Abstract
Knee dislocations (KDs) are frequently found in high-energy impact injuries, ranging
from automobile accidents to contact sports. KDs require careful examination due to
the limb-threatening nature of these injuries. A key examination in any KD comprises
a proper assessment of the vascular status. The risk of popliteal artery injury with
a KD has varied from 7 to 40%, with more contemporary studies reporting injury in
the range of 7 to 15%. The notion of mandatory emergent arteriography was challenged
in the trauma literature as several small retrospective studies suggested that selective
arteriography was a safe and effective treatment protocol. New imaging modalities
have evolved and have found their way into trauma surgery. Computed tomography angiography
and magnetic resonance angiography are two contemporary imaging modalities that have
different characteristics as well as availability. Arteriography has been the gold
standard and is a reliable and proven method of evaluation. However, it has a number
of negative aspects that must be considered when determining the ideal imaging for
a patient following KD. Besides cost savings of about more than US$500,000, conventional
arteriography, which comprises the use of X-ray, arterial puncture and cannulation,
and the use of contrast agents containing iodine, has got a complication rate as high
as 9% and more patient discomfort compared with the new imaging modalities. This clinical
practice review documents that our algorithm of clinical examination first combined
with advanced imaging in cases with abnormalities documented on examination is a safe
and prudent policy in treating patients following KD.
Keywords
knee dislocations - popliteal artery injury - arteriography - angiography - vascular
examination
