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The Acutely Dislocated Knee: Evaluation and Management

Dr. Rihn is Resident Physician, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. Dr. Groff is Clinical Fellow, Center for Sports Medicine, University of Pittsburgh, Pittsburgh. Dr. Harner is Blue Cross of Western Pennsylvania Professor, and Director, Section for Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center. Dr. Cha is Attending Surgeon, Beacon Orthopaedics and Sports Medicine, Cincinnati, OH.

Reprint requests: Dr. Harner, Center for Sports Medicine, 3200 South Water Street, Pittsburgh, PA 15203.

Acute knee dislocations are uncommon orthopaedic injuries. Because they often spontaneously reduce before initial evaluation, the true incidence is unknown. Dislocation involves injury to multiple ligaments of the knee, resulting in multidirectional instability. Associated meniscal, osteochondral, and neurovascular injuries are often present and can complicate management. The substantial risk of associated vascular injury mandates that vascular integrity be confirmed by angiography in all suspected knee dislocations. Evaluation and initial management must be performed expeditiously to prevent limb-threatening complications. Definitive management of acute knee dislocation remains a matter of debate; however, surgical reconstruction or repair of all ligamentous injuries likely can help in achieving the return of adequate knee function. Important considerations in surgical management include surgical timing, graft selection, surgical technique, and postoperative rehabilitation.

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