Knee Dislocation

Dislocation

• Any triple ligament injury
• Vascular injury in 30% (MCL, ACL and PCL)
• Fracture: 60%
• Nerve injury 25%
• Anterior M/C

Talking the talk

• X ray/photograph shows a dislocated knee. This suggests a high velocity injury and I will approach the patient as per ATLS protocol. Once life threatening injury is excluded I will treat this as a surgical emergency as it is highly associated with NV injury and compartment sy
• After taking ample history, I will assess the neurovascular status of the limb and also for dimple sign medially ( PL Dislocation). For vascular assessment I will use doppler in A & E. When in doubt I will use ABPI to assess the need for CT angiogram
• ABPI < 0.9 suggest arterial injury and I will involve the vascular team
• Take X-ray before manipulation
• Reduce ASAP in A & E and Ex Fix and reassess

Reconstruction

• Never before 1st week
• Also MCL injury: brace then reconstruct at 6 week
• Also PLC: repair with in 3 weeks and then reconstruct ACL/PCL 6 week

Ex Fix indication

• Vascular injury
• Gross swelling
• Instability

Ex fix

• Supine: put pins (lateral femoral and AM tibial)
• Prone: Temporary shunt
• Supine: Reduce knee and attach rods
• Prone: definitive anasthemosis
• Concurrent fasciotomy

Complications

• Arthrofibrosis
• May require MUA

PLC