Acute Management of Pediatric Knee Dislocations

Abstract

Although pediatric knee dislocations are relatively uncommon, the potential for devastating complications exists. Current treatment has largely been guided by the adult literature as well as small pediatric case series. Early recognition and treatment of vascular injuries is of the utmost importance. Neurological injuries can also lead to devastating long-term complications and therefore prompt recognition is crucial. Ligament reconstruction as opposed to ligament repair has been shown to have improved outcomes in the pediatric population. The subsequent rehabilitation of a child after reconstruction for a knee dislocation also provides a unique challenge. Various sequelae have been described to include neurovascular injuries, residual laxity, and stiffness as well as those unique to pediatric patients such as growth disturbance. Key Concepts: • Prompt recognition and reduction of a knee dislocation are imperative. • Thorough and prompt neurovascular physical examination and consideration of advanced vascular imaging should be performed with any knee dislocation • After an initial period of immobilization and rehabilitation, stress radiographs play an important role to quantify laxity and guide treatment. • Ligament reconstruction has been shown to be superior to repair.