Skip to main content

Advertisement

SpringerLink
Log in

Management of acute knee dislocation with vascular injury: the use of the external fixator. A systematic review

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Vascular injuries after traumatic knee dislocation pose a potential limb threat for the patient. The benefits of external fixation have been described by many authors. However, the usefulness of the external fixator during acute management of knee dislocations with vascular injuries is a controversial aspect that has no consensus in the literature. The purpose of the present study was to provide data from the current literature on the utility of the external fixator and to investigate the percentage of knee dislocations with vascular injuries treated with an external fixator, the timing between external fixator and vascular repair, and the total time of external fixator.

Material and methods

The present systematic review was conducted according to the PRISMA checklist. MEDLINE (Pubmed), Web of Science, and SCOPUS databases were searched for articles from 1 January 2000 to 6 February 2019. Studies reporting outcomes of treatment of knee dislocations with vascular injuries were included. Exclusion criteria included studies investigating chronic knee dislocations, knee arthroplasties, editorials, case reports, and expert opinions. Two authors independently extracted data and appraised the quality of evidence and risk of bias using the Methodological quality and synthesis of case series and case reports.

Results

Descriptive statistics were used to report the outcome of our findings. Seven studies related to the usefulness of the external fixator during acute management of knee dislocations with vascular injuries were included. The external fixator had been used in the majority of knee dislocations with vascular lesions (72%). Timing between external fixator and vascular repair was reported on four studies (57%), two studies performed external fixation before vascular repair, and two studies performed external fixation after vascular repair. Total time of external fixator was only reported on three studies, ranging from 3 weeks to 3 months. These studies reported acute management, without referring to long-term results and without comparative groups.

Conclusions

External fixator was used in the majority of knee dislocations with vascular injuries but the justification for its use remained unclear. Larger studies are needed to fully understand the merit of the external fixator in knee dislocations with vascular injuries. Joint protocols between vascular surgeons and trauma surgeons are necessary to agree on the aspects related to the management of knee dislocations with vascular injuries.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

MLIK:

Multiple ligament injured knee

References

  1. Darcy G, Edwards E, Hau R (2018) Epidemiology and outcomes of traumatic knee dislocations: isolated vs multi-trauma injuries. Injury 49(6):1183–1187

    Article  Google Scholar 

  2. Engebretsen L, Risberg MA, Robertson B, Ludvigsen TC, Johansen S (2009) Outcome after knee dislocations: a 2–9 years follow-up of 85 consecutive patients. Knee Surg Sport Traumatol Arthrosc 17(9):1013–1026

    Article  Google Scholar 

  3. Lachman JR, Rehman S, Pipitone PS (2015) Traumatic knee dislocations: evaluation, management, and surgical treatment. Orthop Clin N Am 46:479–493

    Article  Google Scholar 

  4. Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ et al (2009) Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy 25:430–438

    Article  Google Scholar 

  5. Rihn JA, Groff YJ, Harner CD, Cha PS (2004) The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg 12:334–346

    Article  Google Scholar 

  6. Matthewson G, Kwapisz A, Sasyniuk T, MacDonald P (2019) Vascular injury in the multiligament injured knee. Clin Sports Med 38:199–213

    Article  Google Scholar 

  7. Howells NR, Brunton LR, Robinson J, Porteus AJ, Eldridge JD, Murray JR (2011) Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee. Injury 42:1198–1204

    Article  Google Scholar 

  8. Kupczik F, Schiavon MEG, de Vieira LA, Tenius DP, Fávaro RC (2013) Knee dislocation: descriptive study of injuries. Rev Bras Ortop English Ed 48(2):145–151

    Article  Google Scholar 

  9. Maslaris A, Brinkmann O, Bungartz M, Krettek C, Jagodzinski M, Liodakis E (2018) Management of knee dislocation prior to ligament reconstruction: what is the current evidence? Update of a universal treatment algorithm. Eur J Orthop Surg Traumatol 28:1001–1015

    Article  Google Scholar 

  10. Seroyer ST, Musahl V, Harner CD (2008) Management of the acute knee dislocation: the Pittsburgh experience. Injury 39:710–718

    Article  CAS  Google Scholar 

  11. Twaddle BC, Bidwell TA, Chapman JR (2003) Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma 17(3):198–202

    Article  Google Scholar 

  12. Gottlieb M, Koyfman A, Long B (2020) Evaluation and management of knee dislocation in the emergency department. J Emerg Med 58(1):34–42

    Article  Google Scholar 

  13. Kanakamedala AC, Sheean AJ, Alaia MJ, Irrgang JJ, Musahl V (2020) Concomitant periarticular fractures predict worse patient-reported outcomes in multiligament knee injuries: a matched cohort study. Arch Orthop Trauma Surg. https://pubmed.ncbi.nlm.nih.gov/31980877/. Accessed 19 Oct 2020

  14. Johnson JP, Kleiner J, Klinge SA, McClure PK, Hayda RA, Born CT (2018) Increased incidence of vascular injury in obese patients with knee dislocations. J Orthop Trauma 32:82–87

    Article  Google Scholar 

  15. Karkos CD, Koudounas G, Giagtzidis IT, Mitka MA, Pliatsios I, Papazoglou KO (2018) Traumatic knee dislocation and popliteal artery injury: a case series. Ann Vasc Surg 1(50):298.e13-298.e16

    Article  Google Scholar 

  16. Medina O, Arom GA, Yeranosian MG, Petrigliano FA, McAllister DR (2014) Vascular and nerve injury after knee dislocation: a systematic review. Clin Orthop Relat Res 472:2621–2629

    Article  Google Scholar 

  17. Natsuhara KM, Yeranosian MG, Cohen JR, Wang JC, McAllister DR, Petrigliano FA (2014) What is the frequency of vascular injury after knee dislocation? Clin Orthop Relat Res 472:2615–2620

    Article  Google Scholar 

  18. Chowdhry M, Burchette D, Whelan D, Nathens A, Marks P, Wasserstein D (2020) Knee dislocation and associated injuries: an analysis of the American College of Surgeons National Trauma Data Bank. Knee Surg Sport Traumatol Arthrosc 28(2):568–575

    Article  Google Scholar 

  19. Kropman RHJ, Kiela G, Moll FL, De Vries JPPM (2011) Variations in anatomy of the popliteal artery and its side branches. Vasc Endovasc Surg 45(6):536–540

    Article  Google Scholar 

  20. Angelini FJ, Helito CP, Bonadio MB, da Albuquerque RFM, Pecora JR, Camanho GL (2015) Surgical management of knee dislocations with ligament reconstruction associated with a hinged external fixator. Orthop Traumatol Surg Res 101(1):77–81

    Article  CAS  Google Scholar 

  21. Angelini FJ, Helito CP, Bonadio MB, Guimarães TM, Barreto RB, Pécora JR et al (2015) External fixator for treatment of the sub-acute and chronic multi-ligament-injured knee. Knee Surg Sport Traumatol Arthrosc 23(10):3012–3018

    Article  Google Scholar 

  22. Stannard JP, Nuelle CW, McGwin G, Volgas DA (2014) Hinged External fixation in the treatment of knee dislocations a prospective randomized study. J Bone Jt Surg Ser A 96(3):184–191

    Article  Google Scholar 

  23. Levy BA, Krych AJ, Shah JP, Morgan JA, Stuart MJ (2010) Staged protocol for initial management of the dislocated knee. Knee Surg Sport Traumatol Arthrosc 18(12):1630–1637

    Article  Google Scholar 

  24. Scheu M, Espinoza GF, Mellado CA, Díaz PA, Garín AF, O’Connell LA (2020) Varus mechanism is associated with high incidence of popliteal artery lesions in multiligament knee injuries. Int Orthop 44(6):1195–1200

    Article  Google Scholar 

  25. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  Google Scholar 

  26. Murad MH, Sultan S, Haffar S, Bazerbachi F (2018) Methodological quality and synthesis of case series and case reports. Evid Based Med 23(2):60–63

    Article  Google Scholar 

  27. Bonnevialle P, Chaufour X, Loustau O, Mansat P, Pidhorz L, Mansat M (2006) Traumatic knee dislocation with popliteal vascular disruption: retrospective study of 14 cases. Rev Chir Orthop Reparatrice Appar Mot 92(8):768–777

    Article  CAS  Google Scholar 

  28. López-Hualda A, Valencia-García H, Martínez-Martín J (2012) Lesiones vasculares asociadas a luxación de rodilla: protocolo diagnóstico. Rev Esp Cir Orthop Traumatol 56(4):260–266

    Google Scholar 

  29. Liu CC, Gao X, Xu M, Kong ZG (2017) Surgical management of posterior knee dislocation associated with extensor apparatus rupture. Knee 24(5):940–948

    Article  Google Scholar 

  30. Sanders TL, Johnson NR, Levy NM, Cole PA, Krych AJ, Stuart M et al (2017) Effect of vascular injury on functional outcome in knees with multi-ligament injury: a matched-cohort analysis. J Bone Jt Surg Am 99(18):1565–1571

    Article  Google Scholar 

  31. Johnson ME, Foster L, DeLee JC (2008) Neurologic and vascular injuries associated with knee ligament injuries. Am J Sports Med 36:2448–2462

    Article  Google Scholar 

  32. Georgiadis AG, Guthrie ST, Shepard AD (2014) Beware of ultra-low-velocity knee dislocation. Orthopedics 37:656–658

    Article  Google Scholar 

  33. Gray JL, Cindric M (2011) Management of arterial and venous injuries in the dislocated knee. Sports Med Arthrosc Rev 19:131–138

    Article  Google Scholar 

Download references

Funding

The authors report no sources of funding and no conflicts of interest with regard to the present study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, C/Sant Quintí 89, 08041, Barcelona, Catalunya, Spain

    Eduard Ramírez-Bermejo & Pablo Eduardo Gelber

  2. ICATME, Hospital Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain

    Pablo Eduardo Gelber

  3. Department of Orthopaedic Surgery and Traumatology, Versailles Hospital, University of West Paris-St Quentin, Versailles-Paris, France

    Nicolas Pujol

Authors
  1. Eduard Ramírez-Bermejo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pablo Eduardo Gelber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicolas Pujol
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eduard Ramírez-Bermejo.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest or sources of funding with regard to the present study. Eduard Ramírez Bermejo, Pablo Gelber, Nicolas Pujol.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ramírez-Bermejo, E., Gelber, P.E. & Pujol, N. Management of acute knee dislocation with vascular injury: the use of the external fixator. A systematic review. Arch Orthop Trauma Surg 142, 255–261 (2022). https://doi.org/10.1007/s00402-020-03684-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-020-03684-0

Keywords

Search

Navigation