Management of Arterial and Venous Injuries in the Dislocated Knee

Abstract

Vascular injury associated with knee dislocation (KD) resulting from multiligament knee injury is a treacherous condition. The orthopaedic injury itself is uncommon and it is accompanied by a vascular injury in only a few cases. In a series of KDs reported since 1992, injury to the popliteal artery has been reported to occur in 7%-32% of cases. In 2014, reviews of 2 large databases of KD by authors from the same institution reported vascular injury frequency of 1.6%-3.3%. The outcome of missed arterial injury causing ischemia is predictably disastrous, so the index of suspicion for this uncommon entity must be high. Significant arterial injury demands prompt recognition and efficient management to prevent devastating consequences. The mechanisms of popliteal vascular injury in KD are reviewed. Diagnostic modalities used to evaluate vascular injury are discussed. Efficient detection and treatment of significant vascular injury is crucial, and an algorithm for diagnosis and management is reviewed. The salient features of vascular reconstruction are elaborated within the context of the dislocated knee and the vascular surgical approach, conduct of the procedure, and adjunctive maneuvers are described. Thoughtful location of the vascular reconstruction would facilitate subsequent orthopaedic reconstruction and minimize the risk of injury to the vascular repair.