Subscribe for unlimited access to DynaMed content, CME/CE & MOC credit, and email alerts on content you follow.

Already subscribed? Sign in now

CME

Knee Dislocation - Emergency Management

General Information

General InformationGeneral Information

Description

  • A knee dislocation is a disruption of the tibiofemoral articulation, which can occur in any direction and typically involves at least two ligaments1
  • The initial description of the dislocation should describe whether the injury is open vs. closed
    • 15%-35% of knee dislocations are open2
  • There are several different classification systems based on the presenting direction, energy of the mechanism, and the anatomic structures involved (ligaments, vascular structures, nerves, and presence of fracture)2
  • Typical classification is based on the position of the displaced tibia relative to the femur1,2,3
    • This assumes that the knee is dislocated on presentation and has not spontaneously reduced, which may occur in up to 50% of cases1,3
    • Incidence of dislocation types
      • 40% anterior (most common type of dislocation)
      • 33% posterior (second most common, and highest risk for popliteal artery injury)
      • 18% lateral
      • 4% medial
      • Very uncommon - rotational

Anatomy

  • Knee joint
    • Largest joint of the body
    • Elements comprising the knee joint
      • Bones (4): distal femur, proximal tibia, patella, fibula
      • Articular cartilage (2): medial and lateral menisci
      • Ligaments (4): anterior and posterior cruciate ligaments, medial and lateral collateral ligaments
      • Tendons (2): quadriceps and patella tendons

Etiology

  • High-energy mechanism2,4,5
    • Motor vehicle crash (up to 50%)
    • Pedestrian hit by vehicle
    • High-energy fall
  • Low-energy mechanism2,4,5
    • Athletic (sports-related) injury (up to 33%)
    • Low-energy fall (obesity is a risk factor)

Epidemiology

  • Hospital admission rate varies from 1 per 10,000-100,0002,3,5
  • Less than 0.02% of all musculoskeletal injuries2,3,5
  • 0.5% of all instances of joint dislocations2,3,5
  • Used to be considered more rare but prevalence increased due to increased motor vehicle speeds, improved imaging methods, more extreme sports, and increased athletic activities in older patients2,3,5

References

References

General references used

  1. Boyce RH, Singh K, Obremskey WT. Acute Management of Traumatic Knee Dislocations for the Generalist. J Am Acad Orthop Surg. 2015 Dec;23(12):761-8
  2. Lachman JR, Rehman S, Pipitone PS. Traumatic Knee Dislocations: Evaluation, Management, and Surgical Treatment. Orthop Clin North Am. 2015 Oct;46(4):479-93
  3. Seroyer ST, Musahl V, Harner CD. Management of the acute knee dislocation: the Pittsburgh experience. Injury. 2008 Jul;39(7):710-8
  4. Stannard JP, Sheils TM, Lopez-Ben RR, McGwin G Jr, Robinson JT, Volgas DA. Vascular injuries in knee dislocations: the role of physical examination in determining the need for arteriography. J Bone Joint Surg Am. 2004 May;86-A(5):910-5
  5. Peskun CJ, Levy BA, Fanelli GC, et al. Diagnosis and management of knee dislocations. Phys Sportsmed. 2010 Dec;38(4):101-11
  6. Medina O, Arom GA, Yeranosian MG, Petrigliano FA, McAllister DR. Vascular and nerve injury after knee dislocation: a systematic review. Clin Orthop Relat Res. 2014 Sep;472(9):2621-9

DynaMed Editorial Process

  • DynaMed topics are created and maintained by the DynaMed Editorial Team and Process.
  • All editorial team members and reviewers have declared that they have no financial or other competing interests related to this topic, unless otherwise indicated.
  • DynaMed content includes Practice-Changing Updates, with support from our partners, McMaster University and F1000.

How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T909565, Knee Dislocation - Emergency Management; [updated 2018 Nov 30, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T909565. Registration and login required.

Published by EBSCO Information Services. Copyright © 2020, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.

top

Subscribe for unlimited access to DynaMed content.
Already subscribed? Sign in