Incidence of knee dislocation and concomitant vascular injury requiring surgery

Sillanpää, Petri; Kannus, Pekka; Niemi, Seppo; Rolf, Christer; Felländer‐Tsai, Li; Mattila, Ville M.

doi:10.1097/ta.0000000000000136

Cited by 71 publications

(70 citation statements)

References 18 publications

(19 reference statements)

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“…They suggested that the traditionally held risk factors for vascular injury (high-energy mechanism, multiple system trauma) may not be applicable for modern practice, especially as BMIs continue to increase. 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].…”

Section: Discussionmentioning

confidence: 99%

“…As they explained, many of the patients included in their meta-analysis had injuries that occurred more than 30 years ago, and when interpreted in the context of the changing demographics of modern society, it would seem valuable to continue reporting the diagnostic utility of various physical examination maneuvers. Although some authors [18,21,24] agree that knee dislocations are best diagnosed and managed through a systematic approach, the specifics of such have been heavily debated [12,13,24]. Levy et al [10] reported a shortage of high-quality evidence from which to base diagnosis and treatment decisions, specifically those related to vascular injury.…”

Section: Discussionmentioning

confidence: 99%

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

Weinberg

Scarcella

Napora

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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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...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Weinberg

Scarcella

Napora

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…This incidence is comparable to above-mentioned studies although a Finnish population-based study has reported popliteal artery injury rates as low as 1.6% with only 0.1% of limb loss. 9 Forty-six per cent of knee dislocations were caused by falls on the same level and the lower rate of popliteal artery injury might be a consequence of this predominantly low-energy injury pattern. Our study was done in a cohort recruited from a single centre and subspecialised Level 1 Trauma Unit, rather than being a population-based study and with this we might have selected more severe injury patterns.…”

Section: Discussionmentioning

confidence: 99%

“…9 Indisputably, each multidirectional knee injury with an adequate history of trauma and presentation should be regarded as a knee dislocation until proven otherwise. 1 The mechanism of injury in knee dislocations can range from high energy injuries due to road accidents and falls from a height to low energy injuries such as sports injuries and even ultra-low-velocity injuries such as simple falls, especially in obese patients.…”

Section: Introductionmentioning

confidence: 99%

High rate of popliteal artery injuries and limb loss in 96 knee dislocations

Held¹,

Laubscher²,

Bormann³

et al. 2016

SA orthop. j.

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Background: Knee dislocations are reported to have an incidence of popliteal artery injuries between 7% and 64%. The purpose of this study was to determine the incidence of injuries to the popliteal artery as well as early limb loss in knee dislocations at a level-1 trauma hospital in South Africa. Methods:Twenty-eight patients with popliteal artery injuries were selected from a prospectively collected database of 96 patients with acute knee dislocations. The incidence of vascular injuries, compartment syndromes and limb loss was determined retrospectively. Results:Of 96 knee dislocations 28 had a popliteal artery injury (29.1%). Seven of 28 patients with popliteal artery injuries needed an amputation. Of the 28 patients, ten were documented as a threatened limb. Five of these ten patients (50%) needed an amputation. The documented median delay to revascularisation of patients who presented with threatened limbs was 10 hours. Conclusion:Overall, one-third of knee dislocations presented with a vascular injury. The prevalence of amputations in knee dislocations with associated popliteal artery injuries was 25% and increased to more than 50% in patients who presented with a threatened limb. A recent study has described popliteal artery injury rates as low as 1.6% with only 0.1% of patients needing an amputation.9 Indisputably, each multidirectional knee injury with an adequate history of trauma and presentation should be regarded as a knee dislocation until proven otherwise. 1The mechanism of injury in knee dislocations can range from high energy injuries due to road accidents and falls from a height to low energy injuries such as sports injuries and even ultra-low-velocity injuries such as simple falls, especially in obese patients. [10][11][12][13] The energy level of the injury can affect the injury pattern itself, which varies from ligamentous disruption only, to knee dislocations with severe soft tissue damage, compartment syndrome, open wounds and fractures, all of which are risk factors for adverse limb outcomes. 14,15 In its most severe presentation a knee dislocation can be associated with popliteal artery injuries resulting in a threatened limb and subsequent limb loss if not treated urgently. The specific anatomy of the popliteal artery makes it susceptible to damage during trauma. It is fixed to the distal femur in the adductor canal, and is tethered distally under the soleus muscle and inbetween the two heads of the gastrocnemius muscles. With its tenuous collateral supply, the arterial flow is very rarely sufficient to guarantee adequate distal perfusion to the limb during a complete disruption of the popliteal artery. The purpose of this study was to determine the frequency of popliteal artery injuries in knee dislocations and evaluate the incidence of early limb loss. MethodsTwenty-eight of 96 consecutive knee dislocations admitted to the trauma unit of a tertiary care hospital in South Africa over a period of 12 years (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)...

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“…Mit 0,2-0,3 % aller Luxationen stellt die Luxation des Kniegelenks eine seltene Verletzung dar [22,26], von der hauptsächlich junge Männer im Alter von 18 bis 25 Jahren betroffen sind. Häu-fig sind Kniegelenksluxationen Folge von Hochrasanztraumen mit direktem Anprall gegen das Knie z.…”

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