Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with a bump under the ipsilateral hip to allow for slight external rotation of the limb, facilitating access to both medial and lateral aspects of the knee.

Anatomical surgical approach:  A posteromedial approach was utilized, with the incision starting at the medial aspect of the popliteal fossa and extending distally along the medial border of the tibia. Subperiosteal dissection was performed to expose the posterior and medial tibial plateau. The anterolateral approach involved a standard incision along the Gerdy's tubercle, extending distally to expose the lateral plateau.

Intraoperatively, significant comminution of the anterior articular surface was noted, necessitating meticulous reconstruction with subchondral support. The posterior tension failure provided a reliable reduction landmark, allowing for effective stabilization with a tensioned plate. Restoration of the native tibial slope was achieved through careful alignment and fixation of both medial and lateral constructs. The anterior buttress plate was positioned more anteriorly than conventional placements to counteract potential deformity recurrence.

Postoperative protocol:   Postoperatively, the patient was placed in a hinged knee brace allowing for controlled range of motion exercises starting at 0-30 degrees in the first two weeks. Weight-bearing was restricted to toe-touch for six weeks, progressing to partial weight-bearing as tolerated thereafter.

Follow up:   Not specified

Orthopaedic implants used:   Posterior tensioned plate, anterolateral buttress plate, subchondral support screws.