Knee dislocations (KDs) are frequently found in high-energy impact injuries, ranging from automobile accidents to contact sports. KDs require careful examination due to the limb-threatening nature of these injuries. A key examination in any KD comprises a proper assessment of the vascular status. The risk of popliteal artery injury with a KD has varied from 7 to 40%, with more contemporary studies reporting injury in the range of 7 to 15%. The notion of mandatory emergent arteriography was challenged in the trauma literature as several small retrospective studies suggested that selective arteriography was a safe and effective treatment protocol. New imaging modalities have evolved and have found their way into trauma surgery. Computed tomography angiography and magnetic resonance angiography are two contemporary imaging modalities that have different characteristics as well as availability. Arteriography has been the gold standard and is a reliable and proven method of evaluation. However, it has a number of negative aspects that must be considered when determining the ideal imaging for a patient following KD. Besides cost savings of about more than US$500,000, conventional arteriography, which comprises the use of X-ray, arterial puncture and cannulation, and the use of contrast agents containing iodine, has got a complication rate as high as 9% and more patient discomfort compared with the new imaging modalities. This clinical practice review documents that our algorithm of clinical examination first combined with advanced imaging in cases with abnormalities documented on examination is a safe and prudent policy in treating patients following KD.
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