Edema, A.B. (2015) Optimaliseren van primaire diagnostiek bij knieluxaties. thesis, Medicine.
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Abstract
Background: Acute knee dislocation is rare but has a high rate of severe complications like neurovascular injuries. Especially the popliteal artery is at risk in knee dislocations with reported incidence from 7-32%. Despite this high rate of associated vascular injuries, evaluation of traumatic knee dislocations remains controversial. Vascular lesions are sometimes missed which can lead to major consequences for the frequently young patient. Aim: The purpose of this study is to determine if based on reliability, availability, sensitivity and specificity Computed Tomography Angiography (CTA) useful is to evaluate all knee dislocations Design: Retrospective cohort study Methods: Nineteen patients , who were diagnosed and treated for a knee dislocation or a multi-ligament knee in the University Medical Center Groningen (UMCG) in the period January 1997 to May 2015, were included in this study. Furthermore, forty-five patients from the Erasmus University Medical Center were included. The median age was 27 years. The patients who were treated in the UMCG were asked to fill in the subjective International Knee Documentation Committee (IKDC) questionnaire and the Walking Impairment Questionnaire (WIQ). They were also asked for a vascular and orthopedic research to measure the (vascular) function of the knee. Results: Ten patients (16%) of the sixty-four included patients were found to have vascular injury. Seventeen patients (27%) had neurologic injury. In 50% of all patients with acute vascular injury revascularization only started after 7 hours. High energy traumas (HET) were often seen in combination with vascular injury (21%) or neurologic injury (30%). Low energy traumas (LET) (sport injuries) were less often associated with vascular (4%) or neurologic (8%) injury. Knee dislocations after ultra-low energy trauma (ULET), in the morbidly obese, were very often associated with vascular (40%) or neurologic (80%) injury. Also dislocations with nerve injury (p=0,017) or tears of both cruciate ligaments or with a periarticular fracture (p=0,001) were associated with vascular injury. The objective scores and the subjective scores of the IKDC and WIQ were below normal, with a median IKDC score of 58 (range 11,5-75,9) and a median WIQ score of 0,89 (range 0,38-1,0). A correlation was found between the IKDC and the WIQ scores (p=0,000). The vascular research revealed no vascular lesions. Patients without a history of acute vascular injury had a mean IMT of the a. poplitea of 0,65 mm with a diameter of 6,4 mm. Conclusion: The high percentage of vascular injury and the enduring time between vascular injury and diagnosis shows the importance of a systematic approach for traumatic knee dislocations. CTA is useful to evaluate knee dislocations based on reliability, availability, sensitivity and specificity especially in the at-risk groups HET, ULET and in patients with neurologic defect.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Diercks, Prof. Dr. R.L. and Vainas, Dr. T. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:01 |
| Last Modified: | 25 Jun 2020 11:01 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2122 |
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