J Korean Orthop Assoc.  2020 Feb;55(1):95-100. 10.4055/jkoa.2020.55.1.95.

Closed Reduction of Irreducible Posterolateral Rotatory Knee Dislocation

• Lee HS
• Lee SH
• Lee SW

• KMID: 2470775
• DOI: http://doi.org/10.4055/jkoa.2020.55.1.95

Abstract

In general, most knee dislocations are reduced easily by simple traction. In rare cases, closed reduction of the knee dislocation is attempted, but ruptured ligaments or muscles are stuck in the joints and cannot be reduced. The cases of this irreducible knee dislocation have sometimes been reported. The authors encountered a case of irreducible knee posterolateral rotational dislocation that was not reduced by simple traction and report it along with a review of the literature. This case provides an opportunity for clinicians to examine the clinical considerations when experiencing an irreducible knee dislocation.

Keyword

knee dislocation; therapeutics; orthopedic procedures

MeSH Terms

Dislocations
Joints
Knee Dislocation*
Knee*
Ligaments
Muscles
Orthopedic Procedures
Traction

Figure

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  Figure 1 Initial knee anterior-posterior (A) and lateral (B) radiographs.

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  Figure 2 Knee anterior-posterior (A) and lateral (B) radiographs after the initial reduction trial. Subluxation remained.

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  Figure 3 Dimple sign (arrows), also known as the pathognomonic sign of irreducible knee dislocation and skin color change during subluxation of the knee.

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  Figure 4 Magnetic resonance imaging of coronal image (A) and axial image (B) taken with remained subluxation of the knee. Sartorius tendon is indicated as arrows. The buttonhole effect is formed.

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  Figure 5 When the knee flexion is more than 90° with tibial internal rotation, a posterior force is applied to the tibia, and the dimple sign is resolved along with the click sound.

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  Figure 6 Knee anterior-posterior (A) and lateral (B) radiographs taken after general anesthesia reduction and external fixation, and the knee joint was reduced without subluxation.

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  Figure 7 Changes in the skin color in medial side of knee after general anesthesia reduction and external fixation. The color of the medial side of the knee, which has changed considerable, is improving gradually. PAD, post-accident days.

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  Figure 8 Two weeks after general anesthesia and external fixation, anterior cruciate ligament and posterior cruciate ligament were reconstructed simultaneously with an allogenic Achilles tendon bone graft. And medial collateral ligament, lateral collateral ligament and medial retinaculum were reattached using an anchor suture.

Reference

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