Knee (tibiofemoral) dislocation and reduction
- Michael C Bachman, MD, MBA
Michael C Bachman, MD, MBA
- Department of Pediatric Emergency Medicine
- Sunrise Children's Hospital
- Section Editors
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
Dislocations of the tibiofemoral joint of the knee are true surgical emergencies. Without rapid identification and repair, associated vascular injuries may jeopardize the leg [1,2]. Immediate reduction followed by careful neurovascular assessment is necessary.
This topic will review the mechanisms and management of acute tibiofemoral dislocations. Patellar dislocations and procedural sedation for the performance of joint reduction is discussed separately. (See "Recognition and initial management of lateral patellar dislocations" and "Procedural sedation in adults outside the operating room" and "Procedural sedation in children outside of the operating room".)
The anatomy of the knee is discussed separately; elements of special relevance to tibiofemoral dislocation are reviewed here. (See "General evaluation of the adult with knee pain", section on 'Basic knee anatomy and biomechanics'.)
The four major ligaments responsible for maintaining the stability of the knee are the anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments (picture 1 and figure 1 and picture 2). Tibiofemoral dislocations cause injuries to multiple ligaments. Usually both cruciate ligaments and one or both of the collateral ligaments are injured.
The popliteal artery is the continuation of the femoral artery. It originates at the tendinous hiatus of the adductor magnus muscle, which firmly anchors it to the femoral shaft (picture 3 and image 1). Within the popliteal space, the artery gives off five branches which arise above and below the knee joint creating a collateral system about the knee. Distally, the popliteal artery is held firmly against the bone by the tendinous arch of the soleus muscle. Thus, the popliteal artery is tethered across the popliteal space like a bowstring, making it susceptible to injury during knee dislocation . Up to 40 percent of patients with knee dislocations sustain an associated vascular injury .
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