Irreducible Knee Dislocation Associated with Interposition of medial structures: A Case Report
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Published:
Dec 27, 2025
Keywords:
Knee dislocation, dimple sign, vastus medialis
Main Article Content
Abstract
We report the case of a patient with an irreducible knee dislocation, multiligamentous injuries, and patellar dislocation following a fall into a ravine. The clinical examination revealed a positive dimple sign. Multiple attempts at closed reduction were unsuccess-ful, requiring an open reduction to expose and release the interposed structures, including the medial capsule, the patellofemoral ligament, and the vastus medialis oblique. A knee immobilizer was applied, and definitive surgery was deferred until soft-tissue conditions improved, at which time a staged multiligament reconstruction was performed, addressing the anterior and posterior cruciate ligaments and the posteromedial corner, with a favorable outcome.
Conclusion: Closed reduction should be attempted initially; however, if the medial structures remain entrapped, urgent open reduction is required. Ligament reconstruction is indicated when multiple ligaments are compromised, and the approach to anterior cruciate ligament reconstruction should be individualized based on the patient’s age, physiological status, and physical activity level. A thorough neurological and vascular evaluation is essential due to the risk of serious complications. This case is reported to highlight this uncommon presentation and the importance of open reduction to achieve proper alignment.
Conclusion: Closed reduction should be attempted initially; however, if the medial structures remain entrapped, urgent open reduction is required. Ligament reconstruction is indicated when multiple ligaments are compromised, and the approach to anterior cruciate ligament reconstruction should be individualized based on the patient’s age, physiological status, and physical activity level. A thorough neurological and vascular evaluation is essential due to the risk of serious complications. This case is reported to highlight this uncommon presentation and the importance of open reduction to achieve proper alignment.
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How to Cite
Londoño García, R., Cano González , M. Ángel, & Avendaño Arango, V. A. (2025). Irreducible Knee Dislocation Associated with Interposition of medial structures: A Case Report. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(6), 561-569. https://doi.org/10.15417/issn.1852-7434.2025.90.6.1780
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Case Presentations
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References
1. Malik SS, Osan JK, Aujla R, Aslam N, D’Alessandro P, MacDonald PB. A systematic review on management and
outcome of irreducible knee dislocations. Orthop Traumatol Surg Res 2022;108(8):103415.
https://doi.org/10.1016/j.otsr.2022.103415
2. Robertson A, Nutton RW, Keating JF. Dislocation of the knee. J Bone Joint Surg Br 2006;88(6):706-11.
https://doi.org/ 10.1302/0301-620X.88B6.17448
3. Brautigan B, Johnson DL. The epidemiology of knee dislocations. Clin Sports Med 2000;19(3):387-97.
https://doi.org/ 10.1016/s0278-5919(05)70213-1
4. Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am 1977;59(2):
236-9. PMID: 845209
5. Yu JS, Goodwin D, Salonen D, Pathria MN, Resnick D, Dardani M, et al. Complete dislocation of the knee: spectrum of associated soft-tissue injuries depicted by MR imaging. AJR Am J Roentgenol 1995;164(1):135-9.
https://doi.org/10.2214/ajr.164.1.7998526
6. Halvorson JJ, Anz A, Langfitt M, Deonanan JK, Scott A, Teasdall RD, et al. Vascular injury associated with extremity trauma: initial diagnosis and management. J Am Acad Orthop Surg 2011;19(8):495-504.
https://doi.org/10.5435/00124635-201108000-00005
7. Xu B, Xu H, Tu J, Guo R. Initial assessment and implications for surgery: The missed diagnosis of irreducible knee dislocation. J Knee Surg 2018;31(3):254-63. https://doi.org/10.1055/s-0037-1602135
8. Bistolfi A, Massazza G, Rosso F, Ventura S, Cenna E, Drocco L, et al. Non-reducible knee dislocation with
interposition of the vastus medialis muscle. J Orthop Traumatol 2011;12(2):115-8. https://doi.org/10.1007/s10195-011-0134-2
9. Gigante F, Lapera M, Zabala MP, Pesolani M, Serpone A. Conducta inicial en la luxación aguda de rodilla.
Nuestra experiencia de 20 años. Artroscopía 2016;23(2);61-9. Disponible en: https://revistarelart.com/edicionesanteriores/103-volumen-05-numero-1/volumen-23-numero-2/740-conducta-inicial-en-la-luxacion-aguda-de-rodillanuestra-experiencia-de-20-anos
10. Chirpaz-Cerbat JM, Rossi J, Mélère G, Martinez T. Luxation irréductible du genou par incarcération du plan
capsulo-ligamentaire médial. Rev Chir Orthop Réparatrice Appar Mot 2004;90(5):449-55. https://doi.org/10.1016/s0035-1040(04)70172-5
11. Gómez-Bermúdez S, Vanegas-Isaza D, Herrera-Almanza L, Roldán-Tabares M, Coronado-Magalhaes G, Fernández-Lopera J, et al. La lesión vascular asociada a la luxación de rodilla. Acta Ortop Mex 2021;35(2):226-35. Disponible en: https://www.medigraphic.com/pdfs/ortope/or-2021/or212t.pdf
12. Angan N, Feghiu B, Gheorghiu N, Feghiu V, Bahadoor MU. Irreducible knee dislocation with vastus medialis
muscle interposition: A case report. Cureus 2023; 15(1):e33409. https://doi.org/10.7759/cureus.33409
13. Jeevannavar SS, Shettar CM. “Pucker sign” an indicator of irreducible knee dislocation. BMJ Case Rep 2013;2013:bcr2013201279. https://doi.org/10.1136/bcr-2013-201279
14. Novoa Sierra B, Estrems Díaz V, Ribas García-Peñuela J, Brú Pomer A. Luxaciones de rodilla: revisión de 11 casos. Revista Española de Cirugía Osteoarticular 2015;50(262):123-7. Disponible en: http://hdl.handle.net/10550/47816
15. Levy BA, Fanelli GC, Whelan DB, Stannard JP, MacDonald PA, Boyd JL, et al. Controversies in the treatment of
knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg 2009;17(4):197-206.
https://doi.org/10.5435/00124635-200904000-00001
16. Reckling FW, Peltier LF. Acute knee dislocations and their complications. Clin Orthop Relat Res 2004;(422):135-
41. https://doi.org/10.1097/01.blo.0000131737.72363.7e
17. Schmicker T, Kocher T, Patel T, Lycans D. Closed reduction of an irreducible knee dislocation: A case report. J
Orthop Case Rep 2020;10(7):6-10. https://doi.org/10.13107/jocr.2020.v10.i07.1894
18. Malik SS, MacDonald PB. The irreducible knee dislocation. J Knee Surg 2020;33(4):328-34.
https://doi.org/10.1055/s-0039-1698749
19. Peskun CJ, Whelan DB. Outcomes of operative and nonoperative treatment of multiligament knee injuries: an
evidence-based review. Sports Med Arthrosc Rev 2011;19(2):167-73. https://doi.org/10.1097/JSA.0b013e3182107d5f
20. Clark SJ, Engebretsen L. Surgical treatment of acute knee dislocations. Tech Knee Surg 2011;10(1):28-36. Disponible en: https://static1.squarespace.com/static/5ed520fd462f3329f89fd0fc/t/5ef21490dbdf86701
2b56769/1592923281696/ClarkandEngebretsen.pdf
21. Pache S, Vázquez JM, Chahla J, Moatshe G, LaPrade RF. Irreducible posterolateral knee dislocation: A case report. JBJS Case Connect 2023;13(1). https://doi.org/10.2106/JBJS.CC.22.00792
22. Plancher KD, Siliski J. Long-term functional results and complications in patients with knee dislocations. J Knee Surg 2008;21(04):261-8. https://doi.org/10.1055/s-0030-1247829
outcome of irreducible knee dislocations. Orthop Traumatol Surg Res 2022;108(8):103415.
https://doi.org/10.1016/j.otsr.2022.103415
2. Robertson A, Nutton RW, Keating JF. Dislocation of the knee. J Bone Joint Surg Br 2006;88(6):706-11.
https://doi.org/ 10.1302/0301-620X.88B6.17448
3. Brautigan B, Johnson DL. The epidemiology of knee dislocations. Clin Sports Med 2000;19(3):387-97.
https://doi.org/ 10.1016/s0278-5919(05)70213-1
4. Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am 1977;59(2):
236-9. PMID: 845209
5. Yu JS, Goodwin D, Salonen D, Pathria MN, Resnick D, Dardani M, et al. Complete dislocation of the knee: spectrum of associated soft-tissue injuries depicted by MR imaging. AJR Am J Roentgenol 1995;164(1):135-9.
https://doi.org/10.2214/ajr.164.1.7998526
6. Halvorson JJ, Anz A, Langfitt M, Deonanan JK, Scott A, Teasdall RD, et al. Vascular injury associated with extremity trauma: initial diagnosis and management. J Am Acad Orthop Surg 2011;19(8):495-504.
https://doi.org/10.5435/00124635-201108000-00005
7. Xu B, Xu H, Tu J, Guo R. Initial assessment and implications for surgery: The missed diagnosis of irreducible knee dislocation. J Knee Surg 2018;31(3):254-63. https://doi.org/10.1055/s-0037-1602135
8. Bistolfi A, Massazza G, Rosso F, Ventura S, Cenna E, Drocco L, et al. Non-reducible knee dislocation with
interposition of the vastus medialis muscle. J Orthop Traumatol 2011;12(2):115-8. https://doi.org/10.1007/s10195-011-0134-2
9. Gigante F, Lapera M, Zabala MP, Pesolani M, Serpone A. Conducta inicial en la luxación aguda de rodilla.
Nuestra experiencia de 20 años. Artroscopía 2016;23(2);61-9. Disponible en: https://revistarelart.com/edicionesanteriores/103-volumen-05-numero-1/volumen-23-numero-2/740-conducta-inicial-en-la-luxacion-aguda-de-rodillanuestra-experiencia-de-20-anos
10. Chirpaz-Cerbat JM, Rossi J, Mélère G, Martinez T. Luxation irréductible du genou par incarcération du plan
capsulo-ligamentaire médial. Rev Chir Orthop Réparatrice Appar Mot 2004;90(5):449-55. https://doi.org/10.1016/s0035-1040(04)70172-5
11. Gómez-Bermúdez S, Vanegas-Isaza D, Herrera-Almanza L, Roldán-Tabares M, Coronado-Magalhaes G, Fernández-Lopera J, et al. La lesión vascular asociada a la luxación de rodilla. Acta Ortop Mex 2021;35(2):226-35. Disponible en: https://www.medigraphic.com/pdfs/ortope/or-2021/or212t.pdf
12. Angan N, Feghiu B, Gheorghiu N, Feghiu V, Bahadoor MU. Irreducible knee dislocation with vastus medialis
muscle interposition: A case report. Cureus 2023; 15(1):e33409. https://doi.org/10.7759/cureus.33409
13. Jeevannavar SS, Shettar CM. “Pucker sign” an indicator of irreducible knee dislocation. BMJ Case Rep 2013;2013:bcr2013201279. https://doi.org/10.1136/bcr-2013-201279
14. Novoa Sierra B, Estrems Díaz V, Ribas García-Peñuela J, Brú Pomer A. Luxaciones de rodilla: revisión de 11 casos. Revista Española de Cirugía Osteoarticular 2015;50(262):123-7. Disponible en: http://hdl.handle.net/10550/47816
15. Levy BA, Fanelli GC, Whelan DB, Stannard JP, MacDonald PA, Boyd JL, et al. Controversies in the treatment of
knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg 2009;17(4):197-206.
https://doi.org/10.5435/00124635-200904000-00001
16. Reckling FW, Peltier LF. Acute knee dislocations and their complications. Clin Orthop Relat Res 2004;(422):135-
41. https://doi.org/10.1097/01.blo.0000131737.72363.7e
17. Schmicker T, Kocher T, Patel T, Lycans D. Closed reduction of an irreducible knee dislocation: A case report. J
Orthop Case Rep 2020;10(7):6-10. https://doi.org/10.13107/jocr.2020.v10.i07.1894
18. Malik SS, MacDonald PB. The irreducible knee dislocation. J Knee Surg 2020;33(4):328-34.
https://doi.org/10.1055/s-0039-1698749
19. Peskun CJ, Whelan DB. Outcomes of operative and nonoperative treatment of multiligament knee injuries: an
evidence-based review. Sports Med Arthrosc Rev 2011;19(2):167-73. https://doi.org/10.1097/JSA.0b013e3182107d5f
20. Clark SJ, Engebretsen L. Surgical treatment of acute knee dislocations. Tech Knee Surg 2011;10(1):28-36. Disponible en: https://static1.squarespace.com/static/5ed520fd462f3329f89fd0fc/t/5ef21490dbdf86701
2b56769/1592923281696/ClarkandEngebretsen.pdf
21. Pache S, Vázquez JM, Chahla J, Moatshe G, LaPrade RF. Irreducible posterolateral knee dislocation: A case report. JBJS Case Connect 2023;13(1). https://doi.org/10.2106/JBJS.CC.22.00792
22. Plancher KD, Siliski J. Long-term functional results and complications in patients with knee dislocations. J Knee Surg 2008;21(04):261-8. https://doi.org/10.1055/s-0030-1247829