The Knee

Lacerations to the knee are under marked active tension. The wound should be examined through range of motion, checking for the integrity of all ligamentous structures (Fig,.,40:9). If joint capsule involvement is suspected, approximately 60 ml NS should be injected in a sterile fashion at a site separate from the wound to assess for leakage. The common peroneal nerve is prone to injury as it runs over the head of the fibula laterally, and distal function should be assessed. Deep popliteal wounds can injure the popliteal artery and tibial nerve. Distal pulses and nerve function should be documented prior to anesthetic administration and closure. Popliteal artery injury requires emergent angiography and vascular surgery consultation because the leg has minimal collateral circulation distal to the knee. Skin can be closed with 4-0 nonabsorbable material, using simple interrupted or horizontal mattress sutures. Skin staples are an alternative in patients subject to poor wound healing. The knee should be splinted or placed in a knee immobilizer to decrease active tension and promote better wound healing.

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