Dislocations of the Knee Tibiofemoral Joint

Dislocations of the Knee Tibiofemoral Joint

Dislocations of the tibiofemoral joint are rarely found in orthopedic sports medicine. This dislocation is described as a complete displacement of the tibia of the femur with rupture of three or more joint ligaments. The puzzling problem with these dislocations is that most cases often spontaneously shrink before initial emergency medical care is provided. The etiology of knee dislocations is associated with extremely violent force on the joint, which generally ruptures both the cruciate ligaments and at least one collateral ligament. In rare cases, only one cruciate ligament is completely torn. The classification system for knee joint dislocations is based on the orientation of the tibial displacement relative to the femur. More specifically, these dislocations are described as anterior, posterior, medial, lateral, and rotational. The so-called rotational dislocations can be classified according to the orientation of the displaced tibial plateau, the most common being the posterolateral one. Finally, knee joint dislocations can also be expressed as open or closed and reducible or irreducible. Dislocations of the knee joint are a traumatic orthopedic emergency and require immediate activation of EMS. Treatment of knee dislocations requires frequent monitoring of distal pulses and sensory distribution. The high prevalence of associated neurovascular disease is of utmost concern for knee joint dislocations. It is of particular specific interest to the popliteal artery and the peroneal nerve. Both of these respective vascular and nerve tissues are subject to significant traction or entrapment following dislocation of the knee joint. Therefore, it is emphasized that athletic trainers are looking for signs of increased cyanosis and hematoma because these symptoms may be indicative of vascular compromise. Knee joint dislocations are best immobilized in the position found with a rigid splint. The physical trainer should frequently monitor neurovascular status pending the arrival of EMS. If the athletic trainer finds a knee joint dislocation suspected of spontaneous reduction, the affected lower limb should be stabilized on one knee.

Joint immobilizer set to 30 degrees of flexion. The injured athlete must therefore be transported urgently to the nearest emergency medical center for follow-up care.

Patellofemoral Joint

Dislocations of the patella most often occur when a partially flexed knee is exposed to simultaneous valgus and extensor forces. As a result, the patella typically dislocates laterally in relation to the knee complex .Associated injury to adjacent neurovascular structures is rare. Isolated reductions of patellar dislocations are not as intricate as the relocation techniques of other joint dislocations. Examination of the knee will display obvious deformity, swelling, and consequent pain. The injured athlete will be unable to ambulate or actively extend the knee from a flexed position.

To successfully reduce a dislocated patella the athletic trainer begins by passively flexing the hip to relieve quadriceps tension. The athletic trainer then fully extends the knee gently while applying firm pressure directed medially to the lateral border of the patella . Successful reduction results in immediate pain relief and loss of obvious anatomical deformity. Treatment of patellar dislocations includes immobilization of the knee joint in full extension with a brace, application of ice, and referral to an orthopedic specialist. If reduction attempts prove unsuccessful, the knee joint should be immobilized in the position found and theainjured athlete should be transported to a hospital.

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