Knee Dislocation - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубликовано: 23 июл 2024
- Dr. Ebraheim’s educational animated video describes dislocation of the knee and types of knee dislocations.
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Dislocation of the knee is a serious problem. It should be recognized and managed appropriately early. Knee dislocation is considered an orthopedic emergency. It is important to recognize the dislocation, and do reduction and perform serial neurovascular exam before the reduction and after the reduction. Approximately 50% of knee dislocations spontaneously reduce before formal evaluation. Morbid Obesity can be a risk factor for knee dislocation. Because the joint capsule is torn, knee swelling may not occur with knee dislocation. The knee dislocation associated with sports injuries have a lower incidence of neurovascular injury than those associated with a high energy mechanism.
There are several types of knee dislocation that are usually described in the literature. There is a classification based on direction of displacement of the tibia and classification system based on the severity of the ligamentous damage was developed by Dr. Schenck. The dislocation of the knee usually involves at least two ligaments. Anterior knee dislocation is caused by hyperextension mechanism that causes failure of the posterior capsule, the PCL and sometimes the ACL. Anterior knee dislocations are the most common types. Posterior dislocations are seen in dashboard injuries. The posterior dislocation has the highest rate of vascular injury (about 25%), and sometimes will be a complete tear of the popliteal artery. Lateral dislocation has the highest rate of peroneal nerve injury. Posterolateral dislocation is the most common rotatory dislocation and it is usually irreducible. In rotatory dislocations, the PCL remains intact as the tibia rotates about the femur. A dimple on the medial side indicates posterolateral dislocation, which means that the dislocation cam be irreducible and the medial femoral condyle button hoes through the joint capsule.
The physical examination and diagnostic studies can direct the treatment in a timely fashion. There could be an obvious deformity. See if there is a dimple sign. You need to check the pulses, get the x-ray, and reduce the knee immediately regardless if there is a pulse or no pulse. When you check the pulses, compare it to the other side. You have to do serial exam of the pulses and the whole idea is to make sure to discover if there is a vascular injury or not, because if there is a vascular injury and there is a delay more than 8 hours in reestablishing the arterial blood flow, that will result in an amputation rate of 85%. The patient may have severe pain, instability, and the exam will be difficult because of guarding and apprehension, but keep focusing on the circulation. Look at the pulses. Look at the x-rays! The patient may have a fracture, such as medical tibial plateau fracture and other intraarticular fractures, the patient may have asymmetry of the joint space, avulsion fractures such as the Segond sign for ACL tear or tibial eminence avulsion fracture. Look for asymmetry of an irregular joint space on the x-rays. After you reduce, you immobilize, get x-rays, and make sure the dislocation is reduced. Up to 1/3 of knee dislocation have associated injuries that require more urgent attention. Knee dislocation is a high energy injury that will have popliteal artery injury, nerve injury, multiple fractures, head and chest trauma, and compartment syndrome. The findings of the knee might be subtle, but having knee dislocation makes you think of these conditions and the swelling may not be that significant because the joint capsule is torn. You may have hyperextension of the knee, popliteal ecchymosis, foot drop, or vascular issues, and the patient may also be normal. The knee can be dislocated or be normal. The patient may or not be overweight.
You examine the pulses and then you reduce the knee. After you reduce the knee, you examine the pulses and get post reduction A.B.I. (ankle brachial index). The ankle brachial index (A.B.I.) is very important in the knee dislocation. The systolic blood pressure measured is divided by that measured at the brachial artery. A ratio less than 0.9 is considered abnormal and needs further investigation. Scenario 1: Good pulses and symmetrical, A.B.I. is more than 0.9, then observe for 24-48 hours with serial neurovascular exam. Scenario 2: After the reduction, if the distal pulses are asymmetrical, or the A.B.I. is less than 0.9, then you will do some kind of a study to see why this is occurring (get a CTA or arteriogram). Scenario 3: If you have absent distal pulses or clear, hard signs of limb ischemia, do not waste time by doing arteriogram. Take the patient to the operating room, do emergency exploration and then on the table, do arteriogram and the patient will probably need fasciotomy. You will stabilize the knee with and external fixator.
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I dislocated my knee yesterday while sitting down at the doctor's office. Luckily I was already at the hospital but the pain was horrific
How?
that must been a traumatic experience for you. Hope you feeling better ✌
I dislocated it in basketball
You are just amazing Dr. Nabel.
Thank you! I have a disorder that leads to my knees dislocating all the time. Since I follow your channel, I clicked this as soon as I got home :)
Yes! Happens to me quite often (might be a couple of times per year). The pain is like getting a cold nail hammered in the side/bottom of the knee. When straightened out it always sort of pops back into place, but it is not super visible?
You are probably dealing with patellofemoral subluxations, which are milder but potentially quite problematic to the patient!
@LAMB BLOOD look into Ehlers danlos Syndrome I have this causes other joints to dislocate
Dang, I’m sorry to hear that. And I thought my frequent kneecap dislocations were back. Can’t imagine dislocating the whole knee. You’re a strong and brave person
@@ercc923 exactly i also have same problem.......
lol i dislocated my knee getting up very fast
my knees were bent and i turned with my hips
@@kayleebracy6977 same
@@kayleebracy6977 same I got so scared my mom told me not to look while trying to fix it but I was looking thru a crack in her hands
@@special_black_guy it’s happened to my right knee a while ago and I just injured it again jumped around like a idiot and it popped out and I just got angry not even painful just angry at myself
i dislocated my knee trying to get on my fuckin bed
thanks doc very helpful video
Excellent Dr.!
Please explain about Breaker's cyst and pain at posterior aspect of knee.
Not to be confused with patellar (kneecap) dislocations, which are much more common and much less serious
Can’t you pop the patellar back into place?
Hello from Alaska.
What type of dislocation did I have?
In 2017 I dislocated my right knee (hyperextension) resulting in patellar subluxation, injury to the acl and MCL, femoral condyle and tibial plateau fractures in 2015. (Good pulses - no vascular injury) treatment was non weigh bearing locked at 90° brace for 6 weeks then ACL repair.
What type of dislocation did I have?
Mechanism of injury: walking my dog from standing bent down to pick up dog waste, and my right knee hyperextened.
HPI: 42 year old Registered Nurse. I am 135 lbs 5'5" . Active in biking, walking, yoga and daily life a actives,
COMPLIANT: inability to bend right knee to sit cross legged during yoga, pain and a weak ankle. Valgus knee, pronated foot
My theory is that there must have been pre existing functional problems for the knee to dislocate without a lot of force, thoughts?
Thanks for this educational video. I find it the anatomy and mechanism of injury explanation extremely information to help me address my chronic complaints listed above. ☝️🙏
Great!
Thank you! 🥺
Thank you in Bangla is ধন্যবাদ......thank you for very good demonstration.....ধন্যবাদ। you can add this in your last slide....
Thank you!
I dislocated my knee last night I literally fell over at the end of my shift and omg it was the worst pain I have ever felt I was lying on the floor with it for 1.5hrs waiting for an ambulance
Omg the same thing happened to me a week ago and the swelling is almost gone
@@nandos_is_nice5545 same for me
Yesterday my knee dislocated and i needed to wait for the ambulance with that pain🥺
@@archanarajan6958 literally had to wait for so long in so much pain it's the worst thing ever I really feel for you cos I know how awful it is 😭
@@archanarajan6958 aw mate ok ur knee is probably really swollen and in a couple days it might get really bruised and at physio if you cant do the exercises its coz of the swelling and keep a pillow under your knee when you sleep on ur back and inbetween if u lie on ur back
Thank you for your videos it helped me out a lot. Can you make a video on the nose.
He is a professor of orthopaedics and does not deal with the nose, Barry.
12 month ago femor broken and surgery done, that time fix on cast , after cut cast and my knee not bend ,
After physio therapy 90 % done , now hip pain , and limping , full bend need
My knee got really messed up after I fell off my skateboard going down a park ramp. My leg stayed straight and my right lower leg bent outward. My knee swelled up like a beach ball. That was in lat 2015. Now my knee will easily dislocate whenver I bend it like how it was damaged the first time. I need to fix this problem because i was sprinting and did a runners launch. My knee dislocated. It went back in after a bit of hassle. My question is where should I go to get it evaluated and treated? And do they accept Medicaid? Nice video btw thanks.
Lovely video
Thanks
I dislocated my knees at karate class once and fell down with severe pain thinking this was the worst leg injury I'd ever have in my life but when I was in the hospital and finally got my bone pushed back to place, I figured out it wasn't something too excessive
How long did your recovery take
I dislocated my knee to it hurt so bad epsalsally when my dad picked me up I screamed but then I grabbed my leg and pulled it back and it poped back in
@@stxqmy0 how did it dislocate ??
And how is it now ??
I dislocated my knee in karate class
In the past 3 months I first dislocated my right knee and now left
Both in karate class
I really wanna join back 😩
Any tips ??
@@mariamahmad6612 I was doing online karate and I stepped wrong and it dislocated but it doesn't hurt anymore I can bend it I just can't bend it all thr way
I dislocated my knee while playing soccer it didn't even hurt it just felt so weird that I couldn't handle it anymore when they popped it back in I realized that it couldn't move it after it started to swell up alot
Mine was similar. I was practicing for cheer tryouts then it popped and I fell. It popped back as I fell but it couldn't more for a few seconds. Happened again the next day but that time I felt it al little more
Samee happened to me, may i know how long u took rest and could u play again?
@@wakifkhan7660 it took me about 3 weeks to start walking and i think 2 months for it feel normal
@@wakifkhan7660 well... i.. uh... i didnt.... i got back up and continued through tryouts. Happend the next day again but thats the past day of try outs
Since mine wasnt that bad they just had me do physical therapy.
@@yogibear3835 it will keep happening if u don't rest
I've had a knee injury for a few years. I fell off a ladder and planted on my right leg, it had hyperextended and then became a problem. I moved last April and had another accident and hopped a fence, and when I landed my knee slipped to the left. Now It slips out naturally but until tonight I was on my stomach and my wife pressed behind my knee to massage my bakers cyst, it then shifted and painfully at that but now idk what to think.
I dislocated my knee. I slipped on the edge of concrete and my knee cap hit the side of concrete and it pushed my knee cap up. No breaks or anything it popped in when they took x-rays. I’m now on crutches just muscle injury
i have just dislocated my knee one hour ago in the shower i just popped it back now am in serious pain
I dislocated my knee today at football the most pain I’ve been in the shock of me trying to get up and my knee sliding out is terrific
I did my knee dislocation 3yrs back and had a same case as yours....and it is still not cured. It happens every time I run play and sometimes climbing upstairs and walking normally....
Thats my problem also.. you think it is possible to cured like back in the normal. So we can do something with out worries
@@ranjanabhatt7782 I have the same problem,and when I go to the hospital they think I'm lying cause they don't find anything wrong with my knee and when I talk to other doctors they say it's just a strain and we all have that once in a while but I tend to have it frequently,and not only that I know it's not a strain cause the knee always pops right back in and so I just reached a point of letting it be and hoping it resolves on its own or maybe start physical therapy or something
Same thing with me, I had knee dislocation my knee pop up it hurt so bad. So I decided to go orthopedic and they found out that theres fracture inside my knee then it also bleed inside because of the fracture.after that it lessen my knee pain and adv me to wear knee stabilizer and not to bend for 3weeks. And now I can walk but with my knee supporter.
I had this two freacking times! And the two times I punch my knee to put it right, yeah the doctors tell my when I was at the hospital and after many studies to know how bad was the injury "are you insane to do that to your knee with a single punch after that injury?! How much force you put in that punch?!", and I was "i was hurting ok, give me a break this fucking thing still hurt" crying like a baby and trying to drag myself away like a zombie, so the doctor could not touch my knee
Thank you!!!!
Pls Doc
help out with my knee dislocation
I think maybe its a posterior
i dislocated my right knee playing football in 2007, it was treated but not properly done, cause now its bent a bit and my left leg is few inches longer tha my right which is slightly affecting my backbone, what do you suggest i do, can a surgery fix all that?
How many days rekavary
@@kotinaidukoti5110 you mean?
My leg disloketion and pcl 50;dameg
And knee back side bone fachar swre fitting how many days rekavary
I used to dislocate my knee a lot. Even when I would stand up was a hard process. I hated it. My Lymes disease that spread to my knee also didn’t make it any better.
How long ago did you get Lymes? I got it about 6 years ago and in between that I have dislocated my knee twice.
Thank you
I'm suffering this for 15 years ,it's hard but i can run faster than my friends
I was doing a TikTok dance today I dislocated my knee. It popped back in but it’s sore.
im a bikers but i work while my 7days training finishing and i work on 6days now but i pool a pallet and my knee was dislocate be careful guys dont use safety shoes if you pool on the back of pallet
Hello sir my knee not go full bend
Hi can bend it now?
@@qismischa not full bend
Limping how to solve
@@shefeerks are this because of discolate ?
I forced my bones back....
Not pretty would not recommend
Dislocated both knees went and got surgery
السلام عليكم دكتور إبراهيم، حفظك الله ورعاك
لو تفضلت بمساعدتي سأكون لك ممتنا
أنا أمارس الكراتيه ومنذ 3 سنوات أصبت على مستوى غضروف الركبة الداخلي، توقفت عن التدريب، والآن بعد 3 سنوات ذهب الألم لكن عندي خلع في الركبة من الجهة الداخلية، عندما أرجعها إلى مكانها لا مشكلة لكن يخرج المفصل من مكانه مجددا عندما أقوم بحركة خاطئة أو عند الجلوس أثناء الصلاة.
الآن رجعت للكراتيه لكن أتدرب بحذر شديد.
أرجو أن تساعدني أريد أن لا ينخلع مفصل الركبة مجددا وأريد أن أرجع لحياتي الطبيعية. جميع الأطباء الذين أذهب إليهم أعطوني مضادات الالتهاب ومسكنات الألم رغم أنني أخبرتهم أن الألم زال وأريد حل مشكلة خلع الركبة.
بارك الله فيك دكتور ونفع بك
How are you now ??
Did it dislocate again ??
I dislocated my knee in karate first right then left and I really wanna join back 😩
My knee got really messed up after I fell off my skateboard going down a park ramp. My leg stayed straight and my right lower leg bent outward. My knee swelled up like a beach ball. That was in lat 2015. Now my knee will easily dislocate whenver I bend it like how it was damaged the first time. I need to fix this problem because i was sprinting and did a runners launch. My knee dislocated. It went back in after a bit of hassle. My question is where should I go to get it evaluated and treated? And do they accept Medicaid? Nice video btw thanks.