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Knee Dislocation in Athletes

  • Paul Herickhoff
  • Marc SafranEmail author
Chapter

Abstract

Knee dislocation is an uncommon but devastating injury to athletes, with significant risks of concurrent vascular and neurologic injury. A well-performed history and physical exam and review of video footage, if available, assist in making the diagnosis in spontaneously reduced knees. In general, a knee with three injured ligaments is a dislocated knee, even if spontaneously reduced. On-the-field management includes gentle closed reduction for dislocated knees and splinting and transfer to the hospital for further workup. Magnetic resonance imaging and CT angiography are recommended for all athletes to assist in preoperative planning and evaluate for vascular injury. Early surgical intervention within 3 weeks of the injury, with repair or reconstruction of all damaged structures, has demonstrated improved outcomes over delayed surgery and nonsurgical treatment; however, the patient and family must be informed that at least 1 year of rehabilitation will be required, with published rates of return to play between 50 and 80%.

Keywords

MLKIs Knee Dislocations Multiligaments Injuries Athletes Schenck 

References

  1. 1.
    Peskun CJ, et al. Diagnosis and management of knee dislocations. Phys Sportsmed. 2010;38(4):101–11. http://www.ncbi.nlm.nih.gov/pubmed/21150149PubMedCrossRefGoogle Scholar
  2. 2.
    Kerr ZY, et al. Dislocation/separation injuries among US high school athletes in 9 selected sports: 2005-2009. Clin J Sport Med. 2011;21(2):101–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Levy BA, Stannard JP, et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy. 2009b;25(4):430–8.  https://doi.org/10.1016/j.arthro.2009.01.008.PubMedCrossRefGoogle Scholar
  4. 4.
    Cole B, Harner C. The multiple ligament injured knee. Clin Sports Med. 1999;18(1):241–62.PubMedCrossRefGoogle Scholar
  5. 5.
    Levy BA, Fanelli GC, et al. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg. 2009a;17(4):197–206.PubMedCrossRefGoogle Scholar
  6. 6.
    Hwang MD, Piefer JW, Lubowitz JH. Anterior cruciate ligament tibial footprint anatomy: systematic review of the 21st century literature. Arthroscopy. 2012;28(5):728–34.  https://doi.org/10.1016/j.arthro.2011.11.025.PubMedCrossRefGoogle Scholar
  7. 7.
    Bernard M, et al. Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg. 1997;10:14–22.PubMedGoogle Scholar
  8. 8.
    Anderson CJ, et al. Arthroscopically pertinent anatomy of the anterolateral and posteromedial bundles of the posterior cruciate ligament. J Bone Joint Surg Am. 2012;94(21):1936–45. http://www.ncbi.nlm.nih.gov/pubmed/23138236%5Cn http://ovidsp.tx.ovid.com/ovftpdfs/FPDDNCGCHFIAGI00/fs046/ovft/live/gv023/00004623/00004623-201211070-00003.pdfCrossRefGoogle Scholar
  9. 9.
    LaPrade RF, et al. The anatomy of the medial part of the knee. J Bone Joint Surg Am. 2007;89(9):2000–10. http://jbjs.org/article.aspx?doi=10.2106/JBJS.F.01176%5Cnpapers2://publication/doi/10.2106/JBJS.F.01176PubMedGoogle Scholar
  10. 10.
    LaPrade RF, et al. The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med. 2003;31(6):854–60. http://www.ncbi.nlm.nih.gov/pubmed/14623649
  11. 11.
    Musahl V, et al. The influence of meniscal and anterolateral capsular injury on knee laxity in patients with anterior cruciate ligament injuries. Am J Sports Med. 2016;20(10):1–6.Google Scholar
  12. 12.
    Matava MJ, Sethi NS, Totty WG. Proximity of the posterior cruciate ligament insertion to the popliteal artery as a function of the knee flexion angle: implications for posterior cruciate ligament reconstruction. Arthroscopy. 2000;16(8):796–804. http://www.ncbi.nlm.nih.gov/pubmed/11078535PubMedCrossRefGoogle Scholar
  13. 13.
    Fanelli GC, Orcutt DR, Edson CJ. Current concepts. The multiple-ligament injured knee: evaluation, treatment, and results. Arthroscopy. 2005;21(4):471–86.PubMedCrossRefGoogle Scholar
  14. 14.
    Kadiyala RK, et al. The blood supply of the common peroneal nerve in the popliteal fossa. J Bone Joint Surg [Br]. 2005;87_B(3):337–42.CrossRefGoogle Scholar
  15. 15.
    Kennedy JC. Complete dislocation of the knee joint. J Bone Joint Surg Am. 1963;45–A(5):889–904.CrossRefGoogle Scholar
  16. 16.
    Shelbourne K, et al. Low-velocity knee dislocation. Orthop Rev. 1991;20(11):995–1004.PubMedGoogle Scholar
  17. 17.
    McCoy G, et al. Vascular injury associated with low-velocity dislocations of the knee. J Bone Joint Surg Am. 1987;69(2):285–7.CrossRefGoogle Scholar
  18. 18.
    Schenck R. Classification of knee dislocations. Oper Tech Sports Med. 2003;11(3):193–8.CrossRefGoogle Scholar
  19. 19.
    Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am. 1977;59–A(2):236–9.CrossRefGoogle Scholar
  20. 20.
    Lachman JR, Rehman S, Do PSP. Traumatic Knee dislocations treatment. Orthop Clin North Am. 2017;2015  https://doi.org/10.1016/j.ocl.2015.06.004.PubMedCrossRefGoogle Scholar
  21. 21.
    Wand JS. A physical sign denoting irreducibility of a dislocated knee. J Bone Joint Surg. 1989;71(5):862. http://www.ncbi.nlm.nih.gov/pubmed/2584265CrossRefGoogle Scholar
  22. 22.
    Natsuhara KM, et al. What is the frequency of vascular injury after knee dislocation ? Clin Orthop Relat Res. 2014;472:2615–20.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Sisto DJ, Warren RF. Complete knee dislocation. A follow-up study of operative treatment. Clin Orthop Relat Res. 1985;(198):94–101. http://www.ncbi.nlm.nih.gov/pubmed/4028570
  24. 24.
    Stannard JP, et al. Vascular injuries in knee dislocations: the role of physical examination in determining the need for arteriography. J Bone Joint Surg Am. 2004;86–A(5):910–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Treiman GS, et al. Examination of the patient with a knee dislocation. The case for selective arteriography. Arch Surg. 1992;127(9):1056–62. 3. http://www.ncbi.nlm.nih.gov/pubmed/1514907PubMedCrossRefGoogle Scholar
  26. 26.
    Hollis JD, Daley BJ. 10-year review of knee dislocations : is arteriography. J Trauma. 2005;59(3):672–6.PubMedGoogle Scholar
  27. 27.
    Klineberg EO, et al. The role of arteriography in assessing popliteal artery injury in knee dislocations. J Trauma. 2004;56(4):786–90.PubMedCrossRefGoogle Scholar
  28. 28.
    McCutchan JDS, Gillham NR. Injury to the popliteal artery associated with dislocation of the knee: palpable distal pulses do not negate the requirement for arteriography. Injury. 1989;20(5):307–10.PubMedCrossRefGoogle Scholar
  29. 29.
    Liow RYL, et al. Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg [Br]. 2001;85–B(6):845–51.Google Scholar
  30. 30.
    Meyers M, Harvey JP. Traumatic dislocation of the knee joint. A study of eighteen cases. J Bone Joint Surg Am. 1971;53–A(1):16–29.CrossRefGoogle Scholar
  31. 31.
    Shields L, Mital M, Cave E. Complete dislocation of the knee: experience at the massachusetts general hospital. J Trauma. 1969;9(3):192–215.PubMedCrossRefGoogle Scholar
  32. 32.
    Twaddle BC, Bidwell TA, Chapman JR. Knee dislocations : where are the lesions ? A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma. 2003;17(3):198–202.PubMedCrossRefGoogle Scholar
  33. 33.
    Frassica FJ, et al. Dislocation of the knee. Clin Orthop Relat Res. 1991;(263):200–5.Google Scholar
  34. 34.
    Niall DM, Nutton RW, Keating JF. Palsy of the common peroneal nerve after traumatic dislocation of the knee. J Bone Joint Surg [Br]. 2005;87–B(5):664–7.CrossRefGoogle Scholar
  35. 35.
    Peskun CJ, Whelan DB. Outcomes of operative and nonoperative treatment of multiligament knee injuries: an evidence-based review. Sports Med Arthrosc Rev. 2011;19(2):167–73.PubMedCrossRefGoogle Scholar
  36. 36.
    Engebretsen L, et al. Outcome after knee dislocations: a 2–9 years follow-up of 85 consecutive patients. Knee Surg Sports Traumatol Arthrosc. 2009;17:1013–26.PubMedCrossRefGoogle Scholar
  37. 37.
    Krych AJ, et al. Is peroneal nerve injury associated with worse function after knee dislocation ? Clin Orthop Relat Res. 2014;472(9):2630–6.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Beltran MJ, et al. The safe zone for external fixator pins in the femur. J Orthop Trauma. 2012;26(11):643–7. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00005131-201211000-00007%5Cnpapers2://publication/doi/10.1097/BOT.0b013e31824aed95
  39. 39.
    Richter M, et al. Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med. 2002;30(5):718–27.PubMedCrossRefGoogle Scholar
  40. 40.
    Ríos A, et al. Results after treatment of traumatic knee dislocations: a report of 26 cases. J Trauma. 2003;55(3):489–94.PubMedCrossRefGoogle Scholar
  41. 41.
    Wong CH, et al. Knee dislocations - a retrospective study comparing operative versus closed immobilization treatment outcomes. Knee Surg Sports Traumatol Arthrosc. 2004;12(6):540–4.PubMedCrossRefGoogle Scholar
  42. 42.
    Levy BA, et al. Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med. 2010;38(4):804–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Stannard JP, et al. 2012. Posteromedial corner injury in knee dislocations posteromedial corner injury in knee dislocations. (November).Google Scholar
  44. 44.
    Stannard JP, et al. 2000. The posterolateral corner of the knee repair versus reconstruction. 3–8.Google Scholar
  45. 45.
    DiFelice GS, Lissy M, Haynes P. When to arthroscopically repair the torn posterior cruciate ligament. Clin Orthop Relat Res. 2012;470(3):861–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Wheatley WB, et al. Arthroscopic posterior cruciate ligament repair. Arthroscopy. 2002;18(7):695–702.PubMedCrossRefGoogle Scholar
  47. 47.
    Brown JA, et al. Avoiding allograft length mismatch during anterior cruciate ligament reconstruction: patient height as an indicator of appropriate graft length. Am J Sports Med. 2007;35(6):986–9. http://www.ncbi.nlm.nih.gov/pubmed/17337725PubMedCrossRefGoogle Scholar
  48. 48.
    Rios CG, et al. Posterolateral corner reconstruction of the knee evaluation of a technique with clinical outcomes and stress radiography. Am J Sports Med. 2010;38(8):1564–74.PubMedCrossRefGoogle Scholar
  49. 49.
    Laprade RF, Johansen S, Engebretsen L. Outcomes of an anatomic posterolateral knee reconstruction surgical technique. J Bone Joint Surg AmJ. 2011;93(92):16–22.Google Scholar
  50. 50.
    Marx RG, Hetsroni I. Surgical technique: medial collateral ligament reconstruction using achilles allograft for combined knee ligament injury. Clin Orthop Relat Res. 2012;470(3):798–805.PubMedCrossRefGoogle Scholar

Copyright information

© ISAKOS 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryPennsylvania State UniversityState CollegeUSA
  2. 2.Department of Orthopaedic SurgeryStanford UniversityRedwood CityUSA

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