Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent operating table, with the right leg in an arthroscopy leg holder allowing intraoperative knee flexion to approximately 100 degrees

Anatomical surgical approach:  A three-centimeter incision was made over the lateral aspect of the inferior knee joint, inferior to Gerdy's tubercle. The fascia overlying the tibialis anterior was incised, followed by creation of an 8x8mm cortical window. A curved bone tamp was used under fluoroscopic guidance to elevate the posterolateral corner, achieving anatomic reduction.

The posterolateral corner reduction was secured with a 4.0mm cannulated screw anterior to posterior, supported by a second lateral to medial screw. The metaphyseal defect was filled with Vitoss bone void filler. Arthroscopy revealed mild degenerative changes in the medial meniscus and a complete femoral side ACL rupture, which was debrided. A semitendinosus graft was harvested and prepared for ACL reconstruction, which was performed arthroscopically with an endobutton and interference screw fixation.

Postoperative protocol:   Postoperative rehabilitation included immediate ROM in a knee orthosis. 20kg weight-bearing was initiated early, with progressive range of motion exercises under physiotherapist guidance. WBAT is anticipated at 6 weeks