Arterial injury complicating knee disruption. Third place winner: Conrad Jobst award.

Because dislocation of the knee (DK) is accompanied by a substantial risk of popliteal artery injury, the importance of arteriography in ruling out occult arterial damage in such patients is well accepted. However, because antecedent DK cannot be ruled out in a trauma victim presenting only with severe knee ligamentous disruption (LD), we have routinely performed arteriography in all patients presenting with grossly unstable knees, whether or not DK is present. To evaluate this policy we reviewed the records of 30 patients with either DK (n = 19) or severe LD (n = 11). There was no significant difference between DK and LD in the frequency of major (22% vs 18%) or minor (38% vs 36%) vascular abnormalities. We also found that Doppler pressure measurements were highly predictive of major arterial trauma in patients in whom it was used. We conclude that arterial injury should be ruled out in all trauma victims with severe knee ligament disruption, whether or not actual joint dislocation is present.