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What Is the Frequency of Vascular Injury After Knee Dislocation?

  • Symposium: Management of the Dislocated Knee
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Vascular injury secondary to an acute knee dislocation is a known complication. However, there exist wide discrepancies in the reported rate of vascular injury in this setting.

Questions/purposes

Using a large private insurance database, we determined the frequency of vascular injury in knee dislocations across year of diagnosis, age, sex, and US geographic region and the proportion of these injuries requiring surgical repair.

Methods

The PearlDiver database, which contains records from 11 million orthopaedic patients, was searched using ICD-9 diagnostic codes for all knee dislocation events from 2004 to 2009. Within this subset, we identified which knee dislocations had an associated vascular injury ICD-9 code. Patients were stratified by year of diagnosis, age, sex, and US geographic region, and Current Procedural Terminology codes were used to identify the subset of patients with vascular injury requiring surgical repair. Differences in frequency across demographic groups and over time were analyzed with Poisson regression analysis.

Results

Among the 8050 limbs with knee dislocation identified over the study period, 267 had a concomitant vascular injury for an overall frequency of 3.3%. Males were found to have an increased risk of vascular injury compared to females (odds ratio = 2.59, p < 0.001). Additionally, patients aged 20 to 39 years had a higher risk of vascular injury when compared to those aged 0 to 19 years (odds ratio = 1.93, p = 0.001), 40 to 59 years (odds ratio = 1.57, p = 0.014), and 60 years or older (odds ratio = 2.81, p = 0.036). There were no differences in vascular injury frequency across US geographic regions or diagnosis year. Thirty-four of the 267 cases of vascular injury (13%) underwent surgical treatment.

Conclusions

This is the largest study, to our knowledge, that analyzes the proportion of knee dislocations that result in vascular injury. Our data suggest that there is a lower frequency of vascular injury associated with knee dislocation and a lower proportion of vascular injuries undergoing surgical treatment than previously reported. These findings may support a more selective angiography protocol to screen for vascular injury, rather than performing this invasive diagnostic test on all knee dislocations, as has been done historically. Future large-scale and prospective studies should analyze factors that may predispose to vascular injuries after knee dislocation and determine which patients should be screened for vascular injury after knee dislocation.

Level of Evidence

Level IV, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

The authors thank the UCLA Statistical Consulting Group from the Institute for Digital Research and Education for their consulting services in the statistical analyses used in this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California–Los Angeles, 10833 Le Conte Avenue, Box 956902, Los Angeles, CA, 90095-6902, USA

    Kyle M. Natsuhara BS, Jeremiah R. Cohen BS, David R. McAllister MD & Frank A. Petrigliano MD

  2. Department of Orthopaedic Surgery, Rutgers University-New Jersey Medical School, Newark, NJ, USA

    Michael G. Yeranosian MD

  3. Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA

    Jeffrey C. Wang MD

Authors
  1. Kyle M. Natsuhara BS
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  2. Michael G. Yeranosian MD
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  3. Jeremiah R. Cohen BS
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  4. Jeffrey C. Wang MD
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  5. David R. McAllister MD
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  6. Frank A. Petrigliano MD
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Corresponding author

Correspondence to Kyle M. Natsuhara BS.

Additional information

One of the authors certifies that he (JCW) has received or may receive payments or benefits, during the study period, an amount less than USD 10,000, from PearlDiver Technologies Inc (Warsaw, IN, USA). Each of the other authors certifies that he or she, or a member of his or her immediate family, has no 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 ® 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 or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at University of California–Los Angeles, Los Angeles, CA, USA.

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Natsuhara, K.M., Yeranosian, M.G., Cohen, J.R. et al. What Is the Frequency of Vascular Injury After Knee Dislocation?. Clin Orthop Relat Res 472, 2615–2620 (2014). https://doi.org/10.1007/s11999-014-3566-1

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  • DOI: https://doi.org/10.1007/s11999-014-3566-1

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