1. Treatment of knee DX Initial management - Vascular inj - Open DX - Irreducible DX - Compartment syn

3. Vascular Injury Palpable pulses alone do not rule out a significant vascular inj Screening for all knee DX (documented & suspected ) recommended ABI > 0.9 means 100% negative predictive value for major Vascular inj ABI < 0.9 means more screening (CT angiogram)

4. Treatment Operative Conservative -superiority of Operative to conservative TX (ROM, functional outcome, stability, return to sport & work ) 32 studies after 2000 peskun et al;

5. Conservative treatment Indications - Comorbidity (head inj-soft tissue problem ) - Old patient (osteoporosis- DJD ) - Skeletally immature patients

6. Conservative treatment Reduction Immobilization 3-6 wk in full Ext ( cast, splint or Ext Fix ; if can not maintain reduction ) Rehabilitation

7. Operative treatment Early (1-3 wk ) ( repair & augmentation ) -Avulsion FX -Stener lesion -Flipped or displased meniscal tear preventing ROM Delayed ( more than 3 wk ) ( reconstruction )

8. Operative treatment Stress x-ray under fluoroscopic imaging - side to side diference ; Lat > 2.7 mm = isolated FCL > 4 mm = FCL, PLC ; Med > 4 mm =isolated MCL > 10 mm = MCL; PMC Arthroscopy for all patient ( meniscal,chondral, loose body ) Tourniquet is applied but rarely inflated

9. Operative treatment (KD classification) KD 2 ( ACL - PCL without Med & Lat ) - delayed OP ( 6-8 wk after inj )

10. Operative treatment (KD classification) KD 3 M (distal tear ) ( stener lesion ) - early op ( MCL repair- ACL & PCL recons ) MCL repair (prox on Tib by anchor in full Ext & dist on Tib by screw –washer in 30 deg Flex )

12. Operative treatment (KD classification) KD 3 M ( MCL mid substance ) - repair is not effective -delayed ( 6-8 wk ) ACL-PCL –MCL recons

13. Operative treatment (KD classification) KD 3 M ( prox ) - hinge knee brace ( 6-8 wk ) then ; If – Med stable ; ACL- PCL recons If – Med lax ; ACL-PCL –MCL recons

14. Operative treatment (KD classification) KD 3 M ( very extensive ) - stage 1 ( Med repair & augmentation with allograft ) - stage 2 (delayed (6-8 wk ) ACL- PCL recons )

15. Operative treatment (KD classification) KD 3 L (avulsion of fibular head ) -early fixation of avulsion & ACL- PCL recons - if quality of tissue or repair is not good go to augmentation

17. Operative treatment (KD classification) KD3 L ( mid substance & prox ) - delayed ACL-PCL –Lat recons

19. Operative treatment (KD classification) KD 4 ( global instability ) - if Med or Lat are reparable - stage 1 ; early repair of Med & Lat - stage 2 ; delyed ACL-PCL recons -if Med or Lat are not reparable - delayed all Lig recons

20. FX-DX As a general rule -stage 1 ; FX fixation and after bone healing - stage 2 ; delayed Lig recons