Multiligament Injured Knee Dislocation
Original Editors - Caro De Koninck
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Search Strategy[edit | edit source]
Key-words: knee dislocation, knee injury
Definition/Description[edit | edit source]
A knee dislocation occurs when the bones that form your knee are out of place. The tibia and fibula get moved compared to the femur. The bones of your knee are held together by the ACL, PCL, LCL and MCL. For a knee dislocation to happen, these ligaments have to tear.
Clinically Relevant Anatomy[edit | edit source]
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Epidemiology /Etiology[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
Knee dislocations occur in 5 main types: anterior, posterior, medial, lateral and rotary. Rotary dislocations can further be divided into anteromedial, anterolateral, posteromedial and posterolateral injuries. (Henrichs, 2004, A1)[1]
Acute knee dislocations are uncommon orthopaedic injuries. Because they often spontaneously reduce before initial evaluation, the true incidence is unknown. Dislocation often results in multidirectional instability. Associated meniscal, osteochondral, and neurovascular injuries are often present and can complicate management. (Rihn et al., 2004, A1)[2]
Differential Diagnosis[edit | edit source]
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Diagnostic Procedures[edit | edit source]
Physical examination of a patient with a suspected knee dislocation should take place shortly after the injury is sustained. (Levy et al., 2010) Recognition is the most important aspect of the diagnosis. When a knee dislocation is suspected, neurovascular assessment is needed. Patients with a knee dislocation complain of severe pain and instability. Also they are unable to continue sports or activities of daily living. Pain tends to be diffuse with palpation and knee ROM's are limited. The Lachman and pivot-shift tests should be performed to test ACL integrity and the posterior drawer and posterior sag tests should be performed to test PCL integrity. Varus and Valgus stress tests should be carried out to test for MCL and LCL injury. (Henrichs, 2004, A1)[1]
All cases of suspected knee dislocation should have an ankle-brachial index performed, reserving arteriography for those with an abnormal finding. (Levy et al., 2010, A1)[3]
Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Definitive management of acute knee dislocation remains a matter of debate; however, surgical reconstruction or repair of all ligamentous injuries likely can help in achieving the return of adequate knee function. (Rihn et al., 2004, A1)[2]
Also Henrichs (2004, A1)[1] says that surgical treatment had proven to be much more beneficial for active patients. Conservative treatment on the other hand is often chosen if the joint feels relatively stable postreduction or if the patient is older or sedentary with intact colletarel ligaments.
Physical Therapy Management
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Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 Henrichs A. A review of knee dislocations. Journal of Athletic Training 2004;39(4): 365–369. A1
- ↑ 2.0 2.1 Rihn J, Groff Y, Harner C & Cha P. The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg. 2004 Sep-Oct;12(5): 334-46. A1
- ↑ Levy B, Peskun C, Fanelli G, Stannard J, Stuart M, MacDonald P, Marx R, Boyd J & Whelan D. Diagnosis and management of knee dislocations. Phys Sportsmed. 2010 Dec;38(4): 101-11. A1
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