Chapter 73

Dislocations of the knee are rare. They are true orthopedic emergencies and have a significant association with soft tissue injuries and neurovascular compromise. A dislocated knee occurs most commonly after a major force is applied to the knee joint from motor vehicle trauma, pedestrian-vehicle collisions, bicycle collisions, or motorcycle collisions. The forces necessary to cause a dislocation of the knee joint often fracture the bones of the leg.

Complete dislocation of the knee joint results in a gross deformity that is confirmed by plain radiographs. Reduction by the Emergency Physician may be reasonable if the Orthopedic Surgeon is not immediately available and/or if the injured extremity shows signs of distal neurologic or vascular compromise.

A careful examination of the distal extremity must be performed and documented. It must include an assessment of the capillary refill, the dorsalis pedis pulse, the posterior tibial pulse, peroneal nerve function, and tibial nerve function.

A knee dislocation is the displacement of the tibiofemoral articulation. It involves the rupture of the anterior cruciate ligament, the posterior cruciate ligament, the joint capsule, and/or the collateral ligaments of the knee. Anterior knee dislocations are the most common type of knee dislocation. This injury is defined as anterior displacement of the tibia relative to the femur. It results from an acute hyperextension injury to the knee joint that ruptures the anterior cruciate ligament completely, the posterior cruciate ligament partially, and the posterior joint capsule, allowing for anterior tibiofemoral displacement. The collateral ligaments usually remain intact. Tibial spine fractures, osteochondral fractures of the tibia or femur, and meniscal injuries are avulsion-type fractures resulting from the rupture of the anterior cruciate ligament. Distal femoral epiphyseal separation, rather than complete dislocation, as a result of a hyperextension injury is more common in children.

An anterior knee dislocation is associated with a popliteal artery injury in 30 to 40 percent of patients.1 The popliteal artery is at particular risk for injury because it is anchored proximally at the adductor hiatus and distally at the soleus arch. The collateral circulation around the knee joint is relatively poor. Therefore disruption of the popliteal artery may result in distal ischemia and limb loss if the reduction is delayed. It is important to note that the presence of distal peripheral pulses and capillary refill does not preclude an arterial injury.

A posterior knee dislocation is defined as the posterior displacement of the tibia relative to the femur. It occurs less commonly than an anterior knee dislocation. It results from a direct force applied to the anterior tibia with the knee slightly flexed, which ruptures the posterior joint capsule and both cruciate ligaments. The collateral ligaments usually remain intact. It is associated with popliteal artery damage and disruption of the extensor mechanism of the knee joint.

A posterolateral knee dislocation is a rare type of knee dislocation that is associated with peroneal nerve injury in ...

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

## Subscription Options

### AccessEmergency Medicine Full Site: One-Year Subscription

Connect to the full suite of AccessEmergency Medicine content and resources including advanced 8th edition chapters of Tintinalli’s, high-quality procedural videos and images, interactive board review, an integrated drug database, and more.