Knee Dislocation
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Basics
Description
- Defined by the position of the tibia in relation to the distal femur:
- Anterior dislocation:
- Most common
- Hyperextension mechanism
- Disruption of the posterior capsule, posterior cruciate ligament (PCL), and often the anterior cruciate ligament (ACL)
- Posterior dislocation:
- Second most common
- Direct blow to the anterior tibia with the knee flexed at 90 degrees, “dashboard injury”
- Medial dislocation:
- Varus stress causing tear to the ACL, PCL, and lateral collateral ligament (LCL)
- Lateral dislocation:
- Valgus stress causing tear to the ACL, PCL, and medial collateral ligament (MCL)
- Rotatory
- PCL remains intact as the tibia rotates around the femur
- Anterior dislocation:
- Associated injuries:
- Popliteal artery injury:
- Associated with up to 40% of dislocations
- High rates of arterial disruption due to anatomic tethering, proximally and distally
- Disruption leads to intimal tears or transection and often delayed thrombosis
- Very high rate of limb loss if vascular repair is delayed >8 hr
- Peroneal nerve injury:
- Associated with 25% of dislocations
- Tethered proximally and distally to fibular neck
- Injury due to traction or transection, most often with medial or rotatory dislocations
- Permanent footdrop in >50% of patients, partial recovery another 25%
- Popliteal artery injury:
Etiology
- High energy:
- Fall from height, motor vehicle crashes, and auto vs. pedestrian accidents
- Low energy:
- Athletic injury (most often football), trampoline fall
- Ultra-low energy:
- Obese individuals
- Routine walking
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Defined by the position of the tibia in relation to the distal femur:
- Anterior dislocation:
- Most common
- Hyperextension mechanism
- Disruption of the posterior capsule, posterior cruciate ligament (PCL), and often the anterior cruciate ligament (ACL)
- Posterior dislocation:
- Second most common
- Direct blow to the anterior tibia with the knee flexed at 90 degrees, “dashboard injury”
- Medial dislocation:
- Varus stress causing tear to the ACL, PCL, and lateral collateral ligament (LCL)
- Lateral dislocation:
- Valgus stress causing tear to the ACL, PCL, and medial collateral ligament (MCL)
- Rotatory
- PCL remains intact as the tibia rotates around the femur
- Anterior dislocation:
- Associated injuries:
- Popliteal artery injury:
- Associated with up to 40% of dislocations
- High rates of arterial disruption due to anatomic tethering, proximally and distally
- Disruption leads to intimal tears or transection and often delayed thrombosis
- Very high rate of limb loss if vascular repair is delayed >8 hr
- Peroneal nerve injury:
- Associated with 25% of dislocations
- Tethered proximally and distally to fibular neck
- Injury due to traction or transection, most often with medial or rotatory dislocations
- Permanent footdrop in >50% of patients, partial recovery another 25%
- Popliteal artery injury:
Etiology
- High energy:
- Fall from height, motor vehicle crashes, and auto vs. pedestrian accidents
- Low energy:
- Athletic injury (most often football), trampoline fall
- Ultra-low energy:
- Obese individuals
- Routine walking
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