Bike accident resulting in severe knee dislocation

Bike accident resulting in severe knee dislocation ⚠️🚲

⁣This is the worst knee joint dislocation you will ever see.💔

Knee dislocation is a relatively rare injury but an important one to recognize because coexistent vascular injury, if missed, often leads to limb loss. In addition, knee dislocation often presents in the context of multisystem trauma or spontaneous relocation, which makes detection more difficult.

The knee is a very stable joint generally requiring high-energy trauma to produce dislocation.

Unreduced dislocations present with an obvious deformity, but spontaneously reduced dislocations can lead the examiner to underestimate the severity of the injury. In any instance in which a knee dislocation is suspected, neurovascular assessment should immediately become the focus of the evaluation.⁣

The knee complex is stabilized by 6 main ligamentous or cartilaginous structures as well as several muscles and tendons. Anterior and posterior tibial translations are prevented by the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), respectively. Excessive valgus forces are restrained by the medial collateral ligament (MCL), whereas excessive varus forces are restrained by the lateral collateral ligament (LCL). The medial and lateral menisci transmit axial loads and stabilize against any rotational forces. The muscles and tendons that aid in stabilizing the knee include the vastus lateralis, vastus medialis, vastus intermedius, rectus femoris, biceps femoris, semitendinosus, semimembranosus, sartorius, gracilis, iliotibial tract, popliteus, and gastrocnemius.⁣

Affected limb has a gross deformity of the knee with swelling and immobility, but up to 50% of knee dislocations are reduced by the time of ED presentation and may not be obvious.

Surgical treatment in such cases is almost always required. It depends on which ligaments were injured and the severity of injury to those ligaments. Allografts tend to be the preferred graft for use in the surgical reconstruction of knee dislocations followed by a long rehabilitation.⁣