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Knee Dislocation

Knee Dislocations


Presentation

  • We present the case of a patient who presented 18 months after a knee dislocation treated with open reduction, soft tissue releases, and static followed by hinged external fixator placement.[omicsonline.org]
  • Fever is present in less than half of cases of septic arthritis so with clinical suspicion an arthrocentesis is indicated.[foamcast.org]
  • Presentation May present with a knee effusion and pain. There may be an avulsion of the tibial attachment of the ACL. MRI is usually needed to evaluate the injury.[patient.info]
  • Donjoy/Exoskeleton) Knee-spanning external fixator to protect vascular repair if instability still present Remaining instability should be addressed at a later stage - normally only 6-12 months later [4] [6] Knee dislocation without a vascular injury[physio-pedia.com]
  • The true frequency of knee dislocations is unclear as up to 50% of injuries self-reduce before presenting to the ED.[emdocs.net]
Swollen Knee
  • knee typically held in 20 to 30 degrees of flexion with the patella displaced Perform distal neurovascular exam including DP/PT pulses.[coreem.net]
  • knee where MCL is disrupted; works well in chronic cases Dial test : PCL and posterolateral corner involvement when finding of increased external rotation of the tibia is present Neural assessment: [7] Mostly done to exclude injuries to common peroneal[physio-pedia.com]
Unable to Stand
  • The patella is felt on the outer aspect of the knee joint and the patient is unable to stand on his leg.[hip-knee.com]
Soft Tissue Swelling
  • The degree of soft-tissue damage that occurs in the setting of a traumatic knee dislocation, typically associated with severe pain, muscle spasm, and extensive soft-tissue swelling from joint capsule disruption, often precludes an accurate physical examination[ajronline.org]
Heart Disease
  • Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or internal bleeding in the past.[medlineplus.gov]
Knee Pain
  • Knee Examinations in Patients with Severe Knee Pain Posterior knee dislocation. ILLUSTRATION: Chris Whissen & shutterstock.com Many patients who have suffered an acute knee injury will experience pain that limits the physical exam.[acepnow.com]
  • Symptoms Symptoms of kneecap dislocation include: Knee appears to be deformed Knee is bent and cannot be straightened out Kneecap (patella) dislocates to the outside of the knee Knee pain and tenderness Knee swelling "Sloppy" kneecap -- you can move the[mountsinai.org]
  • Knee dislocation Plain lateral X-ray of the left knee showing a posterior knee dislocation [1] Specialty Rheumatology Symptoms Knee pain, knee deformity [2] Complications Injury to the artery behind the knee, compartment syndrome [3] [4] Types Anterior[en.wikipedia.org]
  • A 27-year-old woman presents with severe left knee pain after an MVC where she was the front passenger. She states her knee hit the dashboard. An X-ray of the patient’s knee is shown below.[foamcast.org]
Joint Dislocation
  • This article discusses tibiofemoral joint dislocation. Please see separate articles for discussion of medial and lateral patellar dislocations. They account for 1,4. Dislocation of the knee is usually obvious clinically with a marked deformity.[radiopaedia.org]
  • A Word From Verywell Knee dislocation, while serious, is extremely rare, representing less than 0.5 percent of all joint dislocations.[verywellhealth.com]
  • dislocations 2, 3, 5 Used to be considered more rare but prevalence increased due to increased motor vehicle speeds, improved imaging methods, more extreme sports, and increased athletic activities in older patients 2, 3, 5 References References General[dynamed.com]
  • dislocation Tibial plateau fracture Osteochondritis dissecans Our doctor provide consultation, treatment and surgery for sports injuries of the shoulder, elbow, wrist, hip, knee and ankle.[sgbonedoctor.com]
  • Acromioclavicular joint dislocations. Current Reviews in Musculoskeletal Medicine. 2014;7:33. Sherman SC. Shoulder dislocation and reduction. . Accessed July 3, 2016. Joshi SV. Digit dislocation reduction. . Accessed July 3, 2016. Elbow dislocation.[mayoclinic.org]
Fear
  • Pain Feeling the kneecap shift or slide out of the groove Feeling the knee buckle or give way Hearing a popping sound when the patella dislocates Swelling A change in the knee's appearance — the knee may appear misshapen or deformed Apprehension or fear[orthoinfo.aaos.org]
  • […] appearance following spontaneous reduction prior to presentation When there is concern for a spontaneously reduced dislocation, look for more subtle signs of injury including swelling, ecchymosis and joint effusion Injury to the popliteal artery is the most feared[coreem.net]
Dysesthesia
  • The patient reported no neurovascular symptoms and had no neuromotor deficits other than mild common peroneal nerve dysesthesias. Varus stress radiographs showed increased side-to-side gapping (8 mm) of the lateral compartment of the injured knee.[mdedge.com]
Hyperesthesia
  • […] recommended to rule out deep venous thrombosis. 35 Knee dislocations are often complicated by acute compartment syndrome, which necessitates a fasciotomy. 1, 5, 7, 24, 39 Athletic trainers should note any painful passive muscle stretch, swelling, or hyperesthesia[ncbi.nlm.nih.gov]
Irritability
  • Distally, 5 mm to 7 mm of the peroneus longus fascia was incised as part of the neurolysis in order to prevent nerve irritation or foot drop caused by postoperative swelling. 4. PLC Tunnels.[mdedge.com]

Workup

  • Workup may depend on your institution (ex: angiogram vs. CT angio vs. ultrasound) but all patients will need an ABI 24 hour of pulse checks per current standards.[foamcast.org]
Staphylococcus Aureus
  • Cultures showed Methicillin Sensitive Staphylococcus aureus, and following oral antibiotic treatment, the wound finally healed.[omicsonline.org]

Treatment

  • Knee Dislocation Treatment There are two basic categories of knee dislocation treatment: operative and non-operative, also called “conservative treatment.” Operative treatment typically involves surgery.[sgbonedoctor.com]
  • The second case was also following a low velocity injury that presented 8 months following injury and received similar treatment. Six months following treatment, her ROM was 0 to 120 .[omicsonline.org]
  • Preferred Name Closed treatment of knee dislocation; without anesthesia Synonyms CLOSED TX KNEE DISLOCATION W/O ANESTHESIA ID altLabel CLOSED TX KNEE DISLOCATION W/O ANESTHESIA Closed reduction of dislocation of knee without anesthesia Closed treatment[bioportal.bioontology.org]
  • Immediate Treatment If your child's patella remains dislocated, go to the emergency room.[orthoinfo.aaos.org]
  • Skin traction was used followed by splinting with resulting normal knee motion followed by treatment of the hips. No complications resulted from this treatment and the patient is a functional ambulator.[gait.aidi.udel.edu]

Prognosis

  • […] plays a crucial role in the prognosis.[ncbi.nlm.nih.gov]
  • Treatment and prognosis The management of dislocations in the emergency department firstly requires immediate reduction of the knee joint, ideally as a closed procedure. A rapid neurovascular assessment is then performed.[radiopaedia.org]
  • Knee fracture and dislocation prognosis The prognosis is good for patellar and tibial spine or tubercle fractures. The prognosis is not as favourable for tibial plateau and femoral condylar fractures.[patient.info]
  • The prognosis is best with an optimal rehabilitation exercise program. How Can You Prevent from Dislocating a Knee? Attempt to avoid major accidents.[emedicinehealth.com]
  • KeyboardArrowRight General Information KeyboardArrowRight History and Physical KeyboardArrowRight Diagnostic Studies KeyboardArrowRight Management KeyboardArrowRight Disposition KeyboardArrowRight Prognosis and complications Indications for hospital admission[dynamed.com]

Etiology

  • Bones (4): distal femur, proximal tibia, patella, fibula Articular cartilage (2): medial and lateral menisci Ligaments (4): anterior and posterior cruciate ligaments, medial and lateral collateral ligaments Tendons (2): quadriceps and patella tendons Etiology[dynamed.com]
  • DISCUSSION: Incidence: per 100,000 general population; in Denmark 1% of DDH population Female Male 10:3 ratio, One-third bilateral, equal right and left Etiology: Environmental: Fetal position, increased in Breech Fetal knee: round condyles, tibial plateau[gait.aidi.udel.edu]
  • Etiology Most knee dislocations are the result of high-energy injuries, such as motor vehicle or industrial accidents. They also can occur with low-energy injuries, such as those that occur in sports.[emedicine.medscape.com]
  • Epidemiology/Etiology Knee dislocation is estimated to be less than 0,2% of all orthopedic injuries.[physio-pedia.com]

Epidemiology

  • […] and patella tendons Etiology High-energy mechanism 2, 4, 5 Motor vehicle crash (up to 50%) Pedestrian hit by vehicle High-energy fall Low-energy mechanism 2, 4, 5 Athletic (sports-related) injury (up to 33%) Low-energy fall (obesity is a risk factor) Epidemiology[dynamed.com]
  • Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32: 1114-21. full article. females higher risk bc inc q-angle. ages 10-17, prior instability also risk factors. 8) Nomura E et al.[bonetalks.com]
  • Patella: Typically caused by direct trauma or from a twisting movement on a flexed knee Patellar Dislocations (www.hughston.com) Epidemiology True knee dislocations are rare The Mayo Clinic recorded 14 knee dislocations during an interval of 2 million[coreem.net]
  • Epidemiology/Etiology Knee dislocation is estimated to be less than 0,2% of all orthopedic injuries.[physio-pedia.com]
  • Introduction Overview Knee dislocations are traumatic injuries characterized by a high rate of vascular injury treatment is generally emergent reduction and assessment of limb perfusion Epidemiology incidence 0.02% of orthopedic injuries likely underreported[orthobullets.com]
Sex distribution
Age distribution

Pathophysiology

  • […] approximately 50% self-reduce and are misdiagnosed demographics 4:1 male to female ratio location tibiofemoral articulation (knee joint) risk factors morbid obesity is a risk factor for "ultra-low energy" knee dislocations with activities of daily living Pathophysiology[orthobullets.com]
  • Pathophysiology Multiple ligament injuries are required for knee dislocation. Generally, both cruciates and one or both collateral ligaments are injured. However, knee dislocations have been described with one of the cruciates intact.[emedicine.medscape.com]
  • Knee dislocations may be classified by either descriptive or pathophysiologic criteria [ 1, 19 ].[ajronline.org]

Prevention

  • The following can help you manage your symptoms and prevent more injury while you heal: Apply ice. Ice helps decrease swelling and pain, and may help prevent tissue damage. Use an ice pack, or put crushed ice in a plastic bag.[drugs.com]
  • Treatment & Prevention of Knee Dislocation If you have dislocated your knee, you should seek medical help as soon as possible, to reduce the risk of further damage.[susquehannahealth.org]
  • Prevention Use proper techniques when exercising or playing sports. Keep your knees strong and flexible. Some cases of knee dislocation may not be preventable, especially if physical factors make you more likely to dislocate your knee.[mountsinai.org]
  • Physical Therapy is recommended which helps to control pain and swelling, prevent formation of scar of soft tissue, and also helps in collagen formation.[drcoyner.com]

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