The Acutely Dislocated Knee: Evaluation and Management

Rihn, Jeffrey A.; Groff, Yram J.; Harner, Christopher D.; Peter, S.

doi:10.5435/00124635-200409000-00008

Cited by 219 publications

(145 citation statements)

References 40 publications

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“…We agree with the conclusions of Stannard et al [24], that a full concert of physical examination findings can be used to rule out the presence of vascular injury after knee dislocations. However, a physical examination cannot be used to diagnose the occurrence of a vascular injury, and we agree with Rihn et al [18] who suggested that angiography is needed to definitively rule in the existence of vascular injury.…”

Section: Discussionsupporting

confidence: 42%

“…Instead, we used a reference standard of clinical followup at 6 months from the time of injury. Some authors have speculated that vascular injuries should be expected to present within this time [16,18,24]. While we are unaware of any case reports of individuals presenting with vascular injuries after the 6-month time, we acknowledge it may have been possible in our study.…”

Section: Discussionmentioning

confidence: 53%

“…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: Discussionsupporting

confidence: 42%

Section: Discussionmentioning

confidence: 53%

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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“…Dislocation of the knee is a rare injury and accounts for 0.02% to 0.2% of orthopaedic injuries [12,19,20]. The cause of injury can be high-or low-energy trauma [3].…”

Section: Introductionmentioning

confidence: 99%

Posterior Tibial Tendon Transfer Improves Function for Foot Drop After Knee Dislocation

Molund

Engebretsen

Hvaal

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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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.…”

Section: Definition Häufigkeit äTiologieunclassified