acute knee trauma farhan quader june 2013 eliona corrigan, md
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Acute Knee Trauma
Farhan Quader
June 2013
Eliona Corrigan, MD
• 55 y/o female with hx of total knee arthroplasty presented to ED after fall– height of 3-5’ onto concrete– point of impact = left knee
• Could not ambulate after fall• Endorsed tingling around the site which later
resolved– +Pain around site, 10/10
H&P
• PMH: – HTN, obesity, sickle cell trait
• PSH:– Total Knee Arthroplasty
• Physical exam: Left knee deformed, tibia anteriorly translocated. No ankle nor hip pain. Brisk cap refill, however, palpable dp/pt on right side with weakly palpable dp on left and non-palpable pt
Ddx:– Knee dislocation– Contusion– Ligament sprain/tear– Things to consider: arterial/venous insufficiency
Screening:- Knee radiograph- Ultrasound- CT- MRI
DDx and Screening
Screening Modality
• Patient falls under variant 2: inability to bear weight
• Procedure of choice is X-ray knee
• Ottawa Knee Rule: patients with acute knee pain with 1 or more should have X-ray:– Are 55 years of age or older– Have palpable tenderness over the
head of the fibula– Have isolated patellar tenderness– Cannot flex the knee to 90 degrees– Cannot bear weight immediately
following the injury,– Cannot walk in the emergency
room (after taking four steps).
Left Knee Radiograph AP and Lateral Knee
5299990
AP view unremarkable Lateral view remarkable
Left Knee
Left Knee Radiograph AP and Lateral (previous)
5299990
Knee
Knee Radiograph, Lateral view s/p reduction
5300218
Left Knee Xray
Left Knee Radiograph AP and lateral s/p reduction
5300218
Left Knee
Popliteal Ultrasound ultrasound
Left Popliteal artery
Ultrasound longitudinal
Left Popliteal artery
Popliteal arteriogram
Conclusion
- Anterior dislocations are most common after knee trauma- Dislocations characterized in terms of tibial displacement with
respect to femur (anterior, posterior, medial, lateral, and rotary)- Further characterized into high velocity and low velocity
- High: violent force such as car accident; result in damage to the structures of the knee complex
- Low-velocity: occur in sports settings and seen in athletic trainers; lower rates of neurovascular and associated soft-tissue damage
- Predisposing factor = injury to ACL or MCL- Damage to neurovascular system is one of the greatest concerns - Popliteal artery is injured in approximately 20-40% of all knee
dislocations- Peroneal nerve can still be injured due to it’s anatomical location
as it passes around the fibular neck; 33% of knee dislocations
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