Transcript Treatment of knee DX
Treatment of knee DX
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Initial management
- Vascular inj - Open DX - Irreducible DX - Compartment syn
Vascular Injury
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Palpable pulses alone do not rule out a significant vascular inj
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Screening for all knee DX (documented & suspected ) recommended
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ABI > 0.9 means 100% negative predictive value for major Vascular inj
ABI < 0.9 means more screening (CT angiogram)
Treatment
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Operative Conservative
-superiority of Operative to conservative TX
(ROM, functional outcome, stability, return to sport & work )
32 studies after 2000
peskun et al;
Conservative treatment
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Indications
- Comorbidity (head inj-soft tissue problem ) - Old patient (osteoporosis- DJD ) - Skeletally immature patients
Conservative treatment
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Reduction
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Immobilization 3-6 wk in full Ext ( cast, splint or Ext Fix ; if can not maintain reduction )
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Rehabilitation
Operative treatment
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Early
(1-3 wk ) ( repair & augmentation ) -Avulsion FX -Stener lesion -Flipped or displased meniscal tear preventing ROM
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Delayed
( more than 3 wk ) ( reconstruction )
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
body ) for all patient ( meniscal,chondral, loose
Tourniquet
is applied but rarely inflated
Operative treatment
(KD classification)
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KD 2
( ACL - PCL without Med & Lat )
- delayed OP
( 6-8 wk after inj )
Operative treatment
(KD classification)
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KD 3 M
(distal tear ) ( stener lesion )
- early op
( MCL repair- ACL & PCL recons )
MCL repair (prox on Tib
dist on Tib
by anchor in full Ext by screw –washer in 30 deg Flex
) &
Operative treatment
(KD classification)
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KD 3 M
( MCL mid substance )
- repair is not effective
-delayed ( 6-8 wk ) ACL-PCL –MCL recons
Operative treatment
(KD classification)
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KD 3 M
( prox )
- hinge knee brace ( 6-8 wk ) then ;
If – Med stable ; ACL- PCL recons If – Med lax ; ACL-PCL –MCL recons
Operative treatment
(KD classification)
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KD 3 M
( very extensive ) - stage 1 ( Med repair & augmentation with allograft ) - stage 2 (delayed (6-8 wk ) ACL- PCL recons )
Operative treatment
(KD classification)
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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
Operative treatment
(KD classification)
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KD3 L
( mid substance & prox ) - delayed ACL-PCL –Lat recons
Operative treatment
(KD classification)
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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
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As a general rule
FX-DX
-stage 1 ; FX fixation and after bone healing - stage 2 ; delayed Lig recons