Evaluation and Management of Knee Dislocations

Knee dislocations (KDs) are potentially limb-threatening injuries characterized by complete displacement of the tibiofemoral articulation. Historically, most KDs resulted from high-energy trauma and sporting activities. However, KDs occurring in morbidly obese patients from low-energy falls, termed "ultra-low-velocity KDs," are becoming more common. Prompt evaluation and recognition are key to achieving a timely reduction and avoiding potentially devastating complications resulting from popliteal artery injury. A suspected KD should be monitored with serial examinations to assess the vascular status. Emergent vascular surgery consultation is indicated for limbs that have evidence of vascular compromise. KDs that cannot be reduced through closed means should be taken to the operating room emergently for open reduction. Temporary external fixation should be reserved for knees that remain subluxated or grossly unstable after reduction or bracing treatment, in cases with severe open wounds, associated extremity fractures that require stabilization, and in select cases requiring vascular intervention. Controversies in definitive management remain regarding timing of ligament stabilization, repair vs. reconstruction of injured ligaments, and single vs. staged treatment. Complications associated with KDs include vascular injuries with limb loss, arthrofibrosis, compartment syndrome, infection, heterotopic ossification, and nerve recovery challenges and recurrent laxity. Ongoing level 1 clinical trials are being conducted to determine optimal timing of both ligamentous reconstruction and postoperative rehabilitation. Despite the severity of these injuries, many patients are able to return to work and sport-related activities.