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Scientific Articles   |    
Knee Injury in Patients Experiencing a High-Energy Traumatic Ipsilateral Hip Dislocation
Gary L. Schmidt, MD1; Robert Sciulli, MD2; Gregory T. Altman, MD2
1 Departments of Radiology (R.S.) and Orthopaedic Surgery (G.T.A.), Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212
2 531 Perry Highway, Apartment #11, Pittsburgh, PA 15229. E-mail address: schmidt18@hotmail.com
View Disclosures and Other Information
Investigation performed at the Departments of Radiology and Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jun 01;87(6):1200-1204. doi: 10.2106/JBJS.D.02306
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Abstract

Background: Traumatic hip dislocation results from the dissipation of a large amount of energy about the hip joint. Clinically, these forces often are first transmitted through the knee en route to the hip. It is therefore logical to look for coexistent ipsilateral knee injury in patients with a traumatic hip dislocation.

Methods: Over a one-year period, we prospectively evaluated the ipsilateral knee of all patients who had a traumatic hip dislocation on the basis of a standardized history, physical examination, and magnetic resonance imaging.

Results: Twenty-one (75%) of the twenty-eight knees were painful. Twenty-five (89%) of the twenty-eight knees had visible evidence of soft-tissue injury on inspection. Magnetic resonance imaging revealed evidence of some abnormality in twenty-five (93%) of twenty-seven knees, with effusion (37%), bone bruise (33%), and meniscal tear (30%) being the most common findings.

Conclusions: The present study provides evidence of a high rate of associated ipsilateral knee injuries in patients with a traumatic hip dislocation. Bone bruises may provide a plausible explanation for persistent knee pain following a traumatic hip dislocation. The liberal use of magnetic resonance imaging is recommended for the evaluation of these patients in order to detect injuries that may not be discoverable on the basis of a history and physical examination alone.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Senthil Nathan Sambandam
    Posted on June 18, 2005
    The Role of MRI in Evaluating Knee Injuries in Patients with High Energy Traumatic Ipsilateral Hip D
    University Hospital of North Staffordshire

    To the Editor:

    In their well conducted study, the authors have recommended the liberal use of MRI in evaluating injuries of the knee in patients with traumatic ipsilateral hip dislocation. We respectfully wish to make the following points regarding their findings and recommendations.

    The authors have made no mention about the number of instances in which their management plan was changed because of the identification of a knee injury, or the number of patients for whom such factors as the length of hospital stay,the need for continuing rehabilitation, or the clinical outcome was different because of the knee injury.

    Further, the authors have not identified any epidemiological, clinical, or radiological factors that should be viewed as indications for proceeding with MRI evaluation of the knee. Amazingly, the authors have made no mention about the use of a simple investigation like a plain radiograph which can identify injuries such as PCL avulsion.

    In this era of high velocity injury, we believe it is very unlikely to fracture a single bone or dislocate a single joint without suffering injuries to other bones, joints, or soft tissues. Another study has suggested the association of knee injuries and ipsilateral fracture of the femur(1). Hip dislocations and femoral fractures contribute a major proportion of lower limb fractures. Hence if we start using MRI of the knee liberally in such patients,we will end up identifying a large number of knee abnormalities without knowing their clinical significance or whether they were temporally related to the proximal trauma.

    Hence it would be better to be judicious about the use of MRI until we have more evidence about the outcomes of knee injuries associated with hip or femoral trauma in the form of meta-analysis, multicentered prospective trials, and long term follow- up studies.

    Reference

    1. Dickson KF, Galland MW, Barrack RL, Neitzschman HR, Harris MB, Myers L, Vrahas MS. Magnetic resonance imaging of the knee after ipsilateral femur fracture. J Orthop Trauma. 2002; 16:567-71.

    Yours sincerely,

    Mr. Senthil Nathan Sambandam

    Mr. Arif Gul

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