Abstract
Acute knee dislocations are rare orthopedic injuries but represent a myriad of soft tissue and bony damage to the knee that can potentially result in limb loss if mismanaged or misdiagnosed. Injury mechanism can help delineate the type of dislocation. The Schenck/Wascher and Moore classification systems exist to clarify injury based on ligamentous injury, arterial injury, nerve injury, and fracture pattern, if present. Assessment of these injuries begins with vascular examination and urgent closed reduction when possible. Advanced imaging studies are often delayed until any potential vascular injury has been excluded or treated and reduction of the tibiofemoral joint has been achieved. Initial stabilization entails either splint, knee bracing, or possible external fixation when closed reduction cannot be maintained or persistent malreduction exists. Based on physical examination and advanced imaging studies, surgical reconstruction of the injured ligaments is performed in a sequential fashion. These will include the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), the posteromedial corner (PMC), the posterolateral corner (PLC), and any combination thereof. Postoperative rehabilitation will be guided by injury severity, surgical reconstruction, and patient host factors with the goals of returning to normal activities of daily activity and work, military duty, or sports activities at the same level of participation.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Change history
19 November 2019
Dr. Philip P. Roessler’s name had been missed out in chapter 11. The authors’ name has now been updated.
References
Peskun CJ, Levy BA, Fanelli GC, et al. Diagnosis and management of knee dislocations. Phys Sportsmed. 2015;38:101–11.
Hegyes MS, Richardson MW, Miller MD. Knee dislocation. Complications of nonoperative and operative management. Clin Sports Med. 2000;19:519–43.
Arom GA, Yeranosian MG, Petrigliano FA, et al. The changing demographics of knee dislocation: a retrospective database review. Clin Orthop Relat Res. 2014;472:2609–14.
Almekinders LC, Dedmond BT. Outcomes of the operatively treated knee dislocation. Clin Sports Med. 2000;19:503–18.
Sillanpää PJ, Kannus P, Niemi ST, et al. Incidence of knee dislocation and concomitant vascular injury requiring surgery: a nationwide study. J Trauma Acute Care Surg. 2014;76:715–9.
Ogden JA. Subluxation and dislocation of the proximal tibiofibular joint. J Bone Joint Surg Am. 1974;56:145–54.
Kennedy JC. Complete dislocation of the knee joint. J Bone Joint Surg Am. 1963;45:889–904.
Schenck RC, Richter DL, Wascher DC. Knee dislocations: lessons learned from 20-year follow-up. Orthop J Sports Med. 2014;2:2325967114534387.
Moore TM. Fracture-dislocation of the knee. Clin Orthop Relat Res. 1981:128–40.
Medina O, Arom GA, Yeranosian MG, et al. Vascular and nerve injury after knee dislocation: a systematic review. Clin Orthop Relat Res. 2014;472:2621–9.
Lachman JR, Rehman S, Pipitone PS. Traumatic knee dislocations: evaluation, management, and surgical treatment. Orthop Clin North Am. 2015;46:479–93.
Seroyer ST, Musahl V, Harner CD. Management of the acute knee dislocation: the Pittsburgh experience. Injury. 2008;39:710–8.
Peskun CJ, Chahal J, Steinfeld ZY, Whelan DB. Risk factors for peroneal nerve injury and recovery in knee dislocation. Clin Orthop Relat Res. 2012;470:774–8.
Krych AJ, Giuseffi SA, Kuzma SA, et al. Is peroneal nerve injury associated with worse function after knee dislocation? Clin Orthop Relat Res. 2014;472:2630–6.
Woodmass JM, Romatowski NPJ, Esposito JG, et al. A systematic review of peroneal nerve palsy and recovery following traumatic knee dislocation. Knee Surg Sports Traumatol Arthrosc. 2015;23:2992–3002.
Wascher DC, Dvirnak PC, DeCoster TA. Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma. 1997;11:525–9.
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.
Lynch AD, Musahl V, Irrgang J. Current concepts and controversies in rehabilitation after surgery for multiple ligament knee injury. Curr Rev Musculoskelet Med. 2017;10(3):328–45.
Sgaglione NA, Lubowitz JH, Provencher MT. The knee: AANA advanced arthroscopic surgical techniques. Slack Incorporated and AANA. 2016.
Reider B, Terry MA, Provencher MT. Operative Techniques: sports medicine surgery: operative techniques. 2009.
Cruz RS, LaPrade RF. Anatomic posterolateral corner reconstruction. Arthrosc Tech. 2016;5:e1–9.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 ISAKOS
About this chapter
Cite this chapter
Murphy, C.I., Roessler, P.P., Lawyer, T.J., Musahl, V. (2019). Acute Knee Dislocations. In: Margheritini, F., Espregueira-Mendes, J., Gobbi, A. (eds) Complex Knee Ligament Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58245-9_11
Download citation
DOI: https://doi.org/10.1007/978-3-662-58245-9_11
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-58244-2
Online ISBN: 978-3-662-58245-9
eBook Packages: MedicineMedicine (R0)