E Barry McDonough1, Edward M Wojtys. 1. Department of Orthopaedics, Division of Sports Medicine, West Virginia University, Morgantown, West Virginia, USA.
Abstract
BACKGROUND: Recently published studies have raised the question of whether arteriography is warranted in the evaluation of multiligamentous injuries of the knee. PURPOSE: The objective is to report the frequency of associated vascular injuries in the multiligament-injured knee and examine the role arteriography plays in the treatment protocol. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective analysis was performed on 71 patients over a 12-year period who had a diagnosis of multiligamentous injury of the knee with a tibial-femoral dislocation documented based on physical examination and magnetic resonance imaging findings. RESULTS: Of 72 knee injuries involving multiple ligaments, 12 vascular injuries were identified. Four knees were found to have a vascular injury at initial presentation based on abnormal physical examination and confirmed with arteriography. Eight patients with a vascular injury had normal pulses. Routine arteriography discovered an intimal injury of the popliteal artery in 5 of these patients. Arteriography in the remaining 3 patients was interpreted as normal. CONCLUSION: These findings suggest that physical examination alone is not sufficient in detecting the majority of vascular injuries after a suspected knee dislocation.
BACKGROUND: Recently published studies have raised the question of whether arteriography is warranted in the evaluation of multiligamentous injuries of the knee. PURPOSE: The objective is to report the frequency of associated vascular injuries in the multiligament-injured knee and examine the role arteriography plays in the treatment protocol. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective analysis was performed on 71 patients over a 12-year period who had a diagnosis of multiligamentous injury of the knee with a tibial-femoral dislocation documented based on physical examination and magnetic resonance imaging findings. RESULTS: Of 72 knee injuries involving multiple ligaments, 12 vascular injuries were identified. Four knees were found to have a vascular injury at initial presentation based on abnormal physical examination and confirmed with arteriography. Eight patients with a vascular injury had normal pulses. Routine arteriography discovered an intimal injury of the popliteal artery in 5 of these patients. Arteriography in the remaining 3 patients was interpreted as normal. CONCLUSION: These findings suggest that physical examination alone is not sufficient in detecting the majority of vascular injuries after a suspected knee dislocation.
Authors: Omar Medina; Gabriel A Arom; Michael G Yeranosian; Frank A Petrigliano; David R McAllister Journal: Clin Orthop Relat Res Date: 2014-09 Impact factor: 4.176