scholarly journals Posterolateral corner of the knee: a systematic literature review of current concepts of arthroscopic reconstruction

2020 ◽  
Vol 140 (12) ◽  
pp. 2003-2012 ◽  
Author(s):  
Sebastian Weiss ◽  
Matthias Krause ◽  
Karl-Heinz Frosch
Keyword(s):  
Systematic Review ◽  
Surgical Techniques ◽  
Lateral Collateral Ligament ◽  
Clinical Results ◽  
Posterolateral Corner ◽  
Anatomic Reconstruction ◽  
Rotational Instability ◽  
Popliteus Tendon ◽  
Lateral Instability ◽  
Popliteofibular Ligament

Abstract Introduction Injuries of the posterolateral corner (PLC) of the knee lead to chronic lateral and external rotational instability and are often associated with PCL injuries. Numerous surgical techniques for repair and reconstruction of the PLC are established. Recently, several arthroscopic techniques have been published in order to address different degrees of PLC injuries through reconstruction of one or more functional structures. The purpose of this systematic review is to give an overview about arthroscopic techniques of posterolateral corner reconstructions and to evaluate their safeness. Materials and methods A systematic review of the literature on arthroscopic reconstructions of the posterolateral corner of the knee according to the PRISMA guidelines was performed using PubMed MEDLINE and Web of Science Databases on June 15th, 2020. Inclusion criteria were descriptions of surgical techniques to reconstruct different aspects of the posterolateral corner either strictly arthroscopically or minimally-invasive with an arthroscopic assistance. Results Arthroscopic techniques differ with regard to the extent of reconstructed units (popliteus tendon, popliteofibular ligament, lateral collateral ligament), surgical approach (transseptal, lateral) and biomechanical results (anatomic vs. non-anatomic reconstruction, restoration of rotational instability and/or lateral instability). Conclusion Different approaches to arthroscopic PLC reconstruction are presented, yet clinical results are scarce. Up to now good and excellent clinical results are reported. No major complications are reported in the literature so far.

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.

scholarly journals Anatomic Reconstruction of the Triangular Fibrocartilage Complex for the Treatment of Chronic Instability of the Distal Radioulnar Joint. A Systematic Review

2021 ◽  
Vol 49 (02) ◽  
pp. e97-e104
Author(s):  
Ignacio Miranda ◽  
Francisco J. Lucas ◽  
Vicente Carratalá ◽  
Joan Ferràs-Tarragó ◽  
Francisco J. Miranda
Keyword(s):  
Systematic Review ◽  
Surgical Techniques ◽  
Case Series ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Anatomic Reconstruction ◽  
Wrist Arthroscopy ◽  
Radioulnar Joint ◽  
Druj Instability ◽  
Triangular Fibrocartilage

Abstract Introduction Peripheral injuries of the triangular fibrocartilage complex (TFCC) can produce pain and instability of the distal radioulnar joint (DRUJ). There are several techniques for the reconstruction of the TFCC. The aim of the present paper was to summarize the tendon plasties of the DRUJ ligaments for the anatomic reconstruction of TFCC, to analyze the surgical techniques, and to evaluate their outcomes. Methods In order to perform a systematic review, we searched in the literature the terms DRUJ instability OR chronic distal radioulnar joint instability OR distal radioulnar tendon plasty. Results In total, 11 articles with level of evidence IV (case series) were retrieved. Most studies achieved good results, with recovery of wrist stability, improvement of the pain, and increase in grip strength in the functionality tests. In the historical evolution of the published series, wrist surgeons tried to perform a more anatomical plasty, with a more stable fixation and less invasive techniques. Conclusion The Adams procedure continues to be a valid and reproducible technique for the treatment of chronic DRUJ instability. If wrist arthroscopy and implants are available and surgeons have been technically trained, the authors recommend an arthroscopy-assisted technique, or, if possible, an all-arthroscopic TFCC reconstruction with implant fixation of the plasty in its anatomical points of insertion. Comparative studies between open and arthroscopic TFCC reconstruction techniques are needed.

Lateral Augmentation Procedures in Anterior Cruciate Ligament Reconstruction: Anatomic, Biomechanical, Imaging, and Clinical Evidence

2018 ◽  
Vol 47 (3) ◽  
pp. 740-752 ◽  
Author(s):  
Alexander E. Weber ◽  
William Zuke ◽  
Erik N. Mayer ◽  
Brian Forsythe ◽  
Alan Getgood ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Clinical Outcomes ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Rotational Instability ◽  
Imaging Diagnostics ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: There has been an increasing interest in lateral-based soft tissue reconstructive techniques as augments to anterior cruciate ligament reconstruction (ACLR). The objective of these procedures is to minimize anterolateral rotational instability of the knee after surgery. Despite the relatively rapid increase in surgical application of these techniques, many clinical questions remain. Purpose: To provide a comprehensive update on the current state of these lateral-based augmentation procedures by reviewing the origins of the surgical techniques, the biomechanical data to support their use, and the clinical results to date. Study Design: Systematic review. Methods: A systematic search of the literature was conducted via the Medline, EMBASE, Scopus, SportDiscus, and CINAHL databases. The search was designed to encompass the literature on lateral extra-articular tenodesis (LET) procedures and the anterolateral ligament (ALL) reconstruction. Titles and abstracts were reviewed for relevance and sorted into the following categories: anatomy, biomechanics, imaging/diagnostics, surgical techniques, and clinical outcomes. Results: The search identified 4016 articles. After review for relevance, 31, 53, 27, 35, 45, and 78 articles described the anatomy, biomechanics, imaging/diagnostics, surgical techniques, and clinical outcomes of either LET procedures or the ALL reconstruction, respectively. A multitude of investigations were available, revealing controversy in addition to consensus in several categories. The level of evidence obtained from this search was not adequate for systematic review or meta-analysis; thus, a current concepts review of the anatomy, biomechanics, imaging, surgical techniques, and clinical outcomes was performed. Conclusion: Histologically, the ALL appears to be a distinct structure that can be identified with advanced imaging techniques. Biomechanical evidence suggests that the anterolateral structures of the knee, including the ALL, contribute to minimizing anterolateral rotational instability. Cadaveric studies of combined ACLR-LET procedures demonstrated overconstraint of the knee; however, these findings have yet to be reproduced in the clinical literature. The current indications for LET augmentation in the setting of ACLR and the effect on knee kinematic and joint preservation should be the subject of future research.

scholarly journals Arthroscopic Popliteus sling Reconstruction using the ‘Popliteus portal’ : An effective way to restore the Posterolateral corner stability A Case Series and Surgical Technique

2019 ◽  
Author(s):  
Abey Thomas Babu ◽  
Santosh Sahanand ◽  
David Rajan
Keyword(s):  
Surgical Technique ◽  
Clinical Outcomes ◽  
Case Series ◽  
Posterolateral Corner ◽  
Anatomic Reconstruction ◽  
Ligament Injury ◽  
Reconstruction Technique ◽  
Popliteus Tendon ◽  
Collateral Ligament ◽  
Fibular Collateral Ligament

Abstract Background: Posterolateral corner injuries can result in persistent varus and rotary instability. Many open/ arthroscopic procedures of reconstruction/ repair have been reported, but there is a paucity of literature on clinical outcomes. We follow an all arthroscopic reconstruction technique of the popliteus sling with the use of the ‘popliteus portal’ in cases of isolated popliteus injuries (intact fibular collateral ligament). Methodds: Prospective case study of 12 patients undergoing Arthroscopic Popliteus sling reconstruction with or without associated cruciate ligament reconstruction was peformed. We report our surgical technique and clinical outcomes. Results: All our patients had good to excellent knee function at final follow up (IKDC and Tegner Scores). We did not encounter any major complications intra or post – operatively. Conclusions: In cases of Popliteus tendon injury without fibular collateral ligament injury, an ‘all – arthroscopic’ Popliteus sling reconstruction is an effective and reproducible technique of restoring posterolateral stability of the knee. The advantages of our procedure are – an ‘all – arthroscopic Technique’, avoiding damage to the meniscotibial ligaments and a more ‘anatomic’ reconstruction of the popliteus sling. Keywords: Knee, Posterolateral corner injury, popliteus, Arthroscopy, Reconstruction

scholarly journals Sequential Damage Assessment of the Posterolateral Complex of the Knee Joint: A Finite Element Study

2021 ◽  
Author(s):  
Cong-Cong Wu ◽  
Li-Mei Ye ◽  
Xiao-fei Li ◽  
Lin-Jun Shi
Keyword(s):  
Finite Element ◽  
Knee Joint ◽  
External Rotation ◽  
Lateral Collateral Ligament ◽  
Fe Model ◽  
Popliteus Tendon ◽  
Popliteofibular Ligament ◽  
Instantaneous Axis Of Rotation ◽  
Property Data ◽  
Posterolateral Complex

Abstract Background. The posterolateral complex (PLC), which consists of the popliteus tendon (PT), lateral collateral ligament (LCL), and popliteofibular ligament (PFL), is an indispensable structure of the knee joint. The aim of this study was to explore the functionality of the PLC by determining the specific role of each component in maintaining posterolateral knee stability. Methods. A finite element (FE) model was generated based on previous material property data and magnetic resonance imaging of a volunteer’s knee joint. The injury order of the PLC was set as LCL, PFL, and PT. A 134 N anterior load was applied to the tibia to investigate tibial displacement (TD). Tibial external rotation (TER) and tibial varus angulation (TVA) were measured under bending motions of 5 and 10 Nm. The instantaneous axis of rotation (IAR) of the knee joint under different rotation motions was also recorded. Results. The TD of the intact knee under a 134 N anterior load matched the values determined in previous studies. Our model showed consistent increases in TD, TVA, and TER after sequential damage of the PLC. In addition, sequential disruption caused the IAR to shift superiorly and laterally during varus rotation, and medially and anteriorly during external rotation. In the dynamic damage of the PLC, LCL injury had the largest effect on TD, TVA, TER, and IAR. Conclusions. Sequential injury of the PLC caused considerable loss of stability of the knee joint according to an FE model. The most significant structure of the PLC was the LCL.

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.

scholarly journals Arthroscopic anatomy of the posterolateral corner of the knee: anatomic relations and arthroscopic approaches

2021 ◽  
Author(s):  
Jannik Frings ◽  
Sebastian Weiß ◽  
Jan Kolb ◽  
Peter Behrendt ◽  
Karl-Heinz Frosch ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Surgical Techniques ◽  
Region Of Interest ◽  
Biceps Femoris ◽  
Posterolateral Corner ◽  
Lateral Side ◽  
Popliteofibular Ligament ◽  
Peroneal Nerve Injury ◽  
Transseptal Approach ◽  
Surgical Preparation

Abstract Introduction Although open-surgical techniques for the reconstruction of the posterolateral corner (PLC) are well established, the use of arthroscopic procedures has recently increased. When compared with open surgical preparation, arthroscopic orientation in the PLC is challenging and anatomic relations may not be familiar. Nevertheless, a profound knowledge of anatomic key structures and possible structures at risk as well as technical variations of arthroscopic approaches are mandatory to allow a precise and safe surgical intervention. Materials and methods In a cadaveric video demonstration, an anterolateral (AL), anteromedial (AM), posteromedial (PM) and posterolateral (PL) portal, as well as a transseptal approach (TSA) were developed. Key structures of the PLC were defined and sequentially exposed during posterolateral arthroscopy. Finally, anatomic relations of all key structures were demonstrated. Results All key structures of the PLC can be visualized during arthroscopy. Thereby, careful portal placement is crucial in order to allow an effective exposure. Two alternatives of the TSA were described, depending on the region of interest. The peroneal nerve can be visualized dorsal to the biceps femoris tendon (BT), lateral to the soleus muscle (SM) and about 3 cm distal to the fibular styloid (FS). The distal attachment of the fibular collateral ligament (FCL) can be exposed on the lateral side of the fibular head (FH). The fibular attachment of the popliteofibular ligament (PFL) is exposed at the tip of the FS. Conclusion Arthroscopy of the posterolateral recessus allows full visualization of all key structures of the posterolateral corner, which provides the basis for anatomic and safe drill channel placement in PLC reconstruction. A sufficient exposure of relevant anatomic landmarks and precise portal preparation reduce the risk of iatrogenic vascular and peroneal nerve injury.

Comparison of Clinical Results of Anatomic Posterolateral Corner Reconstruction for Posterolateral Rotatory Instability of the Knee With or Without Popliteal Tendon Reconstruction

2011 ◽  
Vol 39 (11) ◽  
pp. 2421-2428 ◽  
Author(s):  
Kyoung Ho Yoon ◽  
Jung Hwan Lee ◽  
Dae Kyung Bae ◽  
Sang Jun Song ◽  
Kee Yun Chung ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Stress Test ◽  
Clinical Results ◽  
Posterolateral Corner ◽  
Anatomic Reconstruction ◽  
Tendon Reconstruction ◽  
Stress Radiographs ◽  
Varus Stress ◽  
Dial Test ◽  
Posterolateral Corner Reconstruction

Background: It is unknown whether popliteal tendon reconstruction is necessary in anatomic posterolateral corner reconstruction, although the tendon has function in the varus and rotatory stability of the knee joint. Hypothesis: Anatomic reconstructions of the posterolateral corner with the popliteal tendon reconstructed will present better clinical and radiographic results than cases with the popliteal tendon not reconstructed. Study Design: Cohort study; Level of evidence, 3. Methods: The authors retrospectively analyzed 32 cases of anatomic posterolateral corner reconstruction with a minimum 2-year follow-up. There were 17 cases of anatomic reconstruction with popliteal tendon reconstruction and 15 cases without popliteal tendon reconstruction. The authors compared preoperative and postoperative range of motion, varus instability by varus stress test, lateral joint opening on varus stress radiographs, posterolateral rotatory instability by dial test, Tegner activity score, Lysholm score, and International Knee Documentation Committee (IKDC) subjective knee evaluation form and knee examination form between the 2 groups. They also compared posterior translation on posterior stress radiographs in cases with posterior cruciate ligament reconstruction. Results: There was no difference in range of motion, varus stress test, dial test, Tegner score, Lysholm score, or the score by IKDC subjective knee evaluation form. The side-to-side difference in lateral joint opening on the varus stress radiographs significantly improved after anatomic reconstruction in both groups ( P < .001, P = .001), but there was no preoperative or postoperative differences between the groups. No difference was found in the grade distribution on the IKDC examination form. In the cases with posterior cruciate ligament reconstruction, there was also no difference in posterior translation between the groups on posterior stress radiographs at the last follow-up. Conclusion: No effect of popliteal tendon reconstruction was found in anatomic posterolateral corner reconstruction on the stability and clinical results.

scholarly journals Comparative Biomechanical Study Between Minimally Invasive Popliteus and LCL Reconstruction Versus LaPrade Technique

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0009
Author(s):  
Bancha Chernchujit ◽  
Arrisna Artha ◽  
Panin Anilabol
Keyword(s):  
Minimally Invasive ◽  
Posterolateral Corner ◽  
Reconstruction Technique ◽  
Popliteus Tendon ◽  
Collateral Ligament ◽  
Popliteofibular Ligament ◽  
Less Invasive ◽  
Stress Radiographs ◽  
Varus Stress ◽  
Grade Iii

Background: Many aspects of the posterolateral corner (PLC) of the knee have been extensively studied within the past 20 years. Quantitative anatomic and biomechanical studies have demonstrated the importance of the 3 static stabilizers of the lateral side of the knee: the fibular collateral ligament, the popliteus tendon, and the popliteofibular ligament. There are various methods of reconstruction. However, currently, there is no consensus on the preferred reconstruction technique for treating patients with chronic PLC injuries. We have developed a new reconstructive technique for PLC based on tibiofibular-based technique, similar to LaPrade, and this technique is less invasive than the previous techniques. Hypothesis: There is no difference between minimally invasive popliteus and LCL reconstruction and LaPrade’s method in restoring the posterolateral stability of knees Methods: Six paired fresh-frozen cadaveric knees were assessed in the intact state and then dissected to simulate a grade III posterolateral knee injury. By using a “Blocked randomization”, each paired knee was randomized into 2 groups (1) reconstruction via LaPrade’s method, (2) minimally invasive popliteus and LCL reconstruction. Biomechanical testing using varus stress radiographs was performed to compare knee stability between 2 groups. Results: This study included six paired knees, three males and three females. The mean age of the cadaver was 70.8 years (range 57-85 years). No difference was found in the demographic data (sex distribution, lateral opening gap of intact knee and side-to-side difference of lateral opening gap of sectioned knee) between the 2 groups. The side-to-side difference in lateral joint opening on the varus stress radiographs significantly improved after PLC reconstruction in both groups (p <0.001, p <0.001), However, there were no differences between the 2 groups in side-to-side difference of lateral opening gap after reconstruction (Mean difference=-0.05 (95%CI, -0.46 to 0.36); p- value=0.039). Conclusion: Biomechanically, minimally invasive popliteus and LCL reconstruction is equivalent to LaPrade’s technique in restoring the stability of knees in case of grade III PLC injury. Additionally, this technique is less invasive than all traditional open technique of PLC reconstruction. The minimally invasive popliteus and LCL reconstruction technique may be a treatment option for grade III PLC injury. Keywords: posterolateral corner; ligament reconstruction; popliteus tendon; lateral collateral ligament; popliteofibular ligament; knee biomechanics; minimally invasive surgery

Comparison of 2 Surgical Techniques of Posterolateral Corner Reconstruction of the Knee

2005 ◽  
Vol 33 (12) ◽  
pp. 1838-1845 ◽  
Author(s):  
Thomas Nau ◽  
Yan Chevalier ◽  
Nicola Hagemeister ◽  
Jacques A. deGuise ◽  
Nicolas Duval
Keyword(s):  
Degrees Of Freedom ◽  
Dynamic Testing ◽  
External Rotation ◽  
Surgical Techniques ◽  
Posterolateral Corner ◽  
Popliteus Tendon ◽  
Tibial Rotation ◽  
Intact State ◽  
Posterolateral Structures ◽  
Internal Tibial Rotation

Background Various surgical techniques to treat posterolateral knee instability have been described. To date, the recommended treatment is an anatomical form of reconstruction, in which the 3 key structures of the posterolateral corner are addressed: the lateral collateral ligament, the popliteofibular ligament, and the popliteus tendon. Hypothesis Two methods of surgical reconstruction will restore posterolateral knee instability, in terms of static laxity as well as dynamic 6 degrees of freedom kinematics, to statistically significant levels compared with the intact state. Study Design Controlled laboratory study. Methods Two surgical techniques (A and B) were used to reconstruct the posterolateral structures in 10 cadaveric knees. Static tests were performed on the intact, sectioned, and reconstructed knees at 30° and 90° of flexion for anterior-posterior laxity and external rotational laxity, as well as at 0° and 30° of flexion for varus laxity; dynamic 6 degrees of freedom kinematic testing, through a path of motion from 90° of flexion to full extension, was also performed. Results For the static varus tests, external rotation and varus laxity were significantly increased after the posterolateral structures were cut. Both reconstruction techniques restored external rotation and varus laxity to levels not significantly different from the intact state. For technique B, dynamic testing did not show any significant difference for all degrees of freedom kinematics compared with the intact state. However, for technique A, a significant internal tibial rotation was observed throughout the entire path of motion from 0° to 90° of knee flexion. Conclusions Both surgical techniques for anatomical posterolateral corner reconstruction showed good results in the static laxity tests. The anatomical reconstruction of all structures, including the popliteus tendon, resulted in an abnormal internal tibial rotation during dynamic testing.

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