Acute Knee Dislocation with Neurovascular Injury- Salvage or Amputation? A Case Report

Vol 8 | Issue 1 | January-June 2022 | page: 15-18 | Ajay Kurahatti, Hariprasad S, Satyarup D

DOI: 10.13107/ti.2022.v08i01.024

Authors: Ajay Kurahatti [1], Hariprasad S [1], Satyarup D [1]

[1] Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka, India.

Address of Correspondence

Dr. Ajay Kurahatti,
Assistant Professor, Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka, India.


Introduction: Traumatic knee dislocation is considered an orthopedic emergency. Knee dislocations are relatively infrequent injuries. This injury frequently occurs from high-energy impact trauma. Neurovascular injuries can result in debilitating consequences if the diagnosis and treatment are delayed. Associated complications include degenerative arthritis, permanent neurovascular injury, and amputation. The poorest prognosis is seen in patients with knee dislocation longer than 6-8 hours before reduction.
History: The 25-year-old male patient presented with a history of a road traffic accident to the emergency department. The patient presented with swelling, pain, and deformity of the left knee and leg. Examination: On examination, the patient had tense swelling and tenderness of the left knee joint and leg. Visible deformity of the left knee joint is seen. The posterior tibial artery and dorsalispedis artery were not palpable. Active ankle and toe movements were absent.
Investigations: Plain radiograph was taken at the emergency department of the left knee and leg. X-rays showed anterior dislocation of the knee joint.
Treatment: After valid written informed consent, the dislocated left knee joint was reduced under sedation in the operation theatre and immobilized in the above knee plaster slab. Reduction of the knee joint was done within 4 hours of injury. Then the distal pulses were re-assessed. The posterior tibial and dorsalispedis artery was absent. Hence, MR Angiography of the left lower limb was done. It showed popliteal artery transection. So, the artery was explored and end-to-end vascular anastomosis was done. A knee-spanning external fixator was applied to the left lower limb. Fasciotomy was done for the tense leg compartments. After a week, the fasciotomy wounds were infected for which extensive debridement of the wounds was done and antibiotic beads were placed. Knee was mobilized with a gradual range of motion exercises and non-weight bearing mobilization with a foot drop splint. Gradually full weight-bearing ambulation was allowed.
Conclusion: Knee dislocation is rare, albeit a serious and potentially limb-threatening condition. The prognosis of knee dislocations is variable and is heavily dependent on the time interval between trauma and initiation of management. Immediate, timely, and proper management can salvage the limb, and amputation is not the only solution.
Keywords: Dislocation, Posterior tibial artery, Fasciotomy


1. Jacodzinski M, Petri M. (2014). Knee dislocations and soft tissue injuries. Skeletal Trauma: Basic Science, Management and reconstruction, Philadelphia, Saunders, 1907-36.

2. Whelan AB, Levy BA. Knee dislocations. Rockwood and Green’s Fractures in Adults, Lippincott Williams & Wilkins, 2369-414.

3. Miller HH, Welch CS. (1949) Quantitative studies on the time factor in arterial injuries. Ann Surg, 130, 428-30.

4. Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am 1977; 59(2): 236-9.

5. Merrill KD. Knee dislocations with vascular injuries. Orthop Clin North Am 1994; 25(4): 707-13.

6. Howells NR, Brunton LR, Robinson J, Porteus AJ, Eldridge JD, Murray JR. Acute knee dislocation: an evidence-based approach to the management of the multiligament injured knee. Injury 2011; 42(11): 1198-204.

7. Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma 2004; 56(6): 1261-5.

8. Sisto DJ, Warren RF. Complete knee dislocation. A follow-up study of operative treatment. Clin Orthop Relat Res 1985(198): 94- 101.

9. Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am 2004; 86-A(2): 262-73.

How to Cite this article: Kurahatti A, S Hariprasad, D Satyarup | Acute Knee Dislocation with Neurovascular Injury- Salvage or Amputation? A Case Report | January-June 2022; 8(1): 15-18.


(Abstract Text HTML)   (Download PDF)