Is it safe to reconstruct the knee Anterolateral Ligament with a femoral tunnel? Frequency of Lateral Collateral Ligament and Popliteus Tendon injury

2015 ◽  
Vol 40 (4) ◽  
pp. 821-825 ◽  
Author(s):  
Camilo Partezani Helito ◽  
Marcelo Batista Bonadio ◽  
Riccardo Gomes Gobbi ◽  
Roberto Freire da Mota e Albuquerque ◽  
José Ricardo Pécora ◽  
...  
Keyword(s):  
Femoral Tunnel ◽  
Lateral Collateral Ligament ◽  
Tendon Injury ◽  
Anterolateral Ligament ◽  
Popliteus Tendon ◽  
Collateral Ligament

scholarly journals ANATOMICAL STUDY OF THE POSTEROLATERAL LIGAMENT COMPLEX OF THE KNEE: LCL AND POPLITEUS TENDON

2021 ◽  
Vol 29 (5) ◽  
pp. 249-252
Author(s):  
MARCEL FARACO SOBRADO ◽  
CAMILO PARTEZANI HELITO ◽  
LUCAS DA PONTE MELO ◽  
ANDRE MARANGONI ASPERTI ◽  
RICCARDO GOMES GOBBI ◽  
...  
Keyword(s):  
Lateral Collateral Ligament ◽  
Anatomical Study ◽  
Population Level ◽  
Mixed Population ◽  
Popliteus Tendon ◽  
Anthropometric Data ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Diagnostic Studies

ABSTRACT Objective: To analyse the distances between the femoral insertions of the popliteus tendon (PT) and the lateral collateral ligament (LCL) through dissections of cadaveric specimens in a mixed population. Methods: Fresh cadavers were dissected, and the anthropometric data of all specimens were recorded. The distances from the origin of the PT to the LCL in the femoral region and the diameter of each structure were measured using a digital calliper. Results: In total, 11 unpaired knees were dissected, eight men and three women, with an average age of 71.5 ± 15.2 years, weight of 57.2 ± 15.6 kg, and a mean height of 170.5 ± 8.2 cm. The distance from the center of the femoral footprint of the LCL to the PT was 10.0 ± 2.4 mm. The distances between the edges closest to each other and those more distant from each other were 3.1 ± 1.1 mm and 16.3 ± 2.4 mm, respectively. Conclusion: The distance between the midpoints of the PT and the LCL in our mixed population is smaller than the distances often reported in the literature. PLC reconstruction with separate tunnels for the LCL and PT may not be technically possible for individuals of any population. Level of Evidence III, Diagnostic studies.

scholarly journals A novel Medial Patellofemoral Ligament Reconstruction Technique; Preliminary Clinical Results

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0007
Author(s):  
Hasan Basri Sezer ◽  
Raffi Armağan ◽  
Muharrem Kanar ◽  
Osman Tuğrul Eren
Keyword(s):  
Range Of Motion ◽  
Medial Patellofemoral Ligament ◽  
Femoral Tunnel ◽  
Full Range ◽  
Lateral Collateral Ligament ◽  
Reconstruction Technique ◽  
Collateral Ligament ◽  
Ligament Rupture ◽  
Patella Luxation ◽  
The Mean

Medial Patellofemoral ligament(MPFL) is the main passive stabilizer of the patellofemoral joint. MPFL is injured in the 2/3 rds of the patients after patella luxation. In this study we present a novel aproach to the anatomical MPFL reconstruction and preliminary results of the technique. We operated 7 patients(4 female and female and 3 male) who applied to our clinic after a patella luxation episode. The mean age was 27,1 years(16-42). The mean follow up time was 23,5 months(24-35). We evaluated the patients clinically and radiologically for concommitant pathologies. 1 patient had patellar cartilage demage and patella alta, 1 patient had medial collateral ligament rupture, 1 patient had lateral collateral ligament and anterior cruciate ligament rupture and these pathologies were treated as well. The operation was done in the supine position on a radiolucent table and under the image intensifier control. The semitendinosus autograft was prepared. The femoral tunnel was drilled and double strand graft was introduced in the femoral tunnel and secured with ToggleLoc femoral fixation device(Biomet). The graft was advanced over the facia to the patellar side and passed through the 2 patellar tunnels and tied to each other. After exercising the knee the graft tension was rechecked at 30 degrees of knee flexion. Early postoperatively range of motion and quadriceps strenghtening exercises were carried out and patients were allowed to bear weight. All of the patients had full range of motion and free of pain. Postoperative x-ray and MRI examinations revealed the correction of patellar tilt and lateral shift of the patella in all patients. The only complication was a fissure of patella in 1 patient in the 6th week of rehabilitation due to anteriorly located patellar tunnel and heavy exercise. We immobilsed the patient in a brace and the patient returned to rehabilitation after 6 weeks when the fissure healed. All the patients returned to the previous functional level. Our anatomical MPFL technique uses ToggleLoc for the femoral side but implant free at the patellar side. The technique provided excellent preliminiary result in all of the patients. The technique allows graft retensioning again and again from both the femoral and the patellar side. The double bundle reconstruction seems to immitate the natural behaviour of the MPFL. However patellar tunnels carry a substantial risk of patella fracture and must be placed with great attention.

scholarly journals The evaluation of the distance between the popliteus tendon and the lateral collateral ligament footprint and the implant in Total Knee Arthroplasty using a 3-dimensional template.

2020 ◽  
Author(s):  
Akihito Takubo ◽  
Keinosuke Ryu ◽  
Takanori Iriuchishima ◽  
Masahiro Nagaoka ◽  
Yasuaki Tokuhashi ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Lateral Collateral Ligament ◽  
Lower Limbs ◽  
Lateral Femoral Condyle ◽  
Popliteus Tendon ◽  
Femoral Bone ◽  
Collateral Ligament ◽  
Bone Resection ◽  
Total Knee ◽  
Resection Area

Abstract Background The popliteus tendon (PT) or lateral collateral ligament (LCL) stabilizes the postero-lateral aspects of the knees. When surgeons perform total knee arthroplasty (TKA), PT and LCL iatrogenic injuries are a risk because the femoral attachments are relatively close to the femoral bone resection area. The purpose of this study was to evaluate the distance between the PT or LCL footprint and the TKA implant using a 3D template system and to evaluate any significant differences according to the implant model.Methods Eighteen non-paired formalin fixed cadaveric lower limbs were used (average age: 80.3). Whole length lower limbs were resected from the pelvis. All the surrounding soft tissue except the PT, knee ligaments and meniscus were removed from the limb. Careful dissection of the PT and LCL was performed, and the femoral footprints were detected. Each footprint periphery was marked with a 1.5 mm K-wire. Computed tomography (CT) scanning of the whole lower limb was then performed. The CT data was analyzed with a 3D template system. This simulation models for TKA were the Journey II BCS and the Persona PS. The area of each footprint, and the length between the most distal and posterior point of the lateral femoral condyle and the edge of each footprint were measured. Matching the implant model to the CT image of the femur, the shortest length between each footprint and the bone resection area were calculated.Results PT and LCL footprint were detected in all knees. The area of the PT and LCL footprints was 38.7±17.7mm2 and 58.0±24.6mm2, respectively. The length between the most distal and posterior point of the lateral femoral condyle and the edge of the PT footprint was 10.3±2.4mm and 14.2±2.8mm, respectively. The length between most distal and most posterior point of the lateral femoral condyle and the edge of the LCL footprint was 16.3±2.3mm and 15.5±3.3mm, respectively. Under TKA simulation, the shortest length between the PT footprint and the femoral bone resection area for the Journey II BCS and the Persona PS was 4.3±2.5mm and 3.2±2.9mm, respectively. The shortest length between the LCL footprint and the femoral bone resection area for the Journey II BCS and the Persona PS was 7.2±2.3mm and 5.6±2.1mm, respectively. The PT attachment was damaged by the bone resection of the Journey II BCS and the Persona PS TKA in 3 and 9 knees, respectively.Conclusion The PT and LCL femoral attachments existed close to the femoral bone resection area of the TKA. To prevent postero-lateral instability in TKA, careful attention is needed to avoid damage to the PT and LCL during surgical procedures.

scholarly journals The evaluation of the distance between the popliteus tendon and the lateral collateral ligament footprint and the implant in Total Knee Arthroplasty using a 3-dimensional template.

2020 ◽  
Author(s):  
Akihito Takubo ◽  
Keinosuke Ryu ◽  
Takanori Iriuchishima ◽  
Masahiro Nagaoka ◽  
Yasuaki Tokuhashi ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Lateral Collateral Ligament ◽  
Simulation Models ◽  
Ct Scanning ◽  
Lower Limbs ◽  
Lateral Femoral Condyle ◽  
Popliteus Tendon ◽  
Collateral Ligament ◽  
Bone Resection ◽  
Resection Area

Abstract Background When surgeons perform TKA, popliteus tendon (PT) and lateral collateral ligament (LCL) iatrogenic injuries are a risk because the femoral attachments are relatively close to the bone resection area. The purpose of this study was to evaluate the distance between the PT or LCL footprint and the TKA implant using a 3D template system and to evaluate any significant differences according to the implant model. Methods Eighteen non-paired formalin fixed cadaveric lower limbs were used. All the surrounding soft tissue except the PT, ligaments and meniscus were removed from the knee. Careful dissection of the PT and LCL was performed, and the femoral footprints were detected. Each footprint periphery was marked with a K-wire. CT scanning was then performed. The data was analyzed with a 3D template system. This simulation models for TKA were the Journey II BCS and the Persona PS. The area of each footprint, and the length between the most distal and posterior point of the lateral femoral condyle and the edge of each footprint were measured. Matching the implant model to the CT image, the shortest length between each footprint and the osteotomy area were calculated. Results The area of the PT and LCL footprints was 38.7±17.7mm 2 and 58.0±24.6mm 2 . The length between the most distal and posterior point of the lateral femoral condyle and the edge of the PT footprint was 10.3±2.4mm and 14.2±2.8mm. The length between these same points and the edge of the LCL footprint was 16.3±2.3mm and 15.5±3.3mm. Under TKA simulation, for the Journey II BCS and the Persona PS, the shortest length between the PT footprint and the osteotomy area was 4.3±2.5mm and 3.2±2.9mm, and the shortest length between the LCL footprint and the osteotomy area was 7.2±2.3mm and 5.6±2.1mm. The PT attachment was damaged by the bone resection of the Journey II BCS and the Persona PS TKA in 3 and 9 knee. Conclusion The PT and LCL femoral attachments existed close to the femoral bone resection area of the TKA. Careful attention is needed to avoid damage to the PT and LCL during surgical procedures.

scholarly journals Kinematics of the posterolateral corner of the knee: A human cadaveric cutting study.

2017 ◽  
Vol 5 (4_suppl4) ◽  
pp. 2325967117S0013
Author(s):  
Tobias Drenck ◽  
Christoph Domnick ◽  
Mirco Herbort ◽  
Michael Raschke ◽  
Karl-Heinz Frosch
Keyword(s):  
Knee Flexion ◽  
External Rotation ◽  
Lateral Collateral Ligament ◽  
Posterolateral Corner ◽  
Clinical Diagnostics ◽  
Popliteus Tendon ◽  
Collateral Ligament ◽  
Intact State ◽  
Posterior Tibial ◽  
Intact Knee

Aims and Objectives: The posterolateral corner of the knee consists of different structures, which contribute to instability when damaged after injury or within surgery. Knowing the kinematic influences may help to improve clinical diagnostics and surgical techniques. The purpose was to determine static stabilizing effects of the posterolateral corner by dissecting stepwise all fibers and ligaments (the arcuat complex, AC) connected with the popliteus tendon (PLT) and the influence on lateral stability in the lateral collateral ligament (LCL) intact-state. Materials ans Methods: Kinematics were examined in 13 fresh-frozen human cadaveric knees using a robotic/UFS testing system with an optical tracking system. The knee kinematics were determined for 134 N anterior/posterior loads, 10 Nm valgus/varus loads and 5 Nm internal/external rotational loads in 0°, 20°, 30°, 60° and 90° of knee flexion. The posterolateral corner structures were consecutively dissected: The I.) intact knee joint, II.) with dissected posterior cruciate ligament, III.) meniscofibular/-tibial fibers, IV.) popliteofibular ligament, V.) popliteotibial fascicle (last structure of static AC), VI.) PLT and VII.) LCL. Results: The external rotation angle increased significantly by 2.6° to 7.9° (P<.05) in 0° to 90° of knee flexion and posterior tibial translation increased by 2.9 mm to 5.9 mm in 20° to 90° of knee flexion (P<.05) after cutting the AC/PLT structures (with intact LCL) in contrast to the PCL deficient knee. Differences between dissected static AC and dissected PLT were only found in 60° and 90° external rotation tests (by 2.1° and 3.1°; P<.05). In the other 28 kinematic tests, no significant differences between PLT and AC were found. Cutting the AC/PLT complex did not further decrease varus, valgus or anterior tibial stability in any flexion angle in comparison to the PCL dissected state. Conclusion: The arcuat complex is an important static stabilizer for external rotatory and posterior tibial loads of the knee, even in the lateral collateral ligament intact-state. After dissecting the major parts of the arcuat complex, the static stabilizing function of the popliteus tendon is lost. The arcuat complex has no varus-stabilizing function in the LCL-intact knee. The anatomy and function of these structures for external-rotational and posterior-translational stabilization should be considered for clinical diagnostics and when performing surgery in the posterolateral corner.

Lateral collateral ligament and anterolateral ligament of the knee – A morphological analysis with orthopedic significance

The Knee ◽  
2021 ◽  
Vol 28 ◽  
pp. 202-206
Author(s):  
Ashwija Shetty ◽  
Sushma Prabhath ◽  
Kurian Alappatt ◽  
Lalu Krishna KN ◽  
Nandini Bhat ◽  
...  
Keyword(s):  
Morphological Analysis ◽  
Lateral Collateral Ligament ◽  
Anterolateral Ligament ◽  
Collateral Ligament

How Well Do Anatomical Reconstructions of the Posterolateral Corner Restore Varus Stability to the Posterior Cruciate Ligament—Reconstructed Knee?

2007 ◽  
Vol 35 (7) ◽  
pp. 1117-1122 ◽  
Author(s):  
Keith L. Markolf ◽  
Benjamin R. Graves ◽  
Susan M. Sigward ◽  
Steven R. Jackson ◽  
David R. McAllister
Keyword(s):  
Posterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
Posterolateral Corner ◽  
Popliteus Tendon ◽  
Tibial Rotation ◽  
Collateral Ligament ◽  
Popliteofibular Ligament ◽  
Grade 3

Background With grade 3 posterolateral injuries of the knee, reconstructions of the lateral collateral ligament, popliteus tendon, and popliteofibular ligament are commonly performed in conjunction with a posterior cruciate ligament reconstruction to restore knee stability. Hypothesis A lateral collateral ligament reconstruction, alone or with a popliteus tendon or popliteofibular ligament reconstruction, will produce normal varus rotation patterns and restore posterior cruciate ligament graft forces to normal levels in response to an applied varus moment. Study Design Controlled laboratory study. Methods Forces in the native posterior cruciate ligament were recorded for 15 intact knees during passive extension from 120° to 0° with an applied 5 N·m varus moment. The posterior cruciate ligament was removed and reconstructed with a single bundle inlay graft tensioned to restore intact knee laxity at 90°. Posterior cruciate ligament graft force, varus rotation, and tibial rotation were recorded before and after a grade 3 posterolateral corner injury. Testing was repeated with lateral collateral ligament, lateral collateral ligament plus popliteus tendon, and lateral collateral ligament plus popliteofibular ligament graft reconstructions; all grafts were tensioned to 30 N at 30° with the tibia locked in neutral rotation. Results All 3 posterolateral graft combinations rotated the tibia into slight valgus as the knee was taken through a passive range of motion. During the varus test, popliteus tendon and popliteofibular ligament reconstructions internally rotated the tibia from 1.5° (0° flexion) to approximately 12° (45° flexion). With an applied varus moment, mean varus rotations with a lateral collateral ligament graft were significantly less than those with the intact lateral collateral ligament beyond 0° flexion; mean decreases ranged from 0.8° (at 5° flexion) to 5.6° (at 120° flexion). Addition of a popliteus tendon or popliteofibular ligament graft further reduced varus rotation (compared with a lateral collateral ligament graft) beyond 25° of flexion; both grafts had equal effects. A lateral collateral ligament reconstruction alone restored posterior cruciate ligament graft forces to normal levels between 0° and 100° of flexion; lateral collateral ligament plus popliteus tendon and lateral collateral ligament plus popliteofibular ligament reconstructions reduced posterior cruciate ligament graft forces to below-normal levels—beyond 95° and 85° of flexion, respectively. Conclusions With a grade 3 posterolateral corner injury, popliteus tendon or popliteofibular ligament reconstructions are commonly performed to limit external tibial rotation; we found that they also limited varus rotation. With the graft tensioning protocols used in this study, all posterolateral graft combinations tested overconstrained varus rotation. Further studies with posterolateral reconstructions are required to better restore normal kinematics and provide more optimum load sharing between the PCL graft and posterolateral grafts. Clinical Relevance A lower level of posterolateral graft tension, perhaps applied at a different flexion angle, may be indicated to better restore normal varus stability. The clinical implications of overconstraining varus rotation are unknown.

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