knees when compared to controls (peroneal nerve from 0.4% to 6.7%, popliteal artery from 0.3% to 6.9%, respectively). Among the predictors for knee injuries were specific mechanisms of injury: e.g., pedestrian struck (Odds ratio [OR] 3.2, 95% confidence interval [CI]: 2.69–3.74 p ≤ 0.001), motorcycle (OR 3.0, 95% CI: 2.58–3.48, p ≤ 0.001), and motor vehicle accidents (OR 2.2, 95% CI: 1.86–2.51, p ≤ 0.001) and associated skeletal injuries, e.g., patella (OR 2.3, 95% CI: 1.99–2.62, p ≤ 0.001), tibia (OR 1.9, 95% CI: 1.75–2.05, p ≤ 0.001), and femur (OR 1.8, 95% CI: 1.64–1.89, p ≤ 0.001), but neither male sex nor general injury severity (ISS). Conclusion: Ligament injuries and knee dislocations are associated with high-risk mechanisms and concomitant skeletal injuries of the lower extremity, but are not predicted by general injury severity or sex. Despite comparable ISS, knee injuries prolong the hospital length of stay. Delayed or missed diagnosis of knee injuries can be prevented by comprehensive clinical evaluation after fracture fixation and a high index of suspicion is advised, especially in the presence of the above mentioned risk factors.

show abstract

Section: Associated Neurovascular Injuriesmentioning

confidence: 56%

“…As with the vascular injuries, injury mechanism and patient-specific factors might again explain these differences. In this context, some literature has suggested that lower energy injuries are more likely to be associated with nerve damage compared with higher energy injuries [41].…”

Section: Associated Neurovascular Injuriesmentioning

confidence: 99%

Which Risk Factors Predict Knee Ligament Injuries in Severely Injured Patients?—Results from an International Multicenter Analysis

Weber

Solomon

Lefering

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…Stewart et al and Chowdhry et al both retrospectively analyzed the American College of Surgeons National Trauma Data Bank and described no advanced protocols, as mentioned earlier, but still reported the use of arteriography as SOC. 40,41 Stewart et al reported that KD is associated with neurovascular injury, regardless of the mechanism of energy, and a high degree of attentiveness is required during initial evaluation and management, suggesting that ultra-low energy KDs associated with obesity is an independent risk factor for vascular injury. 40 Across all 1,324 patients, the number of vascular injuries was 198 (15%), with arteriography being performed in 201 cases.…”

Section: Knee Dislocation Literaturementioning

confidence: 99%

“…40,41 Stewart et al reported that KD is associated with neurovascular injury, regardless of the mechanism of energy, and a high degree of attentiveness is required during initial evaluation and management, suggesting that ultra-low energy KDs associated with obesity is an independent risk factor for vascular injury. 40 Across all 1,324 patients, the number of vascular injuries was 198 (15%), with arteriography being performed in 201 cases. 40 Chowdhry et al reported on 986 (15%) patients with vascular injuries but 1,872 (29%) vascular investigations.…”

Section: Knee Dislocation Literaturementioning

confidence: 99%

“…40 Across all 1,324 patients, the number of vascular injuries was 198 (15%), with arteriography being performed in 201 cases. 40 Chowdhry et al reported on 986 (15%) patients with vascular injuries but 1,872 (29%) vascular investigations. 41 Unfortunately, the authors did not describe their diagnostic processes in detail nor complications related to their imaging, but we can assume overtreatment as a result of conventional arteriography, as discussed earlier, with a lack of comprehensive evidence-based protocols.…”

Section: Knee Dislocation Literaturementioning

confidence: 99%

See 1 more Smart Citation

Vascular Injuries following Knee Dislocation

Stannard

Schreiner

2020

J Knee Surg

View full text Add to dashboard Cite

Knee dislocations (KDs) are frequently found in high-energy impact injuries, ranging from automobile accidents to contact sports. KDs require careful examination due to the limb-threatening nature of these injuries. A key examination in any KD comprises a proper assessment of the vascular status. The risk of popliteal artery injury with a KD has varied from 7 to 40%, with more contemporary studies reporting injury in the range of 7 to 15%. The notion of mandatory emergent arteriography was challenged in the trauma literature as several small retrospective studies suggested that selective arteriography was a safe and effective treatment protocol. New imaging modalities have evolved and have found their way into trauma surgery. Computed tomography angiography and magnetic resonance angiography are two contemporary imaging modalities that have different characteristics as well as availability. Arteriography has been the gold standard and is a reliable and proven method of evaluation. However, it has a number of negative aspects that must be considered when determining the ideal imaging for a patient following KD. Besides cost savings of about more than US$500,000, conventional arteriography, which comprises the use of X-ray, arterial puncture and cannulation, and the use of contrast agents containing iodine, has got a complication rate as high as 9% and more patient discomfort compared with the new imaging modalities. This clinical practice review documents that our algorithm of clinical examination first combined with advanced imaging in cases with abnormalities documented on examination is a safe and prudent policy in treating patients following KD.

show abstract

The accuracy of routine knee MR imaging in detection of acute neurovascular injury following multiligamentous knee injury

et al. 2021

View full text Add to dashboard Cite

Association of Injury Energy Level and Neurovascular Injury Following Knee Dislocation

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 14 publications

References 35 publications

Which Risk Factors Predict Knee Ligament Injuries in Severely Injured Patients?—Results from an International Multicenter Analysis

Which Risk Factors Predict Knee Ligament Injuries in Severely Injured Patients?—Results from an International Multicenter Analysis

Vascular Injuries following Knee Dislocation

The accuracy of routine knee MR imaging in detection of acute neurovascular injury following multiligamentous knee injury

Contact Info

Product

Resources

About