Presentation
Presentation May present with a knee effusion and pain. There may be an avulsion of the tibial attachment of the ACL. MRI is usually needed to evaluate the injury. [patient.info]
Fever is present in less than half of cases of septic arthritis so with clinical suspicion an arthrocentesis is indicated. [foamcast.org]
The first case presented three months following a low velocity injury. [omicsonline.org]
Donjoy/Exoskeleton) Knee-spanning external fixator to protect vascular repair if instability still present Remaining instability should be addressed at a later stage - normally only 6-12 months later [4] [6] Knee dislocation without a vascular injury [physio-pedia.com]
The true frequency of knee dislocations is unclear as up to 50% of injuries self-reduce before presenting to the ED. [emdocs.net]
Entire Body System
- Pain
This may or may not be painful. If painful symptoms start, have your child see one of our doctors as soon as possible. [columbiadoctors.org]
You have severe pain and swelling in your lower leg. Your lower leg looks pale. You feel lightheaded, short of breath, and have chest pain. You cough up blood. Your leg feels warm, tender, and painful. It may look swollen and red. [drugs.com]
After the first day, ice the area every 3 to 4 hours for 2 or 3 days or until the pain goes away. Pain medicines such as acetaminophen, ibuprofen (Advil, Motrin, and others), or naproxen (Aleve, Naprosyn, and others) may help ease pain and swelling. [medlineplus.gov]
Physical Therapy is recommended which helps to control pain and swelling, prevent formation of scar of soft tissue, and also helps in collagen formation. [drcoyner.com]
A dislocated knee will always cause severe pain in the knee. Sometimes, there will be no feeling below the knee. If the knee relocates, it will become swollen from fluid in the knee and be painful with any movement. [emedicinehealth.com]
- Swelling
Physical Therapy is recommended which helps to control pain and swelling, prevent formation of scar of soft tissue, and also helps in collagen formation. [drcoyner.com]
Young athletes may experience a lot of pain and swelling in the front of their knee and have difficulty sitting. They may also experience pain and have feelings of instability or catching while walking. [columbiadoctors.org]
There is usually sudden pain with a rotation activity, combined with a feeling of a pop or something going out of place, and rapid swelling. [fifamedicalnetwork.com]
Patellar dislocations often cause severe pain and swelling. People may have stiffness and difficulty straightening the knee. They may notice the kneecap has slipped off to the side. [luriechildrens.org]
- Falling
Hard falls. It may happen to skiers or runners who lose control and fall on a bent or overextended knee. You may even dislocate your knee if you fall after stepping into a hole in the ground by mistake. [webmd.com]
Tibial plateau fractures [ 11 ] Falls on to an extended leg can cause compression fractures of the proximal tibia. [patient.info]
Low-energy mechanism 2, 4, 5 Athletic (sports-related) injury (up to 33%) Low-energy fall (obesity is a risk factor) Epidemiology Hospital admission rate varies from 1 per 10,000-100,000 2, 3, 5 Less than 0.02% of all musculoskeletal injuries 2, 3, 5 [dynamed.com]
Symptoms Symptoms of kneecap dislocation include: Tenderness and swelling on and around your knee Discomfort when you are active Pain over the edges of the kneecap Collapsing or giving-way of the knee that sometimes causes you to fall Causes and Risk [cedars-sinai.edu]
When this occurs — such as after a hard blow or fall — the patella can completely or partially dislocate. When the patella slips out of place — whether a partial or complete dislocation — it typically causes pain and loss of function. [orthoinfo.aaos.org]
- Weakness
Less force can also cause knee dislocations if you have a history of knee weakness. Previous knee injuries, weak leg muscles, or poor joint alignment may put you at risk for a knee dislocation. [iskinstitute.com]
[…] posterior tibial pulse Ankle-Brachial Index Bedside duplex Ultrasound abnormal Management Urgent vascular surgery Consultation Urgent CT angiogram (or other angiographic assessment of popliteal artery) Vascular compromise (limb-threatening) Findings Weak [fpnotebook.com]
If the dislocation was due to weak thigh muscles or a problem with the alignment or structure of the knee bones, the knee may dislocate again. Ligaments, tendons, muscles, and cartilage in or around the joint may stretch or tear. [healthlinkbc.ca]
This is primarily due to the increased instability around the kneecap, as well as residual weakness and balance as a result of the injury. [physioworks.com.au]
- Severe Pain
A knee cap dislocation is a very dramatic event which causes sudden severe pain and an inability to straighten the knee. Usually the knee cap is visible sitting in a very abnormal position on the outer half of the knee. [shoulderandkneesurgery.com.au]
Symptoms of a dislocated kneecap may include: Severe pain. A misshapen knee that looks like a bone is out of position. A popping sensation, followed by a feeling that something is out of place. Inability to bend or straighten the knee. [healthlinkbc.ca]
A dislocated knee will always cause severe pain in the knee. Sometimes, there will be no feeling below the knee. If the knee relocates, it will become swollen from fluid in the knee and be painful with any movement. [emedicinehealth.com]
Respiratoric
- Cough
You cough up blood. Your leg feels warm, tender, and painful. It may look swollen and red. When should I contact my healthcare provider? You have leg pain that does not go away after you take pain medicine. [drugs.com]
Musculoskeletal
- Fracture
Knee fracture - overview Knee fracture refers to fractures of any of the parts of bone involved in the joint itself. [patient.info]
fracture Segond fracture Tibial plateau fracture Meniscus and ligament knee injuries Patella dislocation Patellar tendonitis Patellar tendon rupture Quadriceps tendon rupture Nontraumatic/Subacute Arthritis Gout and Pseudogout Osgood-Schlatter disease [wikem.org]
Patients and Methods: Out of 187 femoral fractures treated in our institution over a period of 6 years (1994–1999), 4 patients with 5 femoral fractures and ipsilateral knee dislocations were identified. [online.boneandjoint.org.uk]
PATELLA FRACTURE Fix It or Discard It? A Retrospective Analysis of Functional Outcomes after Surgically Treated Patella Fractures Comparing ORIF With Partial Patellectomy. [ota.org]
Knee Fractures and Dislocations Fractures of the knee include fractures of the patella, femoral condyles, tibial eminence, tibial tuberosity and tibial plateau. Fractures of the knee... [evidence.nhs.uk]
- Knee Pain
Spontaneously reduced occult knee dislocation is often missed and may result in ischemic complications culminating in limb amputation. Knee Examinations in Patients with Severe Knee Pain Posterior knee dislocation. [acepnow.com]
Symptoms Symptoms of kneecap dislocation include: Knee appears to be deformed Knee is bent and cannot be straightened out Kneecap (patella) dislocates to the outside of the knee Knee pain and tenderness Knee swelling "Sloppy" kneecap -- you can move the [mountsinai.org]
A 27-year-old woman presents with severe left knee pain after an MVC where she was the front passenger. She states her knee hit the dashboard. An X-ray of the patient’s knee is shown below. [foamcast.org]
Knee dislocation Plain lateral X-ray of the left knee showing a posterior knee dislocation [1] Specialty Rheumatology Symptoms Knee pain, knee deformity [2] Complications Injury to the artery behind the knee, compartment syndrome [3] [4] Types Anterior [en.wikipedia.org]
- Joint Dislocation
Knee dislocations are rare, but a significant number have serious associated neurovascular injury. This article discusses tibiofemoral joint dislocation. Please see separate articles for discussion of medial and lateral patellar dislocations. [radiopaedia.org]
Anatomy Knee joint Largest joint of the body Elements comprising the knee joint Bones (4): distal femur, proximal tibia, patella, fibula Articular cartilage (2): medial and lateral menisci Ligaments (4): anterior and posterior cruciate ligaments, medial [dynamed.com]
A Word From Verywell Knee dislocation, while serious, is extremely rare, representing less than 0.5 percent of all joint dislocations. [verywellhealth.com]
In order to prevent further injury and further facilitate the healing process, the entire joint will be placed in a splint or otherwise immobilised. [sgbonedoctor.com]
An X-ray of your joint is used to confirm the dislocation and may reveal broken bones or other damage to your joint. MRI. This can help your doctor assess damage to the soft tissue structures around a dislocated joint. [mayoclinic.org]
- Muscle Spasm
If there has been a delay in getting medical care, your provider may give you an anesthetic before moving your knee back in place to help prevent pain and muscle spasms. [summitmedicalgroup.com]
"Needed explanation about muscle spasms after removing splint." "Since I am in this situation, the ambulance tip helped." "Very helpful and useful and easy to understand." "The healing time was very helpful. Thank you." [m.wikihow.com]
spasms Pivot-shift and reverse pivot-shift test: Not recommended in acute cases, extremely difficult to test with swollen knee where MCL is disrupted; works well in chronic cases Dial test : PCL and posterolateral corner involvement when finding of increased [physio-pedia.com]
The degree of soft-tissue damage that occurs in the setting of a traumatic knee dislocation, typically associated with severe pain, muscle spasm, and extensive soft-tissue swelling from joint capsule disruption, often precludes an accurate physical examination [ajronline.org]
- Joint Effusion
effusion Injury to the popliteal artery is the most feared complication and is common Check for popliteal, dorsalis pedis (DP) and posterior tibialis (PT) pulses Assess for joint instability by testing each cruciate ligament for laxity both at zero and [coreem.net]
[…] may also be obviously out of place. [2] A joint effusion is not always present. [2] Complications [ edit ] Complications may include injury to the artery behind the knee in about 20% of cases or compartment syndrome. [3] [4] Damage to the common peroneal [en.wikipedia.org]
There is mild lateral patellar subluxation ( open arrow ) and large knee joint effusion ( asterisk ). View larger version (665K) Fig. 1B —16-year-old boy after traumatic right knee injury. [ajronline.org]
Neurologic
- Irritability
Distally, 5 mm to 7 mm of the peroneus longus fascia was incised as part of the neurolysis in order to prevent nerve irritation or foot drop caused by postoperative swelling. 4. PLC Tunnels. [mdedge.com]
Workup
Workup may depend on your institution (ex: angiogram vs. CT angio vs. ultrasound) but all patients will need an ABI + 24 hour of pulse checks per current standards. [foamcast.org]
Treatment
Knee Dislocation Treatment There are two basic categories of knee dislocation treatment: operative and non-operative, also called “conservative treatment.” Operative treatment typically involves surgery. [sgbonedoctor.com]
Skin traction was used followed by splinting with resulting normal knee motion followed by treatment of the hips. No complications resulted from this treatment and the patient is a functional ambulator. [gait.aidi.udel.edu]
[…] plan It’s vital that you quickly recognize and get treatment for a dislocated knee. [healthline.com]
Treatment: First aid: An attempt should be made to reduce the dislocated patella by straightening the knee and pushing the patella gently to its normal position. [hip-knee.com]
The second case was also following a low velocity injury that presented 8 months following injury and received similar treatment. Six months following treatment, her ROM was 0° to 120°. [omicsonline.org]
Prognosis
[…] plays a crucial role in the prognosis. [ncbi.nlm.nih.gov]
Knee fracture and dislocation prognosis The prognosis is good for patellar and tibial spine or tubercle fractures. The prognosis is not as favourable for tibial plateau and femoral condylar fractures. [patient.info]
Treatment and prognosis The management of dislocations in the emergency department firstly requires immediate reduction of the knee joint, ideally as a closed procedure. A rapid neurovascular assessment is then performed. [radiopaedia.org]
The prognosis is best with an optimal rehabilitation exercise program. How Can You Prevent from Dislocating a Knee? Attempt to avoid major accidents. [emedicinehealth.com]
KeyboardArrowRight General Information KeyboardArrowRight History and Physical KeyboardArrowRight Diagnostic Studies KeyboardArrowRight Management KeyboardArrowRight Disposition KeyboardArrowRight Prognosis and complications Indications for hospital admission [dynamed.com]
Etiology
Bones (4): distal femur, proximal tibia, patella, fibula Articular cartilage (2): medial and lateral menisci Ligaments (4): anterior and posterior cruciate ligaments, medial and lateral collateral ligaments Tendons (2): quadriceps and patella tendons Etiology [dynamed.com]
DISCUSSION: Incidence: per 100,000 general population; in Denmark 1% of DDH population Female > Male 10:3 ratio, One-third bilateral, equal right and left Etiology: Environmental: Fetal position, increased in Breech Fetal knee: round condyles, tibial [gait.aidi.udel.edu]
Etiology Most knee dislocations are the result of high-energy injuries, such as motor vehicle or industrial accidents. They also can occur with low-energy injuries, such as those that occur in sports. [emedicine.medscape.com]
Epidemiology/Etiology Knee dislocation is estimated to be less than 0,2% of all orthopedic injuries. [physio-pedia.com]
Epidemiology
[…] and patella tendons Etiology High-energy mechanism 2, 4, 5 Motor vehicle crash (up to 50%) Pedestrian hit by vehicle High-energy fall Low-energy mechanism 2, 4, 5 Athletic (sports-related) injury (up to 33%) Low-energy fall (obesity is a risk factor) Epidemiology [dynamed.com]
Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32: 1114-21. full article. females higher risk bc inc q-angle. ages 10-17, prior instability also risk factors. 8) Nomura E et al. [bonetalks.com]
Patella: Typically caused by direct trauma or from a twisting movement on a flexed knee Patellar Dislocations (www.hughston.com) Epidemiology True knee dislocations are rare The Mayo Clinic recorded 14 knee dislocations during an interval of 2 million [coreem.net]
Epidemiology/Etiology Knee dislocation is estimated to be less than 0,2% of all orthopedic injuries. [physio-pedia.com]
Introduction Overview Knee dislocations are traumatic injuries characterized by a high rate of vascular injury treatment is generally emergent reduction and assessment of limb perfusion Epidemiology incidence 0.02% of orthopedic injuries likely underreported [orthobullets.com]
Pathophysiology
[…] approximately 50% self-reduce and are misdiagnosed demographics 4:1 male to female ratio location tibiofemoral articulation (knee joint) risk factors morbid obesity is a risk factor for "ultra-low energy" knee dislocations with activities of daily living Pathophysiology [orthobullets.com]
Pathophysiology Multiple ligament injuries are required for knee dislocation. Generally, both cruciates and one or both collateral ligaments are injured. However, knee dislocations have been described with one of the cruciates intact. [emedicine.medscape.com]
Knee dislocations may be classified by either descriptive or pathophysiologic criteria [ 1, 19 ]. [ajronline.org]
Prevention
How can I help prevent dislocating the knee again? To prevent dislocating the knee again: Wear a knee brace if recommended by your provider. Avoid dangerous sports and activities. Move and use your body carefully. Developed by RelayHealth. [summitmedicalgroup.com]
The following can help you manage your symptoms and prevent more injury while you heal: Apply ice. Ice helps decrease swelling and pain, and may help prevent tissue damage. Use an ice pack, or put crushed ice in a plastic bag. [drugs.com]
Treatment & Prevention of Knee Dislocation If you have dislocated your knee, you should seek medical help as soon as possible, to reduce the risk of further damage. [susquehannahealth.org]
Prevention Use proper techniques when exercising or playing sports. Keep your knees strong and flexible. Some cases of knee dislocation may not be preventable, especially if physical factors make you more likely to dislocate your knee. [mountsinai.org]
It is the ligament which prevents the kneecap from sliding out laterally and dislocating. [howardluksmd.com]