Does the Pulse Examination in Patients with Traumatic Knee Dislocation Predict a Surgical Arterial Injury? A Meta-analysis

Abstract

This systematic review aimed at evaluating the diagnostic accuracy of pulse examination in detecting surgical arterial lesions associated with knee dislocation. MEDLINE, CINAHL, and SportDiscus databases were searched in all languages to review articles concerning human knee dislocation and associated vascular injuries. We reviewed 116 articles. Seven met our inclusion criteria, providing detailed data on 284 injuries. Pooled data demonstrated that abnormal pedal pulses present a sensitivity of 0.79 (95% confidence interval [CI], 0.64–0.89), a specificity of 0.91 (95% CI 0.78–0.96), a positive predictive value of 0.75 (95% CI, 0.61–0.83), and a negative predictive value of 0.93 (95% CI, 0.85– .96). Our findings suggest that the isolated presence of abnormal pedal pulses on initial examination of patients with knee dislocations is not sensitive enough to detect a surgical vascular injury. On the basis of this meta-analysis, an algorithm for the evaluation of these patients is presented.