Lesión vascular oculta tras luxación traumática de rodilla: diagnóstico precoz, revascularización urgente y manejo anestésico perioperatorio

Kevin Eduardo Macias-Narvaez; Carlos Patricio Sánchez-Macas; Alejandro Israel Valle-Castillo; Nataly Madeley Gadvay-Bonilla

Authors

Macias-Narvaez Kevin Eduardo Médico General, Machala. El Oro, Ecuador. https://orcid.org/0009-0000-3745-1647
Sánchez-Macas Carlos Patricio Médico General, Loja, Ecuador. https://orcid.org/0000-0002-3071-3728
Valle-Castillo Alejandro Israel Médico General, Hospital Manuel Ygnacio Monteros – IESS. Loja, Ecuador. https://orcid.org/0009-0009-3954-2767
Gadvay-Bonilla Nataly Madeley Médico General en funciones hospitalarias, Hospital del IESS Quito Sur. Ecuador.

Keywords:

knee dislocation; popliteal artery; vascular injury; ankle-brachial index; CT angiography; revascularization; anesthesia; reperfusion; hyperkalemia; compartment syndrome

Abstract

DOI: https://doi.org/10.46296/gt.v9i18.0393

Abstract

Background: Traumatic tibiofemoral dislocation may injure the popliteal artery through stretching, intimal disruption, thrombosis, or transection. Spontaneous reduction and collateral circulation may preserve distal pulses and delay recognition. When ischemia is present, urgent revascularization introduces anesthetic challenges related to trauma, bleeding, and reperfusion syndrome. Objective: To integrate evidence on early diagnosis of occult vascular injury, urgent revascularization strategies, and perioperative anesthetic considerations in traumatic knee dislocation. Methods: A qualitative systematic review of PubMed/MEDLINE through September 1, 2026 was complemented by reference tracking and a focused search on anesthesia, vascular trauma, reperfusion, and compartment syndrome. Systematic reviews, cohorts, guidelines, case reports, and case series providing relevant diagnostic, therapeutic, or perioperative information were included. Owing to clinical and methodological heterogeneity, a narrative synthesis without meta-analysis was performed. Results: Clinical reviews report vascular injury in approximately 10.7%-18% of selected knee dislocations, whereas contemporary administrative datasets report lower rates. In a 110-patient cohort, the combination of palpable dorsalis pedis/posterior tibial pulses and an ankle-brachial index ≥0.9 achieved 100% sensitivity and a 100% negative predictive value for major vascular injury. Case reports demonstrate that popliteal thrombosis may coexist with preserved distal pulses or a spontaneously reduced knee. Anesthetic priorities include hemostatic resuscitation, hemodynamically stable induction, risk-adapted monitoring, preparation for reperfusion, serial potassium/acid-base assessment, temperature control, and surveillance for compartment syndrome. Regional analgesia may be selectively used, while avoiding dense prolonged blocks in patients at risk for compartment syndrome and ensuring structured postoperative surveillance. Conclusions: Occult vascular injury after knee dislocation requires protocolized serial vascular examination, ankle-brachial index testing, and selective CT angiography. Revascularization should not be delayed, and the anesthetic plan should explicitly address trauma physiology and reperfusion risk. Multidisciplinary coordination is essential for limb salvage and systemic safety.

Keywords: knee dislocation; popliteal artery; vascular injury; ankle-brachial index; CT angiography; revascularization; anesthesia; reperfusion; hyperkalemia; compartment syndrome.

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