Management of a knee instability after ski trauma in a young woman​

• 32-year-old female​
• Occasional skier​
• Knee trauma skiing 3 years ago operated on with an anteromedial proximal tibial plate​
• Her main complaints are pain and subjective knee instability.

In view of the lateral radiography, which test(s) do you expect to be positive in your physical examination?

• ✔️ Reverse pivot shift test
• ✔️ Posterior sag sign

The lateral X-ray shows a posterior displacement of the tibia due to a PCL torn. In those cases, you should find a positive reverse pivot shift test and a posterior sag sign

^{Nielsen S, Helmig P. Posterior instability of the knee joint. An experimental study. Arch Orthop Trauma Surg (1978). 1986;105(2):121-5. doi: 10.1007/BF00455846. PMID: 3718189.}

Which type of surgery should be proposed to the patient?

• ✔️ Shiba osteotomy

A conservative treatment should be proposed for this very young patient even if a TKA may be a legitimate treatment according to other surgeons. No UKA should be proposed because of the PCL lesion.

^{Mody BS, Mody K. Arthroplasty in young adults: options, techniques, trends, and results. Curr Rev Musculoskelet Med. 2014 Jun;7(2):131-5. doi: 10.1007/s12178-014-9213-3. PMID: 24677185; PMCID: PMC4092200}

^{Kwon HM, Kang KT, Kim JH, Park KK. Medial unicompartmental knee arthroplasty to patients with a ligamentous deficiency can cause biomechanically poor outcomes. Knee Surg Sports Traumatol Arthrosc. 2020 Sep;28(9):2846-2853. doi: 10.1007/s00167-019-05636-7. Epub 2019 Jul 25. PMID: 31346669.}

In this case, our choice was to perform a shiba osteotomy (intra-articular osteotomy) thanks to a custom-made cutting guide (NEWCLIP), and a PCL reconstruction thanks to a posterior tibial tendon allograft.