Delayed Management of Popliteal Artery Injury Following Knee Dislocation—A Case Report

Knee dislocations frequently involve vascular injuries that demand early diagnosis and timely intervention. Time of ischemia is pivotal in determining the outcome for the limb, delays in treatment beyond 8 hours significantly increase the risk of limb loss. Unfortunately, this critical window is often missed in resource-limited settings. Here we report a 25-year-old female sustained a left knee injury after falling into a trench. She was diagnosed with an open knee dislocation accompanied by a popliteal artery injury. However, revascularization was delayed for 18 hours due to limited resources, including the unavailability of a thrombectomy catheter. Postoperatively, the patient received anticoagulation therapy with serial limb assessments and after 3 weeks the laceration healed and the limb was still viable. Knee dislocations frequently result in vascular injury (popliteal artery most common), making prompt diagnosis and intervention essential for limb preservation. In settings with limited resources, like ours, delayed presentation and transfer to specialized centers contribute to prolonged ischemic times. Nonetheless, viable limbs should be revascularized in stable patients, even with prolonged ischemia. This case highlights the importance of limb revascularization despite delay. Efforts should be made to improve prompt diagnosis, timely referral, and availability of necessary equipment for vascular repair to optimize outcomes in similar cases.

Anterolateral complex of the knee: State of the art

Rotatory instability of the knee represents the main reason for failure and poor clinical outcomes regarding anterior cruciate ligament(ACL)reconstruction techniques.It is now clear that the anterolateral complex(ALC)of the knee possesses a fundamental role,in association with the ACL,in controlling internal rotation.Over the past decade,ever since the anterolateral ligament has been identified and described as a distinct structure,there has been a renewed interest in the scientific community about the whole ALC:Lateral extra-articular tenodesis have made a comeback in association with ACL reconstructions to improve functional outcomes,reducing the risks of graft failure and associated injuries.Modern ACL reconstruction surgery must therefore investigate residual instability and proceed,when necessary,to extra-articular techniques,whether functional tenodesis or anatomical reconstruction.This review aims to investigate the latest anatomical and histological descriptions,and the role in rotational control and knee biomechanics of the ALC and its components.The diagnostic tools for its identification,different reconstruction techniques,and possible surgical indications are described..In addition,clinical and functional results available in the literature are reported.

Anterior tibiofemoral dislocation after total knee arthroplasty:A case report and literature review

Anterior tibiofemoral dislocation after total knee arthroplasty is an extremely rare and serious event.Amongst English-published papers,we found only 15 relevant cases,3 of which presented vascular complications.This manuscript aims to present a 77-year-old woman with a TC-Plus(Smith&Nephew)cruciate-retaining type in first time of knee prosthesis,who suffered an anterior tibiofemoral dislocation and were admitted to our hospital.The clinical management and outcome were evaluated.Furthermore,a review of literature was performed.We concluded that early detection and surgical intervention of vascular injury is the key in the survival of the limbs.If there is still knee instability after acute recovery,it seems that revision surgery with constrained total knee arthroplasty can bring about good clinical and functional results.