Knee Dislocation or Dislocated Knee: Treatment, Diagnosis, Risk Factors, Complications

Knee dislocations or dislocated knee is a result of the knee popping out of its place which could be due to trauma, sports injury or sudden change in direction. Let us take a look at the risk factors, complication, diagnosis, treatment and surgery for knee dislocation or dislocated knee.

The following are the possible factors of risk for knee dislocation or dislocated knee:

• Fall Susceptibility Increases the Risk Factor for Knee Dislocation or Dislocated Knee – Exposure to risk of dislocating a knee joint is due to fall exposures and transfer of body weight on the knees at the time of fall as well as sudden twisting of the knee at the time of fall.
• Heredity- Some ligaments of some people are loose and are more vulnerable to injury from birth than those of others^[1]
• Participating in Sports- High-impact or contact sports like wrestling, gymnastic football and basketball exposes a participant to many dislocations including knee dislocation.^[2]
• Motor Vehicles Accidents- Most dislocation including knee dislocation occurs as a result of MVA.

Below are the mentioned complications involved in knee dislocation or dislocated knee:

• One of the most common complications involving knee dislocation or dislocated knee is the tearing down of the tendons, ligaments and muscles reinforcing the injured joint.
• Damage to the blood vessel or nerve around the knee joint.
• There is a high chance of second injury susceptibility if severe knee dislocation has occurred or a repeated dislocation.
• As you age, arthritis will develop in the affected knee joint.^[3]

If tearing or starching has occurred to the tendons or ligaments supporting the injured or dislocated knee joint or if damage has occurred on the blood vessels or nerves surrounding the damaged or dislocated knee joint, surgery may be required to repair the damaged tissues.

The doctor will be using the following ways to check your injury depending on the look of you knee dislocation or dislocated knee:

• X-rays to Diagnose Knee Dislocation or Dislcaoted Knee: This is for ascertaining that you do not have a broken bone.
• Nerve Examination: Nerve runs through the knee and the chances of nerve damage due to knee dislocation or dislocated knee is there. You can check if you can feel your touch and if you can move certain groups of muscle when testing the nerves. Your ability to turn the foot in and out and move it up and down will be checked by the doctor. Concern for nerve injury occurs with a numb feeling.
• Pulses are examined: Knee arteries are common only injured as a result of knee dislocation or dislocated knee. Pulses must be ascertained by your doctor on the foot (position where the artery runs on the knee).
• An angiogram (artery x-ray): Injury to the artery can only be confirmed through performing this X-ray. Dopler (sound wave) and ultrasound machines can be used by some medical centers also when accessing the flow of blood in the arteries.^[4]

Any kind of joint dislocation is treated depending on the severity and the site of the injury and may include:

• Reduction: Some gentle maneuvers might be tried by your doctor so as to help the knee bone to relocate back in position, in this procedure. Swelling and pain will determine if you need an anesthesia prior to the manipulation of the bones.
• Knee Immobilization Treatment for Knee Dislocation or Dislocated Knee: Immobilization of the joint can be done by your doctor with a sling or splint for a couple of weeks after reposition of the bones. The extent of the damage to the nerve, supporting tissues and blood vessels determine the length of time that you will wear the sling or splint.^[5]
• Surgery to Treat Knee Dislocation or Dislocated Knee: If reposition of the dislocated bone is hard, your doctor may perform a surgery on the joint. Also if the ligaments, blood vessels and nerves have been damaged. If dislocation has occurred recurrently, you may also need a surgery, especially your shoulder.
• Rehabilitation for Knee Dislocation or Dislocated Knee: Gradual rehabilitations started after the removal of a sling or splint with the aim of restoring the strength and the range of motion of the joint.

Home care is not suitable for treating a knee dislocation or dislocated knee. Getting medical care immediately is the best idea.

You can decrease swelling and control pain due to knee dislocation or dislocated knee by icing the area. The doctor must be able to access the injury and put back the knee or relocate it back in place. This treatment is the most important.

• Relocation of the Knee Joint to Treat Knee Dislocation or Dislocated Knee. The lower leg will be moved by the doctor back to position in a process known as reduction. Conscious sedation or pain medication must be given to a person with dislocated knee when most doctors want to do a reduction. The relocation process of dislocated knee will be withstood by the patient due to sedation without being completely sedated. The early step that is important is relocation in the repair of the nerves, ligaments, blood vessels and other knee tissues. Orthopedic and emergency doctors usually perform relocation.
• Vascular Surgery of the Knee Joint Knee Dislocation or Dislocated Knee. If there is an injured artery, repair will be done by a vascular surgeon or trauma surgeon through surgery of the injured vessel and the flow of blood to the leg is maintained as necessary.
• Splints for Knee Dislocation or Dislocated Knee. An immobilizer or a splint will be used to keep the entire knee immobilized and paving way for the healing process and prevent further injury from emanating. The knee will be kept from bending and the healing of tissues will be enhanced.
• Reconstruction. Severe sprains and tears are always there in the ligaments when a knee dislocates and sometimes the bones of the knee are broken. Reconstruction may be required after the swelling has gone down in order to regain its functionality. Orthopedist (bone specialist) will have to check you after the injury.

2 weeks is the duration of contradicting a knee arthroscopy for knee dislocation or dislocated knee because fluid extravasations are caused by capsular tears which may give rise to compartment syndrome. Safe performance of knee arthroscopy is after 2 weeks with gravity (low pressure) only and the leg is monitored carefully.

Within two week after injury, acute repair can be performed and better results may be achieved by direct ligament repair as compared to reconstructive procedures. The location of a tear is done by an MRI with the capacity of telling the reparability of the tears.

Due to less success in reconstruction in posterolateral comer injuries acute repair is generally preferred.

(Medial collateral ligament) MCL’s mid-substance tear are not repaired acutely and the reason is because higher proportion will heal with conservative treatment. Reconstruction will be done later when it comes to midsubstance tears of PLC and MCL (Medial collateral ligament).

Avulsion of LCL (lateral collateral ligament) and MCL can be primarily repaired with screws or sutures with a washer made of soft tissues owing to the presence of an avulsion from the present insertion or from the origin. Primary repair of the capsule can address meniscal tears with partial meniscectomy or without it.^[6]

Repair of the ligament is ideally supposed to be performed within the first 3 weeks following injury because formation of scars renders operation difficult. Delay of surgical intervention is prudent up to that time that the soft tissues and skin has recovered from initial insult (especially 1-2 weeks after). The beginning of rehabilitation of the patient should be as though it is nonoperative.

After surgery complications include graft failure, knee arthrofibrosis, infection and future surgery necessity or/ and manipulations of the knee. Whelan et al, in 2014, found reconstruction of the posterior cruciate ligament might be a risk factor that is independent for developing heterotopic ossification following surgery of a dislocated knee.^[7]

References:

Also Read:

• Knee Dislocation or Dislocated Knee: Causes, Classification, Symptoms
• Exercises & Rehab for Knee Dislocation or Dislocated Knee