The Irreducible Knee Dislocation

Abstract

Irreducible knee dislocations are a small subset of acute knee dislocations and are extremely rare. The most common type of irreducible knee dislocation is posterolateral, which can be challenging to diagnose both clinically and on plain radiographs. Vascular injury is uncommon and closed reduction is seldom possible due to medial femoral condyle buttonholing through soft tissues requiring open or arthroscopic reduction. Ligament injuries mostly include medial collateral ligament, anterior cruciate ligament, and posterior cruciate ligament. Literature has numerous case reports with a couple of small series giving short- to mid-term outcomes of posterolateral knee dislocations. There is, however, no consensus on management of ligament injuries with case reports showing good outcomes in early or delayed ligament reconstruction. This article sheds light on previous case reports and describes how to identify irreducible knee dislocations and provides an algorithm on how to manage ligament injuries in posterolateral dislocations.

Keywords

irreducible knee dislocation - posterolateral knee dislocation - multiligament knee injury - MCL - ACL - PCL

Note

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

• References

• 1 Frassica FJ, Sim FH, Staeheli JW, Pairolero PC. Dislocation of the knee. Clin Orthop Relat Res 1991; (263) 200-205
• 2 Wascher DC, Dvirnak PC, DeCoster TA. Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma 1997; 11 (07) 525-529
• 3 Moore TM. Fracture--dislocation of the knee. Clin Orthop Relat Res 1981; (156) 128-140
• 4 Hull LC. IX. Report of a case of irreducible backward dislocation of the bones of the leg at the knee-joint. Ann Surg 1900; 32 (02) 289-290
• 5 Kennedy JC. Complete dislocation of the knee joint. J Bone Joint Surg Am 1963; 45: 889-904
• 6 Schenck R. Classification of knee dislocations. Oper Tech Sports Med 2003; 1: 193-198
• 7 Reckling FW, Peltier LF. Acute knee dislocations and their complications. 1969. Clin Orthop Relat Res 2004; (422) 135-141
• 8 Brennan JJ, Krause ME, MacDonald WF. Irreducible posterolateral dislocation of the knee joint with grossly intact cruciate ligaments. Am J Surg 1962; 104: 117-119
• 9 Curtin W, O'Farrell D, Dolan M, O'Brien T. An irreducible posterolateral knee subluxation. Ir J Med Sci 1994; 163 (10) 459-460
• 10 Pugh KJ, Wilber JH. Irreducible fracture dislocation of the knee. J Orthop Trauma 1996; 10 (05) 359-362
• 11 Anderson RL. Dislocation of the knee: report of four cases. Arch Surg 1943; 46: 598-603
• 12 Griswald AS. Irreducible dislocation of the knee joint. J Bone and Joint Surg 1951; 33A: 787-791
• 13 Quinlan AG, Sharrard WJ. Postero-lateral dislocation of the knee with capsular interposition. J Bone Joint Surg Br 1958; 40-B [phone]
• 14 Tsiagadigui JG, Sabri F, Sintzoff S, Schuind F. Magnetic resonance imaging for irreducible posterolateral knee dislocation. J Orthop Trauma 1997; 11 (06) 457-460
• 15 Huang FS, Simonian PT, Chansky HA. Irreducible posterolateral dislocation of the knee. Arthroscopy 2000; 16 (03) 323-327
• 16 Dubberley J, Burnell C, Longstaffe A, MacDonald PB. Irreducible knee dislocation treated by arthroscopic debridement. Arthroscopy 2001; 17 (03) 316-319
• 17 Kilicoglu O, Akman S, Demirhan M, Berkman M. Muscular buttonholing: an unusual cause of irreducible knee dislocation. Arthroscopy 2001; 17 (06) E22
• 18 Kontakis GM, Christoforakis JJ, Katonis PG, Hadjipavlou AG. Irreducible knee dislocation due to interposition of the vastus medialis associated with neurovascular injury. Orthopedics 2003; 26 (06) 645-646
• 19 Silverberg DA, Acus R. Irreducible posterolateral knee dislocation associated with interposition of the vastus medialis. Am J Sports Med 2004; 32 (05) 1313-1316
• 20 Urgüden M, Bilbaşar H, Ozenci AM, Akyildiz FF, Gür S. Irreducible posterolateral knee dislocation resulting from a low-energy trauma. Arthroscopy 2004; 20 (Suppl. 02) 50-53
• 21 Wilson TC, Talwalkar J, Johnson DL. Lateral patella dislocation associated with an irreducible posterolateral knee dislocation: literature review. Orthopedics 2005; 28 (05) 459-461
• 22 Said HG, Learmonth DJ. Chronic irreducible posterolateral knee dislocation: two-stage surgical approach. Arthroscopy 2007; 23 (05) 564.e1-564.e4
• 23 Braun DT, Muffly MT, Altman GT. Irreducible posterolateral knee dislocation with entrapment of the adductor magnus tendon and medial skin dimpling. J Knee Surg 2009; 22 (04) 366-369
• 24 Harb A, Lincoln D, Michaelson J. The MR dimple sign in irreducible posterolateral knee dislocations. Skeletal Radiol 2009; 38 (11) 1111-1114
• 25 Polyzois VD, Stathopoulos IP, Benetos IS, Pneumaticos SG. A two-stage procedure for the treatment of a neglected posterolateral knee dislocation: gradual reduction with an Ilizarov external fixator followed by arthroscopic anterior and posterior cruciate ligament reconstruction. Knee 2016; 23 (01) 181-184
• 26 Paulin E, Boudabbous S, Nicodème JD, Arditi D, Becker C. Radiological assessment of irreducible posterolateral knee subluxation after dislocation due to interposition of the vastus medialis: a case report. Skeletal Radiol 2015; 44 (06) 883-888
• 27 Xu H, Guo R, Xu B. An irreducible posterolateral knee dislocation: diagnosis, arthroscopic view, and treatment. Am J Emerg Med 2016; 34 (11) 2256.e3-2256.e4
• 28 Tateda S, Takahashi A, Aizawa T, Umehara J. Closed reduction of “irreducible” posterolateral knee dislocation - a case report. J Orthop Case Rep 2016; 6 (02) 20-23
• 29 Al-Juhani W, Ahmed B, AlMugren T. Irreducible knee dislocation with vastus medialis muscle interposition. Knee Surg Relat Res 2019; 31 (01) 72-75
• 30 Quinlan AG. Irreducible posterolateral dislocation of the knee with button-holing of the medial femoral condyle. J Bone Joint Surg Am 1966; 48 (08) 1619-1621
• 31 Hill JA, Rana NA. Complications of posterolateral dislocation of the knee: case report and literature review. Clin Orthop Relat Res 1981; (154) 212-215
• 32 Nystrom M, Samimi S, Ha'Eri GB. Two cases of irreducible knee dislocation occurring simultaneously in two patients and a review of the literature. Clin Orthop Relat Res 1992; (277) 197-200
• 33 Samimi S, Shahriaree H. Arthroscopic view of an irreducible knee dislocation. Arthroscopy 1993; 9 (03) 322-326
• 34 Chen W, Zhang YZ, Su YL, Pan JS. Irreducible lateral knee dislocation with incarceration of the lateral femoral condyle in the posterolateral capsuloligamentary structures: a case report and literature review. Orthop Surg 2011; 3 (02) 138-142
• 35 Wand JS. A physical sign denoting irreducibility of a dislocated knee. J Bone Joint Surg Br 1989; 71 (05) 862
• 36 Kilicoglu O, Demirhan M. Irreducible posterolateral knee dislocation associated with interposition of the vastus medialis. Am J Sports Med 2005; 33 (12) 1931 , author reply 1931
• 37 Durakbaşa MO, Ulkü K, Ermiş MN. Irreducible open posterolateral knee dislocation due to medial meniscus interposition. Acta Orthop Traumatol Turc 2011; 45 (05) 382-386
• 38 Shetty GM, Wang JH, Kim SK. , et al. Incarcerated patellar tendon in Hoffa fracture: an unusual cause of irreducible knee dislocation. Knee Surg Sports Traumatol Arthrosc 2008; 16 (04) 378-381
• 39 Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma 2004; 56 (06) 1261-1265
• 40 Jang KM, Lee HS, Wang JH. Open reduction of irreducible posterolateral rotary knee dislocation without sectioning of incarcerated vastus medialis: a case report with video illustration. Knee 2014; 21 (02) 582-585
• 41 Potter HG, Weinstein M, Allen AA, Wickiewicz TL, Helfet DL. Magnetic resonance imaging of the multiple-ligament injured knee. J Orthop Trauma 2002; 16 (05) 330-339
• 42 Whelan DB, Levy BA. Knee dislocations. In: Court-Brown CM, Heckman DJ, McQueen MM, Ricci MW, Tornetta P, McKee MD. , eds. Rockwood and Green's Fractures in Adults. 8th edition, Vol. 2. Philadelphia: Wolters Kluwer Health; 2015
• 43 Clarke HO. Dislocation of the knee with capsular interposition. Proc R Soc Med 1942; 35: 759
• 44 Schaefer RA, Bellafiore VA, Corzatt RD. Irreducible dislocation of the knee. Mil Med 1999; 164 (11) 827-829
• 45 Hongwu Z, Li J. One-stage arthroscopic reduction combined with multiligament reconstruction or repair for irreducible posterolateral knee dislocation: a retrospective case series with minimum 2-year follow-up. J Knee Surg 2018; 31 (10) 1015-1021
• 46 Gu MQ, Deng L, Liu Y. Posterolateral dislocation of the knee joints: analysis of 9 cases. Chin J Traumatol 2004; 7 (04) 210-216
• 47 Van Thiel GS, Baker III CL, Bush-Joseph C. A chronic posterolateral knee and patella dislocation: case report. J Orthop Trauma 2009; 23 (07) 541-545
• 48 Saini R, Mootha AK, Goni VG, Dhillon MS. Neglected irreducible posterolateral knee dislocation. Indian J Orthop 2010; 44 (04) 468-470