Multiligamentous injuries of the knee and associated vascular injuries

Abstract

Background: Recently published studies have raised the question of whether arteriography is warranted in the evaluation of multiligamentous injuries of the knee.

Purpose: The objective is to report the frequency of associated vascular injuries in the multiligament-injured knee and examine the role arteriography plays in the treatment protocol.

Study design: Case series; Level of evidence, 4.

Methods: A retrospective analysis was performed on 71 patients over a 12-year period who had a diagnosis of multiligamentous injury of the knee with a tibial-femoral dislocation documented based on physical examination and magnetic resonance imaging findings.

Results: Of 72 knee injuries involving multiple ligaments, 12 vascular injuries were identified. Four knees were found to have a vascular injury at initial presentation based on abnormal physical examination and confirmed with arteriography. Eight patients with a vascular injury had normal pulses. Routine arteriography discovered an intimal injury of the popliteal artery in 5 of these patients. Arteriography in the remaining 3 patients was interpreted as normal.

Conclusion: These findings suggest that physical examination alone is not sufficient in detecting the majority of vascular injuries after a suspected knee dislocation.