Beware of Ultra-Low-Velocity Knee Dislocation

Georgiadis, Andrew; Guthrie, S. Trent; Shepard, Alexander D.

doi:10.3928/01477447-20140924-03

Cited by 17 publications

(16 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Sillanpää et al [21] similarly warned increasing body proportions are leading to a changing paradigm in the epidemiology of knee dislocations and associated vascular injuries. Although historical literature suggested that mechanism of injury and the degree of injury severity (ISS) were useful predictors of vascular injury [7,8,10,14,25], this was not the case in our study or others [3,21]. To our knowledge, our study is one of the only studies that investigates open injury as a risk factor for vascular injury after knee dislocation; however, Wright et al [27] reported a series of 19 patients with open knee dislocations and found that nine (47%) had some form of concomitant vascular injury.…”

Section: Discussioncontrasting

confidence: 48%

Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?

Weinberg

Scarcella

Napora

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Knee dislocations are rare injuries with potentially devastating vascular complications. An expeditious and accurate diagnosis is necessary, as failing to diagnose vascular injury can result in amputation; however, the best diagnostic approach remains controversial. Questions/purposes We asked: (1) What patient factors are predictors of vascular injury after knee dislocation? (2) What are the diagnostic utilities of palpable dorsalis pedis or posterior tibial pulses, and the presence of an anklebrachial index (ABI) of 0.9 or greater?Methods A database at a Level I trauma center was queried for patients with evidence of knee dislocation, demographic information (age at the time of injury, sex, Injury Severity Score, BMI, mechanism of injury), and the presence of open injury were recorded. One-hundred fortyone patients underwent screening at initial presentation, of whom 26 (24%) underwent early vascular exploration based on an abnormal physical examination. One-hundred five (91%) of the remaining 115 patients were available at a minimum followup of 6 months (mean, 19 ± 10 months). In total, 31 unique patients were excluded, including 10 patients (7%) who were lost to followup before 6 months. Among the 110 patients who met inclusion criteria, the mean age and SD was 37 ± 13 years, and the Injury Severity Score was 15 ± 9. There were 71 males (65%). Logistic regression was used to determine independent correlates of vascular injury. The vascular examination was reviewed for the presence of a palpable pulse in the dorsalis pedis artery, the presence of a palpable pulse in the posterior tibial artery, and whether the ABI in the dorsalis pedis was 0.9 or greater. Contingency tables were generated to assess the sensitivity, specificity, and accuracy of physical examination maneuvers. The physical examination was collectively regarded as ''normal'' when both pulses were palpable and the ABI was 0.9 or greater. The initial physical examination as just described was considered the diagnostic test being evaluated in this study; ''positive'' tests were evaluated by and confirmed at vascular surgery, and 6 months clinical followup without symptoms or progressive signs of vascular injury confirmed the absence of injury in the remainder of the patients. Contingency tables were generated again to assess the sensitivity, specificity, and accuracy of the combined physical examination.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity w...

show abstract

Section: Discussioncontrasting

confidence: 48%

Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?

Weinberg

Scarcella

Napora

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…40 During the gait cycle, as much as 900 kg of force can be transferred across the tibiofemoral joint in an obese patient who weighs over 400 pounds. 22 Furthermore, obese patients have been found to have displaced centers of mass and altered gait kinematics, placing them at increased risks of falls. 41,42 Therefore, a simple fall that results in a hyperextension moment can be sufficient to generate a large enough force vector to cause an anterior knee dislocation in an obese patient.…”

Section: Mechanism Of Injurymentioning

confidence: 99%

“…12 Since this initial report, several small case reports have also been reported. [13][14][15][16][17][18][19][20][21][22] In 2011, Azar et al became the first group to present a larger, continuous cohort of patients who sustained "ultralow-velocity" knee dislocations, coining the term in their article. 2 This reflects the growing prevalence and recognition of these injuries within the population of knee dislocation patients.…”

mentioning

confidence: 99%

“…24,25 As the prevalence of obesity continues to rise, there has also been an increase in the number of knee dislocations that are attributed to an ultralow-velocity mechanism within the obese population. 22 Obesity can also make the diagnosis of a knee dislocation more challenging because the enlarged soft tissue envelope can mask deformity, leading to a delay in diagnosis. 13,20,26 Additionally, the risk of neurovascular injury is still very high in this population despite the seemingly benign mechanism of injury.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Knee Dislocation in the Morbidly Obese Patient

et al. 2016

View full text Add to dashboard Cite

Though a relatively rare orthopedic injury, knee dislocation in the morbidly obese population has been increasingly reported in the literature. These injuries are often referred to as "ultralow-velocity knee dislocations" since they commonly occur after a seemingly trivial injury, such as a ground level fall. As a result, these injuries are often underappreciated and initially misdiagnosed. Even though these injuries are low-velocity, they should still be regarded as a high energy injury because of the large amount of mass contributing to the dislocating force. Knee dislocations in the morbidly obese are associated with a particularly high rate of neurovascular injury. A timely and accurate diagnosis is crucial to avoid serious limb-threatening complications, including the need for amputation. Therefore, evaluating physicians should maintain a high suspicion for a knee dislocation in any morbidly obese patient who presents with knee pain following a seemingly innocuous injury. Management of these injuries is controversial. Associated vascular injuries must be identified promptly and appropriately managed by a vascular surgery team. There is no consensus on the ideal orthopedic treatment of knee dislocations in the morbidly obese patient. Operative treatment can be fraught with complications, including a higher rate of neurovascular injury, increased surgical complications, and poor subjective patient outcome scores compared with nonobese patients sustaining a high-velocity knee dislocation. It is paramount that treating physicians are familiar with the unique challenges of treating knee dislocations in the morbidly obese patient when discussing risks and benefits of treatment options. This article presents a review of the existing literature on knee dislocations in the morbidly obese population, including diagnosis, management, and outcomes.

show abstract

“…[4][5][6][7] There are various reasons why it is believed these numbers may be lower than the true prevalence-these include omission of frequent spontaneous relocations, as well as the unrecognition of "low velocity" athletic injuries or dislocations in the obese population. [8][9][10] Regardless of whether the joint spontaneously relocates, or requires manual reduction, the risk of neurovascular injury remains. Thus, a dislocation should be assumed until proven otherwise in those patients with a multiligamentous knee injury.…”

mentioning

confidence: 99%

Treatment of Peroneal Nerve Injuries in the Multiligament Injured/Dislocated Knee

et al. 2015

View full text Add to dashboard Cite

Tibiofemoral knee dislocations are typically a consequence of high-energy mechanisms, causing significant damage to the soft tissue and osseous structures of the knee. Concomitant neurovascular injuries such as popliteal artery and peroneal nerve injuries are also common and can have significant long-term consequences. The mechanism typically involves a traction injury to the peroneal nerve subsequent to an extreme varus moment applied to the knee. Complete nerve injuries typically hold a worse prognosis than incomplete palsies. Rates of functional recovery in the setting of a complete palsy following a knee dislocation event have been dismal. A period of observation and nonoperative treatment is initially performed, utilizing orthotic devices to assist with lower extremity deficits. Surgical treatment options include neurolysis, nerve grafting, tendon transfer, arthrodesis, and direct motor nerve transfers. Motor nerve transfers continue to be explored with initial reports showing promising results.

show abstract

Beware of Ultra-Low-Velocity Knee Dislocation

Cited by 17 publications

References 24 publications

Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?

Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation?

Knee Dislocation in the Morbidly Obese Patient

Treatment of Peroneal Nerve Injuries in the Multiligament Injured/Dislocated Knee

Contact Info

Product

Resources

About