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    (adsbygoogle = window.adsbygoogle || []).push({});before-content-x4Medical conditionKnee dislocationPlain lateral X-ray of the left knee showing a posterior knee dislocation[1]SpecialtyOrthopedic surgery\u00a0SymptomsKnee pain, knee deformity[2]ComplicationsInjury to the artery behind the knee, compartment syndrome[3][4]TypesAnterior, posterior, lateral, medial, rotatory[4]CausesTrauma[3]Diagnostic methodBased on history of the injury and physical examination, supported by medical imaging[5][2]Differential diagnosisFemur fracture, tibial fracture, patellar dislocation, ACL tear[6]TreatmentReduction, splinting, surgery[4]Prognosis10% risk of amputation[4]Frequency1 per 100,000 per year[3]       (adsbygoogle = window.adsbygoogle || []).push({});after-content-x4A knee dislocation is an injury in which there is disruption of the knee joint between the tibia and the femur.[3][4] Symptoms include pain and instability of the knee.[2] Complications may include  injury to an artery, most commonly the popliteal artery behind the knee, or compartment syndrome.[3][4][7]About half of cases are the result of major trauma and about half as a result of minor trauma.[3] About 50% of the time, the joint spontaneously reduces before arrival at hospital.[3] Typically there is a tear of the anterior cruciate ligament, posterior cruciate ligament, and either the medial collateral ligament or lateral collateral ligament.[3] If the ankle\u2013brachial pressure index is less than 0.9, CT angiography is recommended to detect blood vessel injury.[3] Otherwise repeated physical exams may be sufficient.[2] More recently, the FAST-D protocol, assessing the posterior tibial  and dorsalis pedis arteries for a \u2018tri-phasic wave pattern\u2019 with ultrasound, has been shown to be reliable in ruling out significant arterial injury.[8]If the joint remains dislocated, reduction and splinting is indicated;[4] this is typically carried out under procedural sedation.[2] If signs of arterial injury are present, immediate surgery is generally recommended.[3] Multiple surgeries may be required.[4] In just over 10% of cases, an amputation of part of the leg is required.[4]       (adsbygoogle = window.adsbygoogle || []).push({});after-content-x4Knee dislocations are rare, occurring in about 1 per 100,000 people per year.[3] Males are more often affected than females.[2] Younger adults are most often affected.[2] Descriptions of this injury date back to at least 20 BC by Meges of Sidon.[9]Table of ContentsSigns and symptoms[edit]Complications[edit]Diagnosis[edit]Classification[edit]Treatment[edit]Epidemiology[edit]References[edit]Signs and symptoms[edit]         (adsbygoogle = window.adsbygoogle || []).push({});after-content-x4CT angiogram 3D reconstruction, posterior view showing a normal artery on the left, and occlusion to right popliteal artery as a result of a knee dislocation[10]Symptoms include knee pain.[2] The joint may also have lost its normal shape and contour.[2] A joint effusion may, or may not, be present.[2]Complications[edit]Complications may include injury to the artery behind the knee (popliteal artery) in about 20% of cases or compartment syndrome.[3][4] Damage to the common peroneal nerve or tibial nerve may also occur.[2] Nerve problems, if they occur, often persist to a variable degree.[11]About half are the result of major trauma, the other half as a result of minor trauma.[3] Major trauma may include mechanisms such as falls from a significant height, motor vehicle collisions, or a pedestrian being hit by a motor vehicle.[2] Cases due to major trauma often have other injuries.[5]Minor trauma may include tripping while walking or while playing sports.[2] Risk factors include obesity.[2]The condition may also occur in a number of genetic disorders such as Ellis\u2013van Creveld syndrome, Larsen syndrome, and Ehlers\u2013Danlos syndrome.[12]Diagnosis[edit]  A Segond fracture seen on X-rayAs the injury may have self-reduced before arrival at hospital, the diagnosis may not be readily apparent.[2] Diagnosis may be suspected based on the history of the injury and physical examination[5] which may include anterior drawer test, valgus stress test, varus stress test, and posterior sag test.[5] An accurate physical exam can be difficult due to pain.[5]Plain X-rays, CT scan, ultrasonography, or MRI may help with the diagnosis.[2][11] Findings on X-ray that may be useful among those who have already reduced include a variable joint space, subluxation of the joint, or a Segond fracture.[5]If the ankle\u2013brachial pressure index (ABI) is less than 0.9, CT angiography is recommended.[3] Standard angiography may also be used.[2] If the ABI is greater than 0.9 repeated physical exams over the next 24 hours to verify good blood flow may be sufficient.[2][11] The ABI is calculated by taking the systolic blood pressure at the ankle and dividing it by the systolic blood pressure in the arm.[2]  More recently, the FAST-D protocol, using ultrasound to assess the posterior tibial and dorsalis pedis arteries for a \u2018tri-phasic wave pattern\u2019, has been shown to be reliable in ruling out significant arterial injury.[8]Classification[edit]  A lateral dislocation of the kneeThey may be divided into five types: anterior, posterior, lateral, medial, and rotatory.[4] This classification is based on the movement of the tibia with respect to the femur.[11] Anterior dislocations, followed by posterior, are the most common.[2] They may also be classified on the basis of which ligaments are injured.[2]Treatment[edit]Initial management is often based on Advanced Trauma Life Support.[5] If the joint remains dislocated reduction and splinting is indicated.[4] Reduction can often be done with simple traction after the person has received procedural sedation.[11] If the joint cannot be reduced in the emergency department, then emergency surgery is recommended.[2]In those with signs of arterial injury, immediate surgery is generally carried out.[3] If the joint does not stay reduced external fixation may be needed.[2] If the nerves and artery are intact the ligaments may be repaired after a few days.[11] Multiple surgeries may be required.[4] In just over 10% of cases an amputation of part of the leg is required.[4]Epidemiology[edit]Knee dislocations are rare: they represent about 1 in 5,000 orthopedic injuries,[5] and about 1 knee dislocation occurs annually per 100,000 people.[3]  Males are more often affected than females, and young adults the most often.[2]References[edit]^ Duprey K, Lin M (February 2010). &#8220;Posterior knee dislocation&#8221;. The Western Journal of Emergency Medicine. 11 (1): 103\u20134. PMC\u00a02850837. PMID\u00a020411095.^ a b c d e f g h i j k l m n o p q r s t u v w x Boyce RH, Singh K, Obremskey WT (December 2015). &#8220;Acute Management of Traumatic Knee Dislocations for the Generalist&#8221;. The Journal of the American Academy of Orthopaedic Surgeons. 23 (12): 761\u20138. doi:10.5435\/JAAOS-D-14-00349. PMID\u00a026493970. S2CID\u00a010713473.^ a b c d e f g h i j k l m n o p Maslaris A, Brinkmann O, Bungartz M, Krettek C, Jagodzinski M, Liodakis E (August 2018). &#8220;Management of knee dislocation prior to ligament reconstruction: What is the current evidence? Update of a universal treatment algorithm&#8221;. European Journal of Orthopaedic Surgery &#038; Traumatology. 28 (6): 1001\u20131015. doi:10.1007\/s00590-018-2148-4. PMID\u00a029470650. S2CID\u00a03482099.^ a b c d e f g h i j k l m n Bryant B, Musahl V, Harner CD (2011). &#8220;59. The Dislocated Knee&#8221;.  In W. Norman Scott (ed.). Insall &#038; Scott Surgery of the Knee E-Book (5th\u00a0ed.). Elsevier Churchill Livingstone. p.\u00a0565. ISBN\u00a0978-1-4377-1503-3.^ a b c d e f g h Lachman JR, Rehman S, Pipitone PS (October 2015). &#8220;Traumatic Knee Dislocations: Evaluation, Management, and Surgical Treatment&#8221;. The Orthopedic Clinics of North America. 46 (4): 479\u201393. doi:10.1016\/j.ocl.2015.06.004. PMID\u00a026410637.^ Eiff MP, Hatch RL (2011). Fracture Management for Primary Care E-Book. Elsevier Health Sciences. p.\u00a0ix. ISBN\u00a0978-1455725021.^ Medina O, Arom GA, Yeranosian MG, Petrigliano FA, McAllister DR (September 2014). &#8220;Vascular and nerve injury after knee dislocation: a systematic review&#8221;. Clinical Orthopaedics and Related Research. 472 (9): 2621\u20139. doi:10.1007\/s11999-014-3511-3. PMC\u00a04117866. PMID\u00a024554457.^ a b Montorfano, Miguel Angel; Montorfano, Lisandro Miguel; Perez Quirante, Federico; Rodr\u00edguez, Federico; Vera, Leonardo; Neri, Luca (December 2017). &#8220;The FAST D protocol: a simple method to rule out traumatic vascular injuries of the lower extremities&#8221;. Critical Ultrasound Journal. 9 (1): 8. doi:10.1186\/s13089-017-0063-2. PMC\u00a05360748. PMID\u00a028324353.^ Elliott JS (1914). Outlines of Greek and Roman Medicine. Creatikron Company. p.\u00a076. ISBN\u00a09781449985219.^ Godfrey AD, Hindi F, Ettles C, Pemberton M, Grewal P (2017). &#8220;Acute Thrombotic Occlusion of the Popliteal Artery following Knee Dislocation: A Case Report of Management, Local Unit Practice, and a Review of the Literature&#8221;. Case Reports in Surgery. 2017: 5346457. doi:10.1155\/2017\/5346457. PMC\u00a05299179. PMID\u00a028246569.^ a b c d e f Pallin DJ, Hockberger R, Gausche-Hill M (2018). &#8220;50. Knee and lower leg&#8221;.  In Walls RM (ed.). Rosen&#8217;s Emergency Medicine \u2013 Concepts and Clinical Practice E-Book (9th\u00a0ed.). Philadelphia: Elsevier Health Sciences. p.\u00a0618. ISBN\u00a0978-0-323-35479-0.^ Graham JM, Sanchez-Lara PA (2016). &#8220;12. Knee dislocation (Genu Recurvatum)&#8221;. Smith&#8217;s Recognizable Patterns of Human Deformation E-Book (4th\u00a0ed.). Philadelphia: Elsevier. p.\u00a081. ISBN\u00a0978-0-323-29494-2.     (adsbygoogle = window.adsbygoogle || []).push({});after-content-x4"},{"@context":"http:\/\/schema.org\/","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"item":{"@id":"https:\/\/wiki.edu.vn\/en\/wiki40\/#breadcrumbitem","name":"Enzyklop\u00e4die"}},{"@type":"ListItem","position":2,"item":{"@id":"https:\/\/wiki.edu.vn\/en\/wiki40\/knee-dislocation-wikipedia\/#breadcrumbitem","name":"Knee dislocation &#8211; Wikipedia"}}]}]