1) Traumatic knee dislocations are associated with a high risk of popliteal artery injury, ranging from 21-81%. 2) Several case studies and reviews have found that 12-28% of knee dislocations with apparently normal pulses post-reduction were found to have popliteal artery injuries on angiography. 3) The presentation argues that angiography should be performed on all knee dislocations given the risk of missed arterial injuries, even in those with normal pulses initially, in order to optimize limb salvage.

1. ROUTINE ANGIOGRAPHY FOR
TRAUMATIC KNEE DISLOCATION
Sharfuddin Chowdhury
MBBS, FCS(SA)
Trauma Centre, Groote Schuur Hospital
University of Cape Town
Surgery Update 2013

2. Current controversy!
Diagnostic angiography should be performed on
all knee dislocations
or
Only on those patients who demonstrate
abnormal findings on physical examination

3. Background
• Knee dislocation = popliteal artery injury
21% to 81%
• Amputation rate = popliteal artery injury
0 – 86 %

4. Knee
dislocation
Abnormal
Angiography
pulses
Reduction
Normal ?
pulses Angiography

5. INJURY TO THE POPLITEAL ARTERY ASSOCIATED WITH DISLOCATION OF
THE KNEE: PALPABLE DISTAL PULSES DO NOT NEGATE THE
REQUIREMENT FOR ARTERIOGRAPHY
The British Journal of Accident Surgery (1989) Vol 20/No.5 page 307-310
Case 1
• normal pulses post-reduction
• 6hrs later – absent foot pulses / doppler
• complete occlusion of popliteal artery
• Outcome: Above knee amputation

6. INJURY TO THE POPLITEAL ARTERY ASSOCIATED WITH DISLOCATION OF
THE KNEE: PALPABLE DISTAL PULSES DO NOT NEGATE THE
REQUIREMENT FOR ARTERIOGRAPHY
The British Journal of Accident Surgery (1989) Vol 20/No.5 page 307-310
Case 2
• normal pulses post-reduction
• 24hrs later – absent foot pulses / cold
• complete occlusion of popliteal artery with
collateral distal reconstitution
• Outcome: limb salvaged

7. VASCULAR INJURY ASSOCIATED WITH LOW VELOCITY
DISLOCATIONS OF THE KNEE
J Bone Joint Surg Br. 1987; 69; 285-287
• 4 cases: normal pulses
• Angiography findings:
1. Complete occlusion (1)
• revascularisation with limb salvage
2. Intimal injury (2)
• (1) – Debridement for complete necrosis of
anterior compartment on D5
• (2) – On exploration 5cm segment of intimal damage
3. Normal angiogram (1)

8. Does the Pulse Examination in Patients with Traumatic Knee
Dislocation Predict a Surgical Arterial Injury? A Meta-analysis
J Trauma 2002; 53: 1109-1114
116 Articles reviewed, 7 met inclusion criteria
18 (12.5%)
145 Positive
218
(66.5%)
Normal pulses
Arteriography
127
284 Normal
Knee
Dislocations
45 (68.2%)
Positive
66 Patients 66
Abnormal pulses Arteriography
21
Normal

9. 10-Year review of knee dislocations: Is arteriography
always necessary?
J Trauma 2005
8 (28.5%)
Positive
28 28
Normal pulses Arteriography
20
39
Normal
Knee
Dislocations
11 11 11
Abnormal pulses Arteriography Positive

10. GSH KNEE DISLOCATION EXPERIENCE
M Held, R von Bormann, J Walters, A Banderker, P Navsaria, A Nicol
Department of Orthopaedic Surgery and Trauma Centre
9 (18.8%)
Positive
48 48
Normal pulses Arteriography
96 39
Knee Normal
Dislocations
(10 excluded
for ischemia)
11 (28.9%)
Positive
38 38
Abnormal pulses Arteriography
27
Normal

11. Conclusion
• Knee Dislocation with normal pulses associated
with 12 – 28% popliteal artery injury
• An aggressive evaluation for an arterial injury will
give us the best opportunity to avoid a missed
injury and probable amputation
• Angiography for all Traumatic Knee Dislocation
with Normal Pulses