Knee dislocations with vascular injuries.
Any knee that is dislocated or that has both anterior and posterior cruciates and one collateral ligament torn should be carefully evaluated for neurologic and vascular injury. Reduction and immobilization should be performed. If the pulses are anything but normal, arrangements should be made to proceed to the operating room immediately. A one-shot arteriogram can be obtained in the operating room, but proceeding directly with popliteal artery exploration is reasonable if the pulses have not returned to normal. If the pulses have returned to normal, an arteriogram should be obtained. After the vascular repair has been done, a fasciotomy of the lower leg should be performed. In the young healthy active patient who does not have significant necrotic muscle or severe nerve injury, delayed reconstruction and early, very aggressive rehabilitation is recommended. Whether this treatment improves the results of this injury remains to be seen. Discussion with the vascular surgeon concerning the use of a tourniquet is recommended. If not functioning, the peroneal nerve is often severely stretched, and no treatment to date has been very encouraging. An ankle foot orthosis or tendon transfers to achieve dorsiflexion may be needed.
Merrill
K D
KD
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston.
D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D003661:Decision Support Techniques; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D016268:Internal Fixators; D004204:Joint Dislocations / Q000150:complications*; D007718:Knee Injuries / Q000150:complications* / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries* / Q000601:surgery; D017888:Medial Collateral Ligament, Knee / Q000293:injuries / Q000601:surgery; D010543:Peroneal Nerve / Q000293:injuries; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery; D011859:Radiography