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Practical Management of Knee Dislocations: A Selective Angiography Protocol to Detect Limb-Threatening Vascular Injuries

Nicandri, Gregg T MD*; Chamberlain, Aaron M MD; Wahl, Christopher J MD

Clinical Journal of Sport Medicine: March 2009 - Volume 19 - Issue 2 - p 125-129
doi: 10.1097/JSM.0b013e31819cd37a
Practical Management

Knee dislocations are relatively uncommon but potentially catastrophic injuries. In athletes, these injuries generally result from high-energy traumatic mechanisms such as collisions in football and rugby, high-velocity falls in skiing, and falls from heights in gymnastics and extreme sports. Knee dislocations are frequently associated with coincident neurological or vascular injuries. Recognition of vascular injury is particularly challenging because vascular compromise may not be immediately associated with clinical signs of ischemia and may result from injuries without complete or evident dislocation. This article reviews the rationale behind selective angiography, adjunctive vascular testing, and the need for observation after multiligament knee trauma. An algorithm for the diagnosis of vascular injuries is presented.

From the *Division of Orthopaedic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; and †Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington.

Submitted for publication May 12, 2008; accepted January 16, 2009.

The authors did not receive grants or outside funding in support of their research or preparation of this article.

Reprints: Gregg T. Nicandri, MD, Sports Medicine Fellow, Division of Orthopaedic Surgery, Department of Surgery, PO Box 3615, Duke University Medical Center, Durham, NC 27710 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.