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    This document summarizes a case study of a 38-year-old male who presented to the emergency department after a motorcycle crash with a posterior knee dislocation of his left knee. Imaging showed significant ligament damage. The risks of knee dislocations include arterial injuries, which have been reported in 10-40% of cases. Traditionally, arteriography was routinely recommended, but recent evidence suggests Doppler ultrasonography and ankle-brachial indices may adequately rule out arterial injuries. Management involves early relocation of the knee and orthopedic referral, with arteriography if arterial injury is suspected.

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    Wjem 11 103 PDF

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    Aby Surya
    37 views2 pages
    This document summarizes a case study of a 38-year-old male who presented to the emergency department after a motorcycle crash with a posterior knee dislocation of his left knee. Imaging showed significant ligament damage. The risks of knee dislocations include arterial injuries, which have been reported in 10-40% of cases. Traditionally, arteriography was routinely recommended, but recent evidence suggests Doppler ultrasonography and ankle-brachial indices may adequately rule out arterial injuries. Management involves early relocation of the knee and orthopedic referral, with arteriography if arterial injury is suspected.

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    This document summarizes a case study of a 38-year-old male who presented to the emergency department after a motorcycle crash with a posterior knee dislocation of his left knee. Imaging showed significant ligament damage. The risks of knee dislocations include arterial injuries, which have been reported in 10-40% of cases. Traditionally, arteriography was routinely recommended, but recent evidence suggests Doppler ultrasonography and ankle-brachial indices may adequately rule out arterial injuries. Management involves early relocation of the knee and orthopedic referral, with arteriography if arterial injury is suspected.

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    © All Rights Reserved
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    37 views2 pages

    Wjem 11 103 PDF

    Uploaded by

    Aby Surya
    This document summarizes a case study of a 38-year-old male who presented to the emergency department after a motorcycle crash with a posterior knee dislocation of his left knee. Imaging showed significant ligament damage. The risks of knee dislocations include arterial injuries, which have been reported in 10-40% of cases. Traditionally, arteriography was routinely recommended, but recent evidence suggests Doppler ultrasonography and ankle-brachial indices may adequately rule out arterial injuries. Management involves early relocation of the knee and orthopedic referral, with arteriography if arterial injury is suspected.

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    of 2

    Images In Emergency Medicine

    Posterior Knee Dislocation


    Kael Duprey MD, JD* * Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, NY
    Michelle Lin, MD
    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 Figure 2. Plain film lateral view of left knee showing posterior
    monitored as an inpatient. No angiography was performed. An knee dislocation
    MRI showed significant ligamentous damage, including tears
    of the anterior and posterior cruciate ligament (ACL, PCL) artery injury has been reported to be 10-40%.1 Traditionally
    and lateral collateral ligament (LCL). The medial collateral routine arteriography has been recommended for all patients
    ligament (MCL) was intact. The patient received an external with knee dislocations regardless of a normal distal vascular
    fixator of the knee in the operating room and was discharged exam, because of the risk of an occult popliteal artery injury
    home with close orthopedics follow up. and thus potential risk for limb amputation. Recently this
    Knee dislocations are high-energy injuries. It is supported recommendation has been challenged.2 Early studies suggest
    by the ACL and PCL, as well as the MCL and LCL. The Doppler ultrasonography and serial ankle-brachial indices
    disruption of all or most of these structures are required in may adequately rule-out arterial injury.3 Management is
    knee dislocations. Complications include ligamentous and early knee relocation using longitudinal traction and prompt
    meniscal injuries, in addition to popliteal artery, popliteal orthopedic referral. Arteriography should be performed for
    vein, and peroneal nerve injuries. Concurrent popliteal knee dislocations, suspicious for any popliteal arterial injury.

    Volume XI, no. 1 : February 2010 103 Western Journal of Emergency Medicine
    Duprey et al. Posterior Knee Dislocation

    Address for Correspondence: Michelle Lin, MD, 1001 Potrero need for arteriography. J Bone Joint Surg Am. 2004;86-A:910-915.
    Avenue, Suite 1E21, SFGH Emergency Medicine San Francisco, 2. Abou-Sayed H., Berger D.L. Blunt lower-extremity trauma and
    CA 94110. Email: [email protected] popliteal artery injuries: revisiting the case for selective arteriography.
    Arch Surg. 2002;137:585-589.
    REFERENCES 3. Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index
    1. 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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