popliteal angiography for asymptomatic knee dislocations

[Zsolt Balogh]

Dear Sal,

Traditionally knee dislocations are classified as high energy (MVC, high falls) and low energy (sport-related). Now we have the new group the ultra-low-energy from morbidly obese patients with minimal trauma, slipping on stairs or kerb etc. This group has as high incidence of vascular lesions as the high energy based on many of us anecdotal experience. Best regards, Zsolt  

>>> <sjasmd at aol.com> 30/07/2008 2:35 pm >>>

I would have enjoyed more discussion of the pros and cons of performing angiography for asymptomatic knee dislocations. It would seem from the few posts that there are some who still perform angiography. We had begun to dismiss this procedure because of an overwhelming amount of fairly good data published in the past decade that showed that signs of vascular injury are almost always present when angiography is positive in detecting popliteal artery injury and that detecting injury in the absence of signs by angiography is uncommon. 

We recently saw an obese ?patient who dislocated her knee anteriorly who underwent angiography three days after the injury because the orthopedic service wanted angiography prior to planning knee repair. 
Angiography showed intraluminal thrombus and intimal flaps with thrombus on them?in the midpopliteal artery. Luminal diameter was compromised about 80%. Distal run-off angiography showed occlusion of the entire posterior tibial artery and embolism of the midportion of the peroneal. The anterior tibial artery was normal. see attached

We elected to place a stent graft over?the injured segment and trap the thrombus under it.?We introduced? a 22 mm atrium stent and applied it exactly at the site of the injury. Anatomical appearance returned with good flow. 

patient was discharged the next day and will undergo elective reconstruction of the knee.

any comments?
about use of angiography for knee dislocations
about use of stent graft in popliteal artery
about use of thrombolysis for the peroneal embolism


thanks

SAL SCLAFANI