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    Posterior Knee Dislocation: I I e M

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    A 38-year-old man presented to the emergency department after a motorcycle crash with a left knee injury. Imaging showed a posterior knee dislocation with tears to the ACL, PCL and LCL ligaments. The patient's knee was relocated in the ED. Traditionally, arteriography is recommended for knee dislocations due to the risk of occult arterial injury. However, recent studies suggest Doppler ultrasonography and ankle-brachial indices may adequately rule out arterial injury without arteriography. The patient received an external fixator and was discharged with orthopedic follow up.

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    Posterior Knee Dislocation: I I e M

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    Aby Surya
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    A 38-year-old man presented to the emergency department after a motorcycle crash with a left knee injury. Imaging showed a posterior knee dislocation with tears to the ACL, PCL and LCL ligaments. The patient's knee was relocated in the ED. Traditionally, arteriography is recommended for knee dislocations due to the risk of occult arterial injury. However, recent studies suggest Doppler ultrasonography and ankle-brachial indices may adequately rule out arterial injury without arteriography. The patient received an external fixator and was discharged with orthopedic follow up.

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    A 38-year-old man presented to the emergency department after a motorcycle crash with a left knee injury. Imaging showed a posterior knee dislocation with tears to the ACL, PCL and LCL ligaments. The patient's knee was relocated in the ED. Traditionally, arteriography is recommended for knee dislocations due to the risk of occult arterial injury. However, recent studies suggest Doppler ultrasonography and ankle-brachial indices may adequately rule out arterial injury without arteriography. The patient received an external fixator and was discharged with orthopedic follow up.

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    10 views2 pages

    Posterior Knee Dislocation: I I e M

    Uploaded by

    Aby Surya
    A 38-year-old man presented to the emergency department after a motorcycle crash with a left knee injury. Imaging showed a posterior knee dislocation with tears to the ACL, PCL and LCL ligaments. The patient's knee was relocated in the ED. Traditionally, arteriography is recommended for knee dislocations due to the risk of occult arterial injury. However, recent studies suggest Doppler ultrasonography and ankle-brachial indices may adequately rule out arterial injury without arteriography. The patient received an external fixator and was discharged with orthopedic follow up.

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    Images In Emergency Medicine

    Posterior Knee Dislocation


    Kael Duprey MD, JD*
    Michelle Lin, MD

    * Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, NY

    San Francisco General Hospital, Department of Emergency Medicine, San Francisco, CA

    Supervising Section Editor: Sean Henderson, MD


    Submission history: Submitted August 13, 2009; Revised August 14, 2009; Accepted August 28, 2009
    Reprints available through open access at http://escholarship.org/uc/uciem_westjem

    [West J Emerg Med. 2010; 11(1):103-104.]

    Figure 1. Lateral view of left knee. Photo courtesy of Sandi Ma

    A 38-year-old male presented to the Emergency


    Department (ED) after a motorcycle crash. The patient was
    unable to walk because of isolated left knee pain. There were
    multiple abrasions over his left anterior tibia and a deformity
    of the left knee (Figure 1). The patient had very limited range
    of motion of his knee because of pain. His pedal pulses were
    normal bilaterally. The lateral view of the left knee showed a
    posterior knee dislocation (Figure 2). The patients knee was
    relocated in the ED, and serial ankle-brachial indices were
    monitored as an inpatient. No angiography was performed. An
    MRI showed significant ligamentous damage, including tears
    of the anterior and posterior cruciate ligament (ACL, PCL)
    and lateral collateral ligament (LCL). The medial collateral
    ligament (MCL) was intact. The patient received an external
    fixator of the knee in the operating room and was discharged
    home with close orthopedics follow up.
    Knee dislocations are high-energy injuries. It is supported
    by the ACL and PCL, as well as the MCL and LCL. The
    disruption of all or most of these structures are required in
    knee dislocations. Complications include ligamentous and
    meniscal injuries, in addition to popliteal artery, popliteal
    vein, and peroneal nerve injuries. Concurrent popliteal
    Volume XI, no. 1 : February 2010

    Figure 2. Plain film lateral view of left knee showing posterior


    knee dislocation

    artery injury has been reported to be 10-40%.1 Traditionally


    routine arteriography has been recommended for all patients
    with knee dislocations regardless of a normal distal vascular
    exam, because of the risk of an occult popliteal artery injury
    and thus potential risk for limb amputation. Recently this
    recommendation has been challenged.2 Early studies suggest
    Doppler ultrasonography and serial ankle-brachial indices
    may adequately rule-out arterial injury.3 Management is
    early knee relocation using longitudinal traction and prompt
    orthopedic referral. Arteriography should be performed for
    knee dislocations, suspicious for any popliteal arterial injury.
    103

    Western Journal of Emergency Medicine

    Duprey et al.

    Posterior Knee Dislocation

    Address for Correspondence: Michelle Lin, MD, 1001 Potrero


    Avenue, Suite 1E21, SFGH Emergency Medicine San Francisco,
    CA 94110. Email: [email protected]

    2.

    REFERENCES

    3.

    need for arteriography. J Bone Joint Surg Am. 2004;86-A:910-915.


    Abou-Sayed H., Berger D.L. Blunt lower-extremity trauma and
    popliteal artery injuries: revisiting the case for selective arteriography.
    Arch Surg. 2002;137:585-589.

    1.

    Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index

    Stannard JP, Sheils TM, Lopez-Ben RR, et al. Vascular injuries in

    for diagnosing arterial injury after knee dislocation: a prospective

    knee dislocations: the role of physical examination in determining the

    study. J Trauma. 2004;56:1261-5.

    Western Journal of Emergency Medicine

    104

    Volume XI, no. 1 : February 2010

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