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14 Feb 2023
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Schatzker II split depression with complete meniscocapsular separation

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Clinical Details

Clinical and radiological findings:  66yo F who sustained a fall whilst hiking. An otherwise fit and active woman, this was an isolated closed injury with minimal to know soft tissue injury, and unremarkable NV examination. Initial swelling was significant, delaying definitive operative management pending improvement of local soft tissue conditions. In addition to a standard preoperative CT, the patient also received an MRI, which demonstrated intact ligamental structures, but a complete peripheral lateral meniscocapsular dissociation. both anterior an posterior roots were intact.

Preoperative Plan

Planning remarks:  Planned approach is a classical anterolateral incision, with the intention to open book the lateral split fragment, and directly address the articular depression. Sequential reassembly of the plateau from central to peripheral, utilising inside-out wires, before "closing the door" and applying a lateral plate. Depending on fragment constellation, fragment specific screw rafting, or plate bound screw rafting would be considered to support the reconstructed surface. no additional medial approach was planned.

Surgical Discussion

Patient positioning:  Supine, with a carbon roll placed under the thigh allowing resting intraop flexion of 20-30deg

Anatomical surgical approach:  Longitudinal anterolateral approach, splitting ITB with subperiosteal elevation from Gerdy's

Operative remarks: 

Intraoperative course followed the preoperative plan. There were a significant number of independent depressed fragments extending into the lateral aspect of the eminentia. These required individual reconstruction, sequentially resulting in a large number of inside-out wires supporting the various stages of reconstruction. I had little faith that these stacked pieces would remain in place on removal of the wires - so augmented the temporary wire fixation with PLLA wire subchondral rafting spanning multiple pieces. This PLLA raft construct was then supported by graft and locked screw rafting once the 'door was closed' with reduction of the lateral splat fragment.

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Dr Ed Oates
  • Germany , Schleswig Holstein
  • Area of Specialty - General Trauma
  • Position - Specialist Consultant
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