Changing presentation of knee dislocation and vascular injury from high-energy trauma to low-energy falls in the morbidly obese

Abstract

LE KDs in obese patients are becoming increasingly prevalent. These patients are more likely to have nerve and vascular injuries and are more likely to undergo vascular repair than patients with HE trauma. The epidemic of obesity in the United States presents unique challenges in the identification and treatment of patients with LE KD and their associated injuries.

Incidence of knee dislocation and concomitant vascular injury requiring surgery

“…3,4,25 Among the patients with low-energy knee dislocations, we were not able to assess patients' body mass index from the register data, to see how many of them were morbidly obese. 3,4,25 Among the patients with low-energy knee dislocations, we were not able to assess patients' body mass index from the register data, to see how many of them were morbidly obese.…”

“…1,2 To our knowledge, the only study assessing the incidence rate for knee dislocation using magnetic resonance imaging (MRI) was conducted by Peltola et al 3 They suggested that the adult incidence is 1.2 per million persons-years and that dislocation of the knee usually results from a high-energy trauma, such as motor vehicle accidents. 4 In a knee dislocation classification system modified by Schenck et al, 5Y8 knee dislocation is defined as a continuous injury pattern varying from injury to a posteromedial or posterolateral corner combined with a single cruciate injury, to fractures with bicruciate and both posterolateral and posteromedial corner injuries. It has been described that up to 40% of knee dislocations can happen in overweight patients sustaining lowenergy trauma, such as falling on even ground or slipping while walking.…”

The Changing Demographics of Knee Dislocation: A Retrospective Database Review

“…In this study, we found an overall incidence of 0.072 events per 100 patient-years among 11.2 million patients with orthopaedic injuries sustained between 2004 and 2009. This knee dislocation incidence increase since the mid-20 th century could be attributed to the growing obese population that sustains low-velocity knee dislocation [5,7,8,11]. Azar et al [2] reported 17 clinically obese patients aged 16 to 59 years (mean, 29 years) who sustained knee dislocations while doing low-or ultralowvelocity activities of daily living (walking, stepping down stairs, etc).…”

Current Concepts in Acute Knee Dislocation: The Missed Diagnosis?

“…More recently there has been literature reporting the rise of knee dislocations in the morbidly obese [9-13]. Georgiadis et al reported an increase in low velocity knee dislocations in the morbidly obese from 17% between 1995-2000 to 53% in 2007- 2012 [11]. The same study also found that obese patients with low energy knee dislocations were more likely to have neurovascular injuries requiring surgical intervention than patients with higher energy traumatic dislocations.…”