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Knee dislocation

Knee dislocation
Dislocation of the femorotibial joint requires major trauma. Most of these injuries are due to motor vehicle accidents, but occasionally they do occur in sports. Additional injuries to the blood vessels around the knee occur about 30% of the time, and injuries to the nerves are common.
Because of the possible loss of blood supply to the lower leg it is important to reduce the dislocation immediately; this is one of the few true orthopedic emergencies. Following reduction, the arteries of the leg must be evaluated by arteriogram where possible. Close observation of Doppler blood pressure measurements has been advocated as an alternative.
Knee dislocation almost always requires hospitalization for observation. If the artery is injured and is impairing the blood supply to the lower leg, immediate surgery is required to repair or bypass the injured area. Knee dislocation will tear several ligaments: which ligaments are torn will depend on the direction of the dislocation. Often both ACL and PCL are torn in combination with lateral (or medial) ligament and capsular structures.
Operative repair and reconstruction of the injured ligaments is becoming more common, although some have reported satisfactory results with nonoperative treatment using a brace for 6–8 weeks. If operative treatment is elected, ideally it should be performed within the first 2 weeks when at least the collateral and capsular ligaments should be repaired. The ACL and PCL can be reconstructed later.If the patient’s condition delays the procedure, reconstruction can be done later but the results are not as good. Knee dislocation is a devastating injury and most athletes will have difficulty returning to their previous level of activity. Return to sport may be possible within 9–12 months.

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