S'abonner

Vascular lesions associated with bicruciate and knee dislocation ligamentous injury - 09/12/09

Doi : 10.1016/j.otsr.2009.10.002 
P. Boisrenoult a, , S. Lustig b, P. Bonneviale c, E. Leray d, G. Versier e, P. Neyret b, P. Rosset f, D. Saragaglia g

the French Society of Orthopedic Surgery and Traumatology (SOFCOT)h

a Orthopedic Surgery and Traumatology Department, Versailles Hospital, 177, rue de Versailles, 78150 Versailles, France 
b Albert Trillat Sports Medicine Center, centre Livet, 8, rue de Margnolles, 69300 Lyon-Caluire, France 
c Orthopedic Surgery and Traumatology Department, Purpan Teaching Hospital, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France 
d Public Health Department, Rennes Medical School, 2, avenue Léon-Bernard, 35043 Rennes cedex, France 
e Orthopedic Surgery and Traumatology Department, Begin Hospital, 69, avenue de Paris, 94160 Saint-Mandé, France 
f Orthopedic Surgery and Traumatology Department, Tours Teaching Hospital, 37044 Tours cedex 9, France 
g Orthopedic Surgery and Traumatology Department, hôpital Sud, Grenoble Teaching Hospital, BP 185, 38042 Grenoble cedex 9, France 
h 56, rue Boissonade, 75014 Paris, France 

Corresponding author. Tel.: +33 139639566.

Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.

Connectez-vous pour en bénéficier!

Summary

Introduction

The incidence of associated vascular lesions in biligamentous cruciate injuries of the knee ranges from 16 to 64%, with a mean rate of 30%. Treatment of ischemic vascular lesions associated with ligaments injury is well established, comprising emergency arterial vascular repair, most of the times combined to external fixation. In the absence of clinical symptoms of vascular lesion, some authors recommend systematically performing arteriography, while others advocate selectively prescribing this examination in doubtful clinical situations. The present study analyzed data extracted from the prospective series of the 2008 SOFCOT Symposium (dedicated to management of bicruciate knee lesions) and from an analysis of the literature, with emphasis on developing a diagnostic strategy for vascular lesions associated with bicruciate lesions.

Material and methods

This multicenter prospective study included all patients treated in the reference centers for dislocation or bicruciate lesion of the knee between January 2007 and January 2008. All patients underwent early objective vascular imaging.

Results

Sixty-seven patients were included. Mean dislocation reduction time was 2hrs45min (max, 21 hrs). There were nine vascular lesions (12%). Absence of vascular lesion could be confirmed in 58 of the 59 patients exhibiting presence of peripheral pulses at initial examination. In one case, a vascular lesion was found on early imaging, but with no clinical consequence. In all eight cases with associated clinical pulse abnormality, complementary vascular check-up confirmed the presence of a vascular lesion. Angioscan induced no error of vascular assessment in this series, with no false positives or false negatives. One patient underwent amputation for critical ischemia. Three patients had vascular surgical treatment, two not undergoing secondary ligament surgery. Four of the five patients whose vascular lesion was conservatively managed by simple observation were able to undergo the scheduled treatment for their ligament lesions.

Discussion

At initial examination, it is essential to look for the peripheral pulse. In case of ischemic syndrome, the priority is a revascularization procedure associated to intraoperative arteriography. In case of abnormal pulse without obvious ischemia, emergency imaging (usually arteriogram or angioscan) is essential. Where there is no initial clinical vascular abnormality, good practice is less clearly cut. Initially, present pulses are found in a mean 30% (17–55%) of cases of popliteal artery lesion, according to the series. Different authors draw diverging conclusions from this fact. For some, the absence of frank abnormality on clinical examination is sufficient to exclude not any possible anatomic vascular lesion but any vascular lesion requiring surgery. However, even without pulse abnormality, we consider systematic imaging to be justified, partly by the difficulty of ensuring strict monitoring, and partly by the decompensation risk of clinically asymptomatic intimal lesions during the ligament surgery under consideration in most cases. Although many authors cling to the dogma of late emergency arteriography, recent reports argue against this attitude. Angio-MRI has good diagnostic value, but in practice is difficult to obtain in emergency. We would rather advocate angioscanning, which is easily available in emergency and does not incur the risk of local complication associated with arteriography.

Type of study

Prospective continuous. Level IV.

Le texte complet de cet article est disponible en PDF.

Keywords : Knee, Dislocation, Multiligament knee injury, Vascular lesions


Plan


© 2009  Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Vol 95 - N° 8

P. 621-626 - décembre 2009 Retour au numéro
Article précédent Article précédent
  • Dislocation and bicruciate lesions of the knee: Epidemiology and acute stage assessment in a prospective series
  • S. Lustig, E. Leray, P. Boisrenoult, C. Trojani, P. Laffargue, D. Saragaglia, P. Rosset, P. Neyret
| Article suivant Article suivant
  • Bicruciate ligament lesions and dislocation of the knee: Mechanisms and classification
  • S. Boisgard, G. Versier, S. Descamps, S. Lustig, C. Trojani, P. Rosset, D. Saragaglia, P. Neyret

Bienvenue sur EM-consulte, la référence des professionnels de santé.

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.


Tout le contenu de ce site: Copyright © 2025 Elsevier, ses concédants de licence et ses contributeurs. Tout les droits sont réservés, y compris ceux relatifs à l'exploration de textes et de données, a la formation en IA et aux technologies similaires. Pour tout contenu en libre accès, les conditions de licence Creative Commons s'appliquent.