Northwestern University Feinberg School of Medicine

Orthopedic Teaching

Leg/Knee Case 5 ED Management

Anterior Knee Dislocation


ED Management

Knee dislocations require prompt reduction, particularly in the setting of a pulse deficit. These are typically reduced under conscious sedation by traction-countertraction.

Due to the high incidence of popliteal artery injury and reports of high amputation rates from delayed interventions, arteriography has been traditionally mandated regardless of vascular exam findings. There has been a growing body of literature, however, demonstrating that selective angiography only on patients with vascular deficits is safe and effective, missing no clinically significant injuries.

This controversy, along with the instability of the injury and severity of injury to surrounding ligamentous structures, requires emergent orthopedics consultation to select the diagnostic approach, arrange for inpatient observation, and determine definitive management after reduction.