Knee dislocation in touch rugby: a case study.

On Initial Examinations: Tender swollen left knee, with difficulty examining ligaments due to pain but ligaments appear intact. Intact sensation distal to knee, but unable to palpate distal pulses. Investigation: X-ray NAD Initial Diagnosis: Patella Dislocation with ?vascular injury Initial Plan: Referred to Orthopaedics. Subsequent Examination: Painful swollen knee and calf, 2cm circumference difference left to right. No palpable pulses. Pain on passive extension of toes. Diagnosis: Dislocated left knee with Popliteal artery disruption and acute compartment syndrome. Listed for Immediate Surgery. Initial Surgical Findings and Treatment: Knee, complete disruption of all four ligaments, no bony injury. Intimal tear to popliteal artery and vein with large haemotoma around popliteal artery. Sciatic Nerve explored and found to be intact. Marked compartment syndrome all four compartments. Knee stabilised with external fixator, reverse saphenous graft and vascular repair performed. Four compartment fasciotomies. Subsequent Medical Issues: Rhabdomyolysis requiring HDU treatment. Subsequent Surgical Intervention: Delayed primary closure and split skin grafts to fasciotomy wounds. Delayed Left knee reconstruction. Outcome: Not able to play rugby but walking with minimal pain and stable knee.