Vascular and nerve injury after knee dislocation: a systematic review

Area of Science:

• Orthopedic Surgery
• Vascular Surgery
• Trauma Care

Background:

• Acute knee dislocation is a significant cause of vascular injury, potentially leading to limb-threatening complications.
• There is considerable variability in reported frequencies of vascular injury and diagnostic approaches for knee dislocations.

Purpose of the Study:

• To determine the incidence of vascular and neurologic injuries following knee dislocation.
• To analyze the frequency of surgical repair for vascular injuries and amputation rates.
• To evaluate the utilization of various imaging modalities in diagnosing vascular injury.

Main Methods:

• A meta-analysis was conducted on English-language studies from the MEDLINE database concerning knee dislocations.
• Data on vascular and nerve injury incidence, surgical repair rates, and amputation rates were pooled.
• Diagnostic modalities employed and specific vessels injured were also assessed.

Main Results:

• Vascular injury occurred in 18% of 862 patients with knee dislocations; nerve injuries were present in 25% of 272 patients.
• Eighty percent of vascular injuries required surgical repair, with a 12% amputation rate.
• The highest vascular injury prevalence was associated with KDIIIL (32%) and posterior dislocations (25%). Selective angiography was the most common diagnostic tool (61%).

Conclusions:

• This review clarifies the frequency of vascular and nerve injuries, surgical repair, and amputation following knee dislocation.
• A lack of consensus exists regarding optimal diagnostic and treatment algorithms for vascular injury.
• Given the high morbidity of missed diagnoses, a cautious approach to ruling out arterial injury is recommended.