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Multiligamentous injuries and knee dislocations

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Abstract

Complex capsular ligamentous structures contribute to stability of the knee joint. Simultaneous injury of two or more knee ligaments, aside from concurrent tears involving the anterior cruciate and medial collateral ligaments, is considered to be associated with femorotibial knee dislocations. Proximal tibiofibular joint dislocations are not always easily recognized and may be overlooked or missed. Patellofemoral dislocations can be transient with MR imaging sometimes required to reach the diagnosis. In this article, the authors describe the mechanism of injury, ligamentous disruptions, imaging, and treatment options of various types of knee dislocations including injuries of the femorotibial, proximal tibiofibular, and patellofemoral joints.

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References

  1. Walker RE, McDougall D, Patel S, Grant JA, Longino PD, Mohtadi NG. Radiologic review of knee dislocation: from diagnosis to repair. AJR Am J Roentgenol. 2013;201(3):483–95.

    Article  PubMed  Google Scholar 

  2. Brautigan B, Johnson DL. The epidemiology of knee dislocations. Clin Sports Med. 2000;19(3):387–97.

    Article  CAS  PubMed  Google Scholar 

  3. 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(11):1198–204.

    Article  PubMed  Google Scholar 

  4. Arom GA, Yeranosian MG, Petrigliano FA, Terrell RD, McAllister DR. The changing demographics of knee dislocation: a retrospective database review. Clin Orthop Relat Res. 2014;472(9):2609–14.

    Article  PubMed Central  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  6. Schenck Jr RC, Hunter RE, Ostrum RF, Perry CR. Knee dislocations. Instr Course Lect. 1999;48:515–22.

    PubMed  Google Scholar 

  7. Boisgard S et al. Bicruciate ligament lesions and dislocation of the knee: mechanisms and classification. Orthop Traumatol Surg Res. 2009;95(8):627–31.

    Article  CAS  PubMed  Google Scholar 

  8. Peltola EK, Lindahl J, Hietarants H, Koskinen SK. Knee dislocation in overweight patients. AJR Am J Roentgenol. 2009;192(1):101–6.

    Article  PubMed  Google Scholar 

  9. Sillanpaa PJ, Kannus P, Niemi ST, Rolf C, Fellander-Tsai L, Mattila VM. Incidence of knee dislocation and concomitant vascular injury requiring surgery: a nationwide study. J Trauma Acute Care Surg. 2014;76(3):715–9.

    Article  PubMed  Google Scholar 

  10. Bui KL, Ilaslan H, Parker RD, Sundaram M. Knee dislocations: a magnetic resonance imaging study correlated with clinical and operative findings. Skeletal Radiol. 2008;37(7):653–61.

    Article  PubMed  Google Scholar 

  11. Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am. 1977;59(2):236–9.

    PubMed  Google Scholar 

  12. Medina O, Arom GA, Yeranosian MG, Petrigliano FA, McAllister DR. Vascular and nerve injury after knee dislocation. Clin Orthop Relat Res. 2014;472(9):2621–9.

    Article  PubMed Central  PubMed  Google Scholar 

  13. 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(2):285–7.

    CAS  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  15. Rihn JA, Cha PS, Yram JG, Harner CD. The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg. 2004;12(5):334–46.

    PubMed  Google Scholar 

  16. Geyer LL, Koerner M, Wirth S, Mueck FG, Reiser MF, Linsenmaier U. Polytrauma: optimal imaging and evaluation algorithm. Semin Musculoskelet Radiol. 2013;17(4):371–9.

    Article  PubMed  Google Scholar 

  17. Peng PD, Spain DA, Tataria M, Hellinger JC, Rubin GD, Brundage SI. CT angiography effectively evaluates extremity vascular trauma. Am Surg. 2008;74(2):103–7.

    PubMed  Google Scholar 

  18. Vanderhave KL, Brighton B, Casey V, Montijo H, Scannell B. Applications of musculoskeletal ultrasonography in pediatric patients. J Am Acad Orthop Surg. 2014;22(11):691–8. Review.

    Article  PubMed  Google Scholar 

  19. Baltodano PA, Tong AJ, Chhabra A, Rosson GD. The role of magnetic resonance neurography in the postoperative management of peripheral nerve injuries. Neuroimaging Clin N Am. 2014;24(1):235–44.

    Article  PubMed  Google Scholar 

  20. Levy BA, Fanelli GC, Whelan DB, Stannard JP, MacDonald PA, Boyd JL, et al. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg. 2009;17(4):197–206.

    PubMed  Google Scholar 

  21. Yeh WL, Tu YK, Su JY, Hsu RW. Knee dislocation: treatment of high-velocity knee dislocation. J Trauma. 1999;46(4):693–701.

    Article  CAS  PubMed  Google Scholar 

  22. Ohkoshi Y, Nagasaki S, Shibata N, Yamamoto K, Hashimoto T, Yamane S. Two-stage reconstruction with autografts for knee dislocations. Clin Orthop Relat Res. 2002;398:169–75.

    Article  PubMed  Google Scholar 

  23. Ogden JA. Subluxation and dislocation of the proximal tibiofibular joint. J Bone Joint Surg Am. 1974;56(1):145–54.

    CAS  PubMed  Google Scholar 

  24. Kapur S, Wissman RD, Robertson M, Verma S, Kreeger MC, Oostveen RJ. Acute knee dislocation: review of an elusive entity. Curr Probl Diagn Radiol. 2009;38:237–50.

    Article  PubMed  Google Scholar 

  25. Veth RP, Klasen HJ, Kingma LM. Traumatic instability of the proximal tibiofibular joint. Injury. 1981;13(2):159–64.

    Article  CAS  PubMed  Google Scholar 

  26. Iosifidis MI, Giannoulis I, Tsarouhas A, Traios S. Isolated acute dislocation of the proximal tibiofibular joint. Orthopedics. 2008;31(6):605.

    Article  PubMed  Google Scholar 

  27. Rethnam U, Sinha A. Instability of the proximal tibiofibular joint, and unusual cause for knee pain. Injury Extra. 2006;37:190–2.

    Article  Google Scholar 

  28. Van Den Bekerom MPJ, Weir A, Van Der Flier RE. Surgical stabilisation of the proximal tibiofibular joint using temporary fixation a technical note. Acta Orthop Belg. 2004;70(6):604–8.

    PubMed  Google Scholar 

  29. Earhart C, Patel DB, White EA, Gottsegen CJ, Forrester DM, Matcuk Jr GR. Transient lateral patellar dislocation: review of imaging findings, patellofemoral anatomy, and treatment options. Emerg Radiol. 2013;20:11–23.

    Article  PubMed  Google Scholar 

  30. Kohlitz T et al. Prevalence and patterns of anatomical risk factors in patients after patellar dislocation: a case control study using MRI. Eur Radiol. 2013;23(4):1067–74.

    Article  PubMed  Google Scholar 

  31. Tecklenburg K, Dejour D, Hoser C, Fink C. Bony and cartilaginous anatomy of the patellofemoral joint. Knee Surg Sports Traumatol Arthrosc. 2006;14(3):235–40.

    Article  CAS  PubMed  Google Scholar 

  32. Elias DA, White LM. Imaging of patellofemoral disorders. Clin Radiol. 2004;59(7):543–57.

    Article  CAS  PubMed  Google Scholar 

  33. Panni AS, Cerciello S, Maffulli N, Di Cesare M, Servien E, Neyret P. Patellar shape can be a predisposing factor in patellar instability. Knee Surg Sports Traumatol Arthrosc. 2011;19(4):663–70.

    Article  PubMed  Google Scholar 

  34. Samim M, Smitaman E, Lawrence D, Moukaddam H. MRI of anterior knee pain. Skeletal Radiol. 2014;43(7):875–93.

    Article  PubMed  Google Scholar 

  35. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994;2(1):19–26.

    Article  CAS  PubMed  Google Scholar 

  36. Diederichs G, Issever AS, Scheffler S. MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics. 2010;30(4):961–81.

    Article  PubMed  Google Scholar 

  37. Thomas S, Rupiper D, Stacy GS. Imaging of the patellofemoral joint. Clin Sports Med. 2014;33(3):413–36.

    Article  PubMed  Google Scholar 

  38. Insall J, Salvati E. Patella position in the normal knee joint. Radiology. 1971;101(1):101–4.

    Article  CAS  PubMed  Google Scholar 

  39. Blackburne JS. A new method of measuring patellar height. J Bone Joint Surg (Br). 1977;59(2):241–2.

    CAS  Google Scholar 

  40. Caton J. Method of measuring the height of the patella. Acta Orthop Belg. 1989;55(3):385–6.

    CAS  PubMed  Google Scholar 

  41. Balcarek P, Oberthür S, Hopfensitz S, Frosch S, Walde TA, Wachowski MM, et al. Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2308–14.

    Article  PubMed  Google Scholar 

  42. Gakhar H, Sinhal A. Superior dislocation of the patella: case report and review of the literature. J Emerg Med. 2013;44(2):478–80.

    Article  PubMed  Google Scholar 

  43. Haas JP, Collins MS, Stuart MJ. The “sliver sign”: a specific radiographic sign of acute lateral patellar dislocation. Skeletal Radiol. 2012;41(5):595–601.

    Article  PubMed  Google Scholar 

  44. Sillanpaa PJ, Maenpjaa HM. First-time patellar dislocation: surgery or conservative treatment? Sports Med Arthrosc Rev. 2012;20(3):129–35.

    Article  Google Scholar 

  45. Panni AS, Vasso M, Cerciello S. Acute patellar dislocation. What to do? Knee Surg Sports Traumatol Arthrosc. 2013;21(2):275–8.

    Article  PubMed  Google Scholar 

  46. Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. Clin Sports Med. 2002;21(3):499–519.

    Article  PubMed  Google Scholar 

  47. Willis RB, Firth G. Traumatic patellar dislocation: loose bodies and the MPFL. J Pediatr Orthop. 2012;32 Suppl 1:S47–51.

    Article  PubMed  Google Scholar 

  48. Harrison RK, Magnussen RA, Flanigan DC. Avoiding complications in patellofemoral surgery. Sports Med Arthrosc. 2013;21(2):121–8.

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medical Imaging, The University of Arizona College of Medicine, Banner University Medical Center Tucson, 1501 N Campbell Ave., P.O. Box 245067, Tucson, AZ, 85724, USA

    Lana H. Gimber, David M. Melville & Mihra S. Taljanovic

  2. Department of Radiology, Image Guided Therapeutics, 450 Stanyan Street, San Francisco, CA, 94117, USA

    Luke R. Scalcione

  3. Department of Orthopaedic Surgery, The University of Arizona College of Medicine, Banner University Medical Center Tucson, 1501 N Campbell Ave., P.O. Box 245064, Tucson, AZ, 85724, USA

    Andrew Rowan

  4. Department of Orthopaedic Surgery, Sports Medicine Clinic, The University of Arizona College of Medicine, South Campus Banner University Medical Center Tucson, 2800 E Ajo Way, Suite 200, Tucson, AZ, 85713, USA

    Jolene C. Hardy

Authors
  1. Lana H. Gimber
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  2. Luke R. Scalcione
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Correspondence to Lana H. Gimber.

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Gimber, L.H., Scalcione, L.R., Rowan, A. et al. Multiligamentous injuries and knee dislocations. Skeletal Radiol 44, 1559–1572 (2015). https://doi.org/10.1007/s00256-015-2169-6

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  • DOI: https://doi.org/10.1007/s00256-015-2169-6

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