Evaluation and Management of Knee Dislocations.

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Vascular Surgery

Background:

• Knee dislocations (KDs) are complete displacements of the tibiofemoral articulation, historically from high-energy trauma.
• Ultra-low-velocity KDs from low-energy falls are increasing, particularly in morbidly obese patients.
• Prompt recognition and management are vital to prevent limb-threatening complications, especially popliteal artery injury.

Purpose of the Study:

• To review the evaluation and management of knee dislocations.
• To highlight the increasing incidence of ultra-low-velocity KDs in obese patients.
• To discuss current controversies and complications associated with knee dislocations.

Main Methods:

• Review of current literature and clinical practices regarding knee dislocations.
• Emphasis on diagnostic criteria and immediate management strategies.
• Discussion of surgical indications, including open reduction and external fixation.
• Analysis of potential complications and ongoing research.

Main Results:

• Prompt vascular assessment is critical; emergent vascular surgery consultation is indicated for compromised limbs.
• KDs irreducible by closed means require emergent open reduction.
• Temporary external fixation is reserved for specific instability or complex cases.
• Definitive management controversies include timing of ligament stabilization and repair versus reconstruction.

Conclusions:

• Knee dislocations require urgent evaluation and management to optimize outcomes.
• Ultra-low-velocity KDs present unique challenges, particularly in obese populations.
• Potential complications are significant, including vascular compromise and long-term joint dysfunction.
• Ongoing research aims to refine optimal treatment strategies for ligamentous injuries and rehabilitation.