PMC9899122_01
Physical examination of the right knee at the time of presentation.. Valgus deformity and protrusion of the medial femoral condyle (1a) and at 90 degrees of knee flexion (1b).
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FIG1
Initial inspection revealed an abnormal right knee contour characterized by a medial prominence above the knee, flexion, and valgus deviation of the knee (Figure 1).
Anteroposterior and lateral radiographs of the right knee.
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FIG2
Before the injury, the patient had mild chronic pain in the right knee, a range of motion from 20 to 120 degrees, and on X-ray, there were femoral osteophytes and subchondral sclerosis (Figure 2). Plain radiographs confirmed the diagnosis of posterolateral KD without any fracture (Figure 2).
Physical examination after attempting a closed reduction in the operating theater.. Preinjury alignment of the leg was achieved (~20 degrees of extension deficit and no valgus deformity).
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FIG3
Knee extension deficit (~20 degrees) (Figure 3), tibia subluxation, and widening of the medial tibiofemoral compartment were observed on C-arm radiographs (Figure 4).
Anteroposterior and lateral radiographs showing posterolateral subluxation and medial tibiofemoral compartment widening.
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FIG4
Knee extension deficit (~20 degrees) (Figure 3), tibia subluxation, and widening of the medial tibiofemoral compartment were observed on C-arm radiographs (Figure 4).
Anteroposterior and lateral view after close reduction of the right knee (in cast).
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FIG5
The following day, a check X-ray was performed which showed valgus deformity and subluxated knee (Figure 5).
Skin pucker containing a recess at the level of the joint line, dimple sign, medial view.
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FIG6
Skin pucker containing a recess at the level of the joint line, dimple sign, anterior view.
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FIG7
Intraoperative views demonstrating the buttonholded medial condyle.. Before (a) and after (b) vastus medialis muscle release. Intraoperative views demonstrating the buttonholded medial condyle through the vastus medialis muscle belly.. a: vastus medialis muscle belly; b: tibia; c: anterior cruciate ligament; d: medial femoral condyle; e: posterior cruciate ligament
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FIG8
The incarcerated vastus medialis muscle belly was reduced from the notch and the medial femoral condyle (Figure 8a) using as a lever Cobb's elevator. This restored the alignment and mobility of the joint and gave a better perspective of the capsular and ligamentous lesions (Figure 8b).
Temporary stabilization using K-wires and cast immobilization of the right knee, anteroposterior and lateral radiographs.
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FIG9
After reduction, knee stabilization was performed using two crossed 2.5 mm K-wires passed from the distal femur to the proximal tibia (Figure 9).