Skip to main content
SpringerLink
Log in

Knee Dislocations in the Morbidly Obese Patient

  • Chapter
  • First Online:
The Multiple Ligament Injured Knee

  • 940 Accesses

Abstract

Ultra-low-velocity (ULV) knee dislocations are rare but increasingly common events. They occur most frequently in obese, morbidly obese, and super obese patients during everyday activities, but they can be as severe or more severe than high-velocity knee dislocations. ULV knee dislocations frequently are associated with neurovascular injury and other complications. Diagnosis, early reduction, and identification and treatment of vascular injuries are critical to reducing the risk of limb ischemia and possibly amputation. Given the size of the limb, maintenance of reduction in these patients almost always requires external fixation. While surgery on morbidly obese patients may be technically challenging, surgical reconstruction leads to improved subjective and objective results and is recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bratt HD, Newman AP. Complete dislocation of the knee without disruption of both cruciate ligaments. J Trauma. 1993;34:383–9.

    Article  CAS  PubMed  Google Scholar 

  2. Brautigan B, Johnson DL. The epidemiology of knee dislocations. Clin Sports Med. 2000;19:387–97.

    Article  CAS  PubMed  Google Scholar 

  3. Hegyes MS, Richardson NW, Miller MD. Knee dislocation. Complications of nonoperative and operative management. Clin Sports Med 2000;19:519–543.

    Article  CAS  PubMed  Google Scholar 

  4. Hoover NW. Injuries of the popliteal artery associated with fractures and dislocations. Surg Clin North Am. 1961;41:1099–112.

    Article  CAS  PubMed  Google Scholar 

  5. Kennedy JC. Complete dislocation of the knee joint. J Bone Joint Surg Am. 1963;45:889–904.

    Article  CAS  PubMed  Google Scholar 

  6. Meyers MH, Moore TM, Harve JP Jr. Traumatic dislocation of the knee joint. J Bone Joint Surg Am. 1975;57:430–3.

    Article  CAS  PubMed  Google Scholar 

  7. Merrill KD. Knee dislocations with vascular injuries. Orthop Clin North Am. 1994;25:707–13.

    CAS  PubMed  Google Scholar 

  8. Sisto DJ, Warren RF. Complete knee dislocation. A follow-up study of operative treatment. Clin Orthop Relat Res 1985;198:94–101.

    Google Scholar 

  9. Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am. 1977;59:236–9.

    Article  PubMed  Google Scholar 

  10. Shelbourne KD, Porter DA, Clingman JA, McCarroll JR, Rettig AC. Low-velocity knee dislocation. Orthop Rev. 1991;20:995–1004.

    CAS  PubMed  Google Scholar 

  11. Streubel PN, Arndt S, Armitage MS, Wilson CD, Gladden PB. Fatal knee dislocation in a morbidly obese Jehovah’s Witness. A case report. Obes Surg. 2010;20:1316–8.

    Article  PubMed  Google Scholar 

  12. Bui KL, Illaslan H, Parker RD, Sundaram M. Knee dislocations: a magnetic resonance imaging study correlated with clinical and operative findings. Skeletal Radiol. 2008;37:653–61.

    Article  PubMed  Google Scholar 

  13. Engebretsen L, Risberg MA, Robertson B, Ludvigsen TC, Johansen S. Outcome after knee dislocations: a 2–9 years follow-up of 85 consecutive patients. Knee Surg Sports Traumatol Arthrosc. 2009;17:1013–26.

    Article  PubMed  Google Scholar 

  14. McCoy GF, Hannon DG, Barr RJ, Templeton J. Vascular injury associated with low-velocity dislocations of the knee. J Bone Joint Surg Br. 1987;69:285–7.

    Article  CAS  PubMed  Google Scholar 

  15. Marin EL, Bifulco SS, Fast A. Obesity. A risk factor for knee dislocation. Am J Phys Med Rehabil 1990;69:132–134.

    Google Scholar 

  16. Hagino RT, DeCaprio JD, Valentine RJ, Clagett GP. Spontaneous popliteal vascular injury in the morbidly obese. J Vasc Surg. 1988;28:458–62.

    Article  Google Scholar 

  17. Georgiadis AG, Mohammad FH, Mizerik KT, Nypaver TJ, Shepard AD. Changing presentation of knee dislocation and vascular injury from high energy falls in the morbidly obese. J Vasc Surg. 2013;57:1196–203.

    Article  PubMed  Google Scholar 

  18. Azar FM, Brandt JC, Miller TH 3rd, Phillips BB. Ultra-low-velocity knee dislocations. Am J Sports Med. 2011;39:2170–4.

    Article  PubMed  Google Scholar 

  19. Peltola EK, Lindahl J, Hietaranta H, Koskinen SK. Knee dislocation in overweight patients. AJR. 2009;192:101–6.

    Article  PubMed  Google Scholar 

  20. Hamblin T, Curtis SH, D’Astous J, Aoki SK. Childhood obesity and low-velocity knee dislocation in a fifteen-year-old girl. A case report. J Bone Joint Surg Am 2010;92:2216–2219.

    Article  PubMed  Google Scholar 

  21. Centers for Disease Control and Prevention. Defining adult overweight and obesity. Available at https://www.cdc.gov/obesity/adult/defining.html. Accessed 24 April 2018.

  22. American Academy of Orthopaedic Surgeons. Position statement. The impact of obesity on bone and joint health. Available at https://www.aaos.org/uploadedFiles/PreProduction/About/Opinion_Statements/position/1184%20The%20Impact%20of%20Obesity%20on%20Bone%20and%20Joint%20Health(1).pdf. Accessed 24 April 2018.

  23. Johnson JP, Kleiner J, Klinge SA, McClure PK, Hayda RA, Born CT. Increased incidence of vascular injury in obese patients with knee dislocations. J Orthop Trauma. 2018;32:82–7.

    Article  PubMed  Google Scholar 

  24. Georgiadis AG, Guthrie T, Shepard AD. Beware of ultra-low-velocity knee dislocation. Orthopedics. 2014;37:656–8.

    Article  PubMed  Google Scholar 

  25. Roman PD, Hopson CN, Zenni EJ Jr. Traumatic dislocation of the knee: a report of 30 cases and literature review. Orthop Rev. 1987;16:917–24.

    CAS  PubMed  Google Scholar 

  26. Ranavolo A, Donini LM, Mari S, Serrao M, Silvetti A, Iavicoli S, et al. Lower-limb joint coordination pattern in obese subjects. Biomed Res Int. 2013;2013:142323.

    Article  PubMed  Google Scholar 

  27. Mignardot JB, Olivier I, Pomayon E, Nourgier V. Origins of balance disorders during a daily living movement in obese: can biomechanical factors explain everything? PLoS ONE. 2013;8:e60491.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Vaidya R, Roth M, Nanavati D, Prince M, Sethi A. Low-velocity knee dislocations in obese and morbidly obese patients. Orthop J Sports Med. 2015;3:2325967.

    Article  Google Scholar 

  29. Wascher DC. High-velocity knee dislocation with vascular injury. Treatment principles. Clin Sports Med. 2000;19:457–77.

    Article  CAS  PubMed  Google Scholar 

  30. Lefrak EA. Knee dislocation. An illusive cause of critical arterial occlusion. Arch Surg. 1976;111:1021–4.

    Article  CAS  PubMed  Google Scholar 

  31. Folt J, Vohra T. Low-velocity knee dislocation in the morbidly obese. Am J Emerg Med. 2012;30(2090):e5–6.

    Google Scholar 

  32. Shetty RR, Mostofi SB, Housden PL. Knee dislocation of a morbidly obese patient: a case report. J Orthop Surg. 2005;13:76–8.

    Article  CAS  Google Scholar 

  33. Natsuhara KM, Yeranosian MG, Cohen JR, Wang JC, McAllister DR, Petrigliano FA. What is the frequency of vascular injury after knee dislocation? Clin Orthop Relat Res. 2014;472:2615–20.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Stannard JP, Sheils TM, Lopez-Ben RR, McGwin G Jr, Robinson JT, Volgas DA. Vascular injuries in knee dislocations: the role of physical examination in determining the need for arteriography. J Bone Joint Surg Am. 2004;86:910–5.

    Article  PubMed  Google Scholar 

  35. Kaufman SL, Martin LG. Arterial injuries associated with complete dislocation of the knee. Radiology. 1992;184:153–5.

    Article  CAS  PubMed  Google Scholar 

  36. Werner BC, Gwathmey W Jr, Higgins ST, Hart JM, Miller MD. Ultra-low velocity knee dislocations. Patient characteristics, complications, and outcomes. Am J Sports Med. 2013;42:358–63.

    Article  PubMed  Google Scholar 

  37. Weinberg DS, Scarcella NR, Napora JK, Vallier HA. Can vascular injury be appropriately assessed with physical examination after knee dislocation? Clin Orthop Relat Res. 2016;474:1453–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. McDonough EB Jr, Wojtys EM. Multiligamentous injuries of the knee and associated vascular injuries. Am J Sports Med. 2009;37:156–9.

    Article  PubMed  Google Scholar 

  39. Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma. 2004;56:1261–5.

    Article  PubMed  Google Scholar 

  40. Abou-Sayed H, Berger DL. Blunt lower-extremity trauma and popliteal artery injuries: revisiting the case for selective arteriography. Arch Surg. 2002;137:585–9.

    Article  PubMed  Google Scholar 

  41. Kendall RW, Taylor DC, Slavian AJ, O’Brien PJ. The role of arteriography in assessing vascular injuries associated with dislocations of the knee. J Trauma. 1993;35:875–8.

    Article  CAS  PubMed  Google Scholar 

  42. Miranda FE, Dennis JW, Veldenz HC, Dovgan PS, Frykberg EF. Confirmation of the safety and accuracy of physical examination in the evaluation of knee dislocation for injury of the popliteal artery: a prospective study. J Trauma. 2002;52:247–51.

    PubMed  Google Scholar 

  43. Treiman GS, Yellin AE, Weaver FA, Wang S, Ghalambor N, Barlow W, et al. Examination of the patient with a knee dislocation. The case for selective arteriography. Arch Surg. 1992;127:1056–62.

    Article  CAS  PubMed  Google Scholar 

  44. Howells NR, Brunton LR, Robinson J, Porteus AJ, Eldridge JD, Murray JR. Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee. Injury. 2011;42:1198–204.

    Article  PubMed  Google Scholar 

  45. Nicandri GT, Dunbar RP, Wahl CJ. Are evidence-based protocols which identify vascular injury associated with knee dislocation underutilized? Knee Surg Sports Traumatol Arthrosc. 2010;18:1005–12.

    Article  PubMed  Google Scholar 

  46. O’Donnell TF Jr, Brewster DC, Darling RC, Veen H, Waltman AA. Arterial injuries associated with fractures and/or dislocations of the knee. J Trauma. 1977;17:775–84.

    Article  PubMed  Google Scholar 

  47. Dedmond BT, Almekinders LC. Operative versus nonoperative treatment of knee dislocations: a meta-analysis. Am J Knee Surg. 2001;14:33–8.

    CAS  PubMed  Google Scholar 

  48. Geeslin AG, Moulton SG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, Part 1: surgical treatment of acute injuries. Am J Sports Med. 2016;44:1336–42.

    Article  PubMed  Google Scholar 

  49. Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am. 2004;86:262–73.

    Article  PubMed  Google Scholar 

  50. Sims WF, Jacobson KE. The posteromedial corner of the knee: medial-sided injury patterns revisited. Am J Sports Med. 2004;32:337–45.

    Article  PubMed  Google Scholar 

  51. Robinson JR, Bull AM, Thomas RR, Amis AA. The role of the medial collateral ligament and posteromedial capsule in controlling knee laxity. Am J Sports Med. 2006;34:1815–23.

    Article  PubMed  Google Scholar 

  52. Burks RT, Schaffer JJ. A simplified approach to the tibial attachment of the posterior cruciate ligament. Clin Orthop Relat Res. 1990;254:216–9.

    Google Scholar 

  53. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, et al. Prevention of VTE in orthopedic surgery patients. Antithrombotic therapy and prevention of thrombosis, 9th ed. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141 (Suppl):e278S–325S.

    Google Scholar 

  54. Werner BC, Hadeed MM, Gwathmey FW Jr, Gaskin CM, Hart JM, Miller MD. Medial injury in knee dislocations: what are the common injury patterns and surgical outcomes? Clin Orthop Relat Res. 2014;472:2658–66.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Scarcella NR, Weinberg DS, Bowen S, Vallier HA. Clinical and functional results of 119 patients with knee dislocations. J Orthop Trauma. 2017;31:380–6.

    Article  PubMed  Google Scholar 

  56. Ridley TJ, Cook S, Bollier M, McCarthy M, Gao Y, Wolf B, et al. Effect of body mass index on patients with multiligamentous knee injuries. Arthroscopy. 2014;30:1447–52.

    Article  CAS  PubMed  Google Scholar 

  57. Hanley J, Westermann R, Cook S, Glass N, Amendola N, Wolf BR, et al. Factors associated with knee stiffness following surgical management of multiligament knee injuries. J Knee Surg. 2017;30:549–54.

    Article  PubMed  Google Scholar 

  58. Werner BC, Higgins MD, Pehlivan HC, Carothers JT, Browne JA. Super obesity is an independent risk factor for complications after primary total hip arthroplasty. J Arthroplasty. 2017;32:402–6.

    Article  PubMed  Google Scholar 

  59. Zusmanovich M, Kester BS, Schwarzkopf R. Postoperative complications of total joint arthroplasty in obese patients stratified by BMI. J Arthroplasty. 2018;33:856–64.

    Article  PubMed  Google Scholar 

  60. Meller MM, Toossi N, Johanson NA, Gonzalez MH, Son MS, Lau EC. Risk and cost of 90-day complications in morbidly and superobese patients after total knee arthroplasty. J Arthroplasty. 2016;31:2091–8.

    Article  PubMed  Google Scholar 

  61. Seenath MM, Parry DJ, Macdonald D, Pollard SG, Scott DJA. Pathological knee dislocation in the morbidly obese. EJVES Extra. 2005;10:15–7.

    Article  Google Scholar 

  62. Carr JB, Werner BC, Miller MD, Gwathmey FW. Knee dislocation in the morbidly obese patient. J Knee Surg. 2016;29:278–85.

    Article  PubMed  Google Scholar 

  63. Sems SA, Levy BA, Dajani K, Herrera DA, Templeman DC. Incidence of deep venous thrombosis after temporary joint spanning external fixation for complex lower extremity injuries. J Trauma. 2009;66:1164–6.

    Article  PubMed  Google Scholar 

  64. Born TR, Engasser WM, King AH, Krych AJ, Dahm DL, Levy BA, et al. Low frequency of symptomatic venous thromboembolism after multiligamentous knee reconstruction with thromboprophylaxis. Clin Orthop Relat Res. 2014;472:2705–11.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Delis KT, Hunt N, Strachan RK, Nicolaides AN. Incidence, natural history and risk factors of deep vein thrombosis in elective knee arthroscopy. Thromb Haemost. 2001;86:817–21.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA

    Ian Power & Frederick M. Azar

Authors
  1. Ian Power
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frederick M. Azar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frederick M. Azar .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Geisinger Medical Center/Health System, Danville, PA, USA

    Gregory C. Fanelli

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Power, I., Azar, F.M. (2019). Knee Dislocations in the Morbidly Obese Patient. In: Fanelli, G. (eds) The Multiple Ligament Injured Knee. Springer, Cham. https://doi.org/10.1007/978-3-030-05396-3_35

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-05396-3_35

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-05395-6

  • Online ISBN: 978-3-030-05396-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation