Vascular injury may occur during an injury causing knee dislocation. Serious morbidity for the patient may occur if this is not specifically looked for. Perron et al developed an algorithm for managing vascular injury in a patient with a knee dislocation. The authors are from the Universities of Virginia and North Carolina.


Injury to the popliteal artery tends to occur in high velocity injuries such as motor vehicle accidents, especially those occurring in the anterior-posterior axis.



(1) Initially reduce the knee joint.

(2) Evaluate the affected limb for distal perfusion looking for:

(2a) hard signs of vascular injury

(2b) soft signs of vascular injury

(3) If no hard signs are present, then perform an ankle-brachial artery index (ABI) and/or duplex Doppler ultrasound of the affected limb.

(4) Perform emergency revascularization surgery if either:

(4a) 1 or more hard signs are present

(4b) The ABI and/or duplex doppler ultrasound is abnormal.

Else admit the patient for observation.



• An abnormal ABI is < 0.9.


Hard signs of vascular injury:

(1) pulse deficit on the affected side

(2) distal ischemia

(3) active hemorrhage

(4) expanding and pulsatile hematoma


Soft signs of vascular injury:

(1) small, stable hematoma

(2) injury to an anatomically related nerve

(3) history of hemorrhage


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