32 Yo Woman With Excruciating Left Lower Extremity Pain - Page #4
 

Working Diagnosis:
Based on the physical examination and studies findings of multiligament injury, the patient seems to have sustained a knee dislocation with spontaneous reduction , although we do not have a definite mechanism of injury nor do we have physical findings and medical documentations to confirm our diagnosis.

Treatment:
Had we seen the patient in the acute phase, the treatment would have been:
1 Reduction of the dislocation as soon as possible.
2 Non weight bearing knee immobilization.
3 Screening for vascular injury.
4 PLC structure reconstruction followed by ACL and PCL repair 2 to 3 months later after PLC reconstruction stabilization.

Outcome:
Since patient had a multi-ligament knee injury that necessitated surgical consultation, patient was referred to orthopedics for further care. The standard of care is open surgery to reconstruct the posterolateral corner structures as they are extra capsular and an arthroscopic approach for the cruciate ligaments.

Author's Comments:
The point of this presentation is not so much about the surgical intervention of a knee dislocation. It is about making sure that the primary sports physician is aware of the urgency of the condition and act in a timely fashion within 7 to 8 hours to save an injured athlete's leg.

References:
1 Cho, Dosang, et al. "Peroneal nerve injury associated with sports-related knee injury." Neurosurgical Focus 31.5 (2011): 11.

2 Howells, Nick R., et al. "Acute knee dislocation: An evidence based approach to the management of the multiligament injured knee." Injury 42.11 (2011): 1198-1204.

3 Boss, Stuart E., et al. "Critical orthopedic skills and procedures." Emergency medicine clinics of North America 31.1 (2013): 261-290.

4 Sekiya, Jon K., et al. "A clinically relevant assessment of posterior cruciate ligament and posterolateral corner injuriesEvaluation of isolated and combined deficiency." The Journal of Bone & Joint Surgery 90.8 (2008): 1621-1627.

5 Frassica, FRANK J., et al. "Dislocation of the knee." Clinical orthopaedics and related research 263 (1991): 200.

6 Fanelli, Gregory C., et al. "Management of complex knee ligament injuries."The Journal of Bone & Joint Surgery 92.12 (2010): 2235-2246.

7 Fanelli, Gregory C., and Daniel D. Feldmann. "Management of combined anteriorcruciate ligament/posterior cruciate ligament/posterolateral complex injuries of the knee." Operative Techniques in Sports Medicine 7.3 (1999): 143-149.

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