Evaluation and Management of Knee Dislocations in Low-income Settings: Evidence-based Strategies and Practical Considerations.

Knee dislocations are rare but severe injuries, often resulting from high-energy trauma and commonly associated with vascular and neurologic damage. In low-income settings, the evaluation and management of these injuries are especially challenging because of limited access to advanced imaging, surgical implants, and structured rehabilitation services. This review aims to provide a practical, evidence-based framework for managing knee dislocations in resource-constrained environments. A focused literature review was conducted on studies published in the past decade that address diagnosis, treatment strategies, and system-level barriers in underserved regions. Key topics include simplified diagnostic approaches using clinical evaluation and basic imaging, early detection of vascular and nerve injuries without advanced tools, and cost-effective surgical techniques. These include the use of autografts, external fixators, and implantless fixation methods such as press-fit and bone bridges, as well as the use of the same tunnels and fixation devices for more than one ligament. Rehabilitation strategies are also adapted, with emphasis on simplified protocols that consider social and logistical barriers to follow-up. Despite notable limitations, appropriate prioritization, creative use of available materials, and staged reconstructions can ensure acceptable outcomes. This article offers orthopaedic surgeons working in low-resource environments practical guidance to maintain standards of care through adaptable, cost-conscious decision-making.