Advertisement

Clinical Orthopaedics and Related Research®

, Volume 472, Issue 9, pp 2615–2620 | Cite as

What Is the Frequency of Vascular Injury After Knee Dislocation?

  • Kyle M. Natsuhara
  • Michael G. Yeranosian
  • Jeremiah R. Cohen
  • Jeffrey C. Wang
  • David R. McAllister
  • Frank A. Petrigliano
Symposium: Management of the Dislocated Knee

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.

Keywords

Vascular Injury Popliteal Artery Current Procedural Terminology Vascular Repair Knee Dislocation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

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.

Supplementary material

11999_2014_3566_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 kb)

References

  1. 1.
    Bui KL, Ilaslan H, Parker RD, Sundaram M. Knee dislocations: a magnetic resonance imaging study correlated with clinical and operative findings. Skeletal Radiol. 2008;37:653–661.PubMedCrossRefGoogle Scholar
  2. 2.
    Dwyer T, Whelan D. Anatomical considerations in multiligament knee injury and surgery. J Knee Surg. 2012;25:263–274.PubMedCrossRefGoogle Scholar
  3. 3.
    Fanelli GC, Orcutt DR, Edson CJ. The multiple ligament injured knee: evaluation, treatment, and results. Arthroscopy. 2005;21:471–486.PubMedCrossRefGoogle Scholar
  4. 4.
    Georgiadis AG, Mohammed FH, Mizerik KT, Nypaver TJ, Shepard AD. Changing presentation of knee dislocation and vascular injury from high-energy to low-energy falls in the morbidly obese. J Vasc Surg. 2013;57:1196–1203.PubMedCrossRefGoogle Scholar
  5. 5.
    Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am. 1977;59:236–239.PubMedGoogle Scholar
  6. 6.
    Halvorson JJ, Anz A, Langfitt M, Deonanan JK, Scott A, Teasdall RD, Carroll EA. Vascular injury associated with extremity trauma: initial diagnosis and management. J Am Acad Orthop Surg. 2011;19:495–504.PubMedGoogle Scholar
  7. 7.
    Henrichs A. A review of knee dislocations. J Athl Train. 2004;39:365–369.PubMedCentralPubMedGoogle Scholar
  8. 8.
    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;42:1198–1204.PubMedCrossRefGoogle Scholar
  9. 9.
    Johnson ME, Foster L, DeLee JC. Neurologic and vascular injuries associated with knee ligament injuries. Am J Sports Med. 2008;36:2448–2462.PubMedCrossRefGoogle Scholar
  10. 10.
    Kendall RW, Taylor DC, Salvian AJ, O’Brian PJ. The role of angiography in assessing vascular injuries associate with dislocation of the knee. J Trauma. 1993;35:875–878.PubMedCrossRefGoogle Scholar
  11. 11.
    Merritt AL, Wahl C. Initial assessment of the acute and chronic multiple-ligament injured (dislocated) knee. Sports Med Arthrosc. 2011;19:93–103.PubMedCrossRefGoogle Scholar
  12. 12.
    Nicandri GT, Chamberlain AM, Wahl CJ. Practical management of knee dislocations: a selective angiography protocol to detect limb-threatening vascular injuries. Clin J Sport Med. 2009;19:125–129.PubMedCrossRefGoogle Scholar
  13. 13.
    Patterson BM, Agel J, Swiontkowski MF, Mackenzie EJ, Bosse MJ, LEAP Study Group. Knee dislocations with vascular injury: outcomes in the Lower Extremity Assessment Project (LEAP) study. J Trauma. 2007;63:855–858.Google Scholar
  14. 14.
    Rios A, Villa A, Fahandezh H, de Jose C, Vaquero J. Results after treatment of traumatic knee dislocation: a report of 26 cases. J Trauma. 2003;55:489–494.PubMedCrossRefGoogle Scholar
  15. 15.
    Seroyer ST, Musahl V, Harner CD. Management of the acute knee dislocation: the Pittsburgh experience. Injury. 2008;39:710–718.PubMedCrossRefGoogle Scholar
  16. 16.
    Stannard JP, Sheils TM, Lopez-Ben RR, McGwin G, Robinson JT, Volgas DA. Vascular injuries in knee dislocations: the role of physical examination in determining the need for angiography. J Bone Joint Surg Am. 2004;86:910–915.PubMedGoogle Scholar
  17. 17.
    Stayner LR, Coen MJ. Historic perspectives of treatment algorithms in knee dislocation. Clin Sports Med. 2000;19:399–413.PubMedCrossRefGoogle Scholar
  18. 18.
    Treiman GS, Yellin AE, Weaver FA, Wang S, Ghalambor N, Barlow W, Snyder B, Pentecost MJ.. Examination of the patient with a knee dislocation: the case for selective angiography. Arch Surg. 1992;127:1056–1062.PubMedCrossRefGoogle Scholar
  19. 19.
    Wascher DC. High-velocity knee dislocation with vascular injury: treatment principles. Clin Sports Med. 2000;19:457–477.PubMedCrossRefGoogle Scholar
  20. 20.
    Wascher DC, Dvimak PC, DeCoster TA. Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma. 1997;11:525–529.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  • Kyle M. Natsuhara
    • 1
  • Michael G. Yeranosian
    • 2
  • Jeremiah R. Cohen
    • 1
  • Jeffrey C. Wang
    • 3
  • David R. McAllister
    • 1
  • Frank A. Petrigliano
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity of California–Los AngelesLos AngelesUSA
  2. 2.Department of Orthopaedic SurgeryRutgers University-New Jersey Medical SchoolNewarkUSA
  3. 3.Department of Orthopaedic SurgeryUniversity of Southern CaliforniaLos AngelesUSA

Personalised recommendations