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The Changing Demographics of Knee Dislocation: A Retrospective Database Review

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

Abstract

Background

Knee dislocations are uncommon but devastating orthopaedic injuries. Little is known about their frequency and the types of patients who are affected.

Questions/purposes

Using a large national insurance database, we determined (1) the incidence of knee dislocation in patients with orthopaedic injuries and examined the incidence as a function of (2) year of diagnosis, (3) dislocation type (open versus closed, direction), and (4) patient demographic factors (sex, age).

Methods

We searched the PearlDiver database, a national database of private insurance records consisting of 11 million patients with orthopaedic diagnoses, using diagnosis (ICD-9-CM) codes for knee dislocation between the years 2004 and 2009. The PearlDiver database does not include Medicare, Medicaid, or uninsured patients. Patients were stratified by age, sex, and year of diagnosis. Incidence was defined as the number of dislocation events per 100 patient-years.

Results

We identified 8050 dislocations, representing an incidence of 0.072 events per 100 patient-years between 2004 and 2009. Annual dislocation incidence did not increase during the 6-year study period. Of the 8050 dislocations, 1333 (17%) were open and 6717 (83%) were closed, representing an incidence of 0.060 per 100 for closed dislocations and 0.012 per 100 for open dislocations. The most common direction of dislocation was unspecified or other (65%), followed by anterior (13%), lateral (11%), posterior (6%), and medial (5%). Of the patients sustaining dislocations, 4172 (52%) were female and 3878 (48%) were male. Males displayed an increased risk of knee dislocation compared to females (odds ratio = 1.09). The mean patient age was 35 years, and patient age was inversely correlated to the incidence of knee dislocation (10-year odds ratio = 0.77).

Conclusions

Our data suggest that knee dislocation might represent a significantly larger burden among orthopaedic injuries than previously thought. The finding that males and females have a nearly equal risk of knee dislocation enhances the diagnosing physician’s clinical suspicion of this injury. Future large prospective studies analyzing the various causes of knee dislocation could provide insight into the changing demographics of this injury.

Level of Evidence

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

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References

  1. Abrams GD, Frank RM, Gupta AK, Harris JD, McCormick FM, Cole BJ. Trends in meniscus repair and meniscectomy in the United States, 2005–2011. Am J Sports Med. 2013;41:2333–2339.

    Article  PubMed  Google Scholar 

  2. Azar FM, Brandt JC, Miller RH 3rd, Phillips BB. Ultra-low-velocity knee dislocations. Am J Sports Med. 2011;39:2170–2174.

    Article  PubMed  Google Scholar 

  3. Boisrenoult P, Lustig S, Bonneviale P, Leray E, Versier G, Neyret P, Rosset P, Saragaglia D. Vascular lesions associated with bicruciate and knee dislocation ligamentous injury. Orthop Traumatol Surg Res. 2009;95:621–626.

    Article  CAS  PubMed  Google Scholar 

  4. Brautigan B, Johnson DL. The epidemiology of knee dislocations. Clin Sports Med. 2000;19:387–397.

    Article  CAS  PubMed  Google Scholar 

  5. Edwards GA, Sarasin SM, Davies AP. Dislocation of the knee: an epidemic in waiting? J Emerg Med. 2013;44:68–71.

    Article  PubMed  Google Scholar 

  6. Eranki V, Begg C, Wallace B. Outcomes of operatively treated acute knee dislocations. Open Orthop J. 2010;4:22–30.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Folt J, Vohra T. Low-velocity knee dislocation in the morbidly obese. Am J Emerg Med. 2012;30:2090.e5–e6.

    Google Scholar 

  8. Georgiadis AG, Mohammad FH, Mizerik KT, Nypaver TJ, Shepard AD. Changing presentation of knee dislocation and vascular injury from high-energy trauma to low-energy falls in the morbidly obese. J Vasc Surg. 2013;57:1196–1203.

    Article  PubMed  Google Scholar 

  9. Good L, Johnson RJ. The dislocated knee. J Am Acad Orthop Surg. 1995;3:284–292.

    PubMed  Google Scholar 

  10. Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am. 1977;59:236–239.

    PubMed  Google Scholar 

  11. Hagino RT, DeCaprio JD, Valentine RJ, Clagett GP. Spontaneous popliteal vascular injury in the morbidly obese. J Vasc Surg. 1998;28:458–462; discussion 462–463.

    Google Scholar 

  12. Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am. 2004;86:262–273.

    PubMed  Google Scholar 

  13. Henrichs A. A review of knee dislocations. J Athl Train. 2004;39:365–369.

    PubMed Central  PubMed  Google Scholar 

  14. Hoover N. Injuries of the popliteal artery associated with fractures and dislocations. Surg Clin North Am. 1961;41:1099–1112.

    CAS  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  17. King JJ 3rd, Cerynik DL, Blair JA, Harding SP, Tom JA. Surgical outcomes after traumatic open knee dislocation. Knee Surg Sports Traumatol Arthrosc. 2009;17:1027–1032.

    Article  PubMed  Google Scholar 

  18. Montgomery SR, Foster BD, Ngo SS, Terrell RD, Wang JC, Petrigliano FA, McAllister DR. Trends in the surgical treatment of articular cartilage defects of the knee in the United States. Knee Surg Sports Traumatol Arthrosc. 2013 July 30 [Epub ahead of print].

  19. Montgomery SR, Ngo SS, Hobson T, Nguyen S, Alluri R, Wang JC, Hame SL. Trends and demographics in hip arthroscopy in the United States. Arthroscopy. 2013;29:661–665.

    Article  PubMed  Google Scholar 

  20. Montgomery SR, Zhang A, Ngo SS, Wang JC, Hame SL. Cross-sectional analysis of trends in meniscectomy and meniscus repair. Orthopedics. 2013;36:e1007–e1013.

    PubMed  Google Scholar 

  21. Peltola EK, Lindahl J, Hietaranta H, Koskinen SK. Knee dislocation in overweight patients. AJR Am J Roentgenol. 2009;192:101–106.

    Article  PubMed  Google Scholar 

  22. Quinlan AG, Sharrard WJ. Postero-lateral dislocation of the knee with capsular interposition. J Bone Joint Surg Br. 1958;40:660–663.

    PubMed  Google Scholar 

  23. Ríos A, Villa A, Fahandezh H, de José C, Vaquero J. Results after treatment of traumatic knee dislocations: a report of 26 cases. J Trauma. 2003;55:489–494.

    Article  PubMed  Google Scholar 

  24. Robertson A, Nutton RW, Keating JF. Dislocation of the knee. J Bone Joint Surg Br. 2006;88:706–711.

    Article  CAS  PubMed  Google Scholar 

  25. Schenck RC Jr. Classification of knee dislocations. In: Fanelli GC, ed. The Multiple Ligament Injured Knee: A Practical Guide to Management. New York, NY: Springer; 2004:37–49.

    Chapter  Google Scholar 

  26. Schenck RC Jr, McGanity PL, Heckman JD. Femoral-sided fracture-dislocation of the knee. J Orthop Trauma. 1997;11:416–421.

    Article  PubMed  Google Scholar 

  27. Talbot M, Berry G, Fernandes J, Ranger P. Knee dislocations: experience at the Hopital dú Sacré-Coeur de Montréal. Can J Surg. 2004;47:20–24.

    PubMed Central  PubMed  Google Scholar 

  28. Terrell RD, Montgomery SR, Pannell WC, Sandlin MI, Inoue H, Wang JC, SooHoo NF. Comparison of practice patterns in total ankle replacement and ankle fusion in the United States. Foot Ankle Int. 2013 June 17 [Epub ahead of print].

  29. 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 arteriography. Arch Surg. 1992;127:1056–1062; discussion 1062–1063.

    Google Scholar 

  30. 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;17:198–202.

    Article  PubMed  Google Scholar 

  31. Zhang AL, Kreulen C, Ngo SS, Hame SL, Wang JC, Gamradt SC. Demographic trends in arthroscopic SLAP repair in the United States. Am J Sports Med. 2012;40:1144–1147.

    Article  PubMed  Google Scholar 

  32. Zhang AL, Montgomery SR, Ngo SS, Hame SL, Wang JC, Gamradt SC. Analysis of rotator cuff repair trends in a large private insurance population. Arthroscopy. 2013;29:623–629.

    Article  CAS  PubMed  Google Scholar 

  33. Zusman NL, Ching AC, Hart RA, Yoo JU. Incidence of second cervical vertebral fractures far surpassed the rate predicted by the changing age distribution and growth among elderly persons in the United States (2005–2008). Spine (Phila Pa 1976). 2013;38:752–756.

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Authors and Affiliations

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

    Gabriel A. Arom BS, Michael G. Yeranosian MD, Frank A. Petrigliano MD, Rodney D. Terrell MD & David R. McAllister MD

Authors
  1. Gabriel A. Arom BS
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  2. Michael G. Yeranosian MD
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  3. Frank A. Petrigliano MD
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  4. Rodney D. Terrell MD
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  5. David R. McAllister MD
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Corresponding author

Correspondence to Gabriel A. Arom BS.

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Each author 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.

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Arom, G.A., Yeranosian, M.G., Petrigliano, F.A. et al. The Changing Demographics of Knee Dislocation: A Retrospective Database Review. Clin Orthop Relat Res 472, 2609–2614 (2014). https://doi.org/10.1007/s11999-013-3373-0

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  • DOI: https://doi.org/10.1007/s11999-013-3373-0

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