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The Dislocated Knee

Department of Orthopaedics and Rehabilitation, College of Medicine, The University of Vermont, Burlington; and Department of Orthopaedic Surgery, University Hospital, Linkoping, Sweden.

Knee dislocation, although relatively rare, may be the result of high-or low-velocity injuries. Well established is the need for urgent diagnosis and treatment to avoid vascular complications and amputation. The initial evaluation should include objective assessment of arterial circulation by means of Doppler pressure measurements; the finding of any asymmetric pressure warrants an arteriogram. Late arterial occlusion may occur, which mandates careful serial reexamination in all patients, including those with initially symmetric pressure. Injury to the peroneal nerve is also common, and the recovery of neurologic function is unpredictable. An operative approach for the young and otherwise healthy patient is outlined. In the absence of definitive clinical studies, the timing and extent of the repair/reconstruction and the optimum rehabilitation still remain uncertain. Therefore, individual patient management must be dictated by circumstances such as instability, swelling, activity level, and the risk of postoperative joint stiffness.