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.

The Pathoanatomy of Posterolateral Corner Ligamentous Disruption in Multiligament Knee Injuries Is Predictive of Peroneal Nerve Injury

2020 ◽  
Vol 48 (14) ◽  
pp. 3541-3548
Author(s):  
Joseph B. Kahan ◽  
Don Li ◽  
Christopher A. Schneble ◽  
Patrick Huang ◽  
James Bullock ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Peroneal Nerve ◽  
Nerve Palsy ◽  
Case Series ◽  
Lateral Collateral Ligament ◽  
Posterolateral Corner ◽  
Peroneal Nerve Palsy ◽  
Injury Patterns ◽  
Level Of Evidence ◽  
Peroneal Nerve Injury

Background: A description of the precise locations of ligamentous and myotendinous injury patterns of acute posterolateral corner (PLC) injuries and their associated osseous and neurovascular injuries is lacking in the literature. Purpose: To characterize the ligamentous and myotendinous injury patterns and zones of injury that occur in acute PLC injuries and determine associated rates of peroneal nerve palsies and vascular injuries, as well as fracture and dislocation. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively identified all patients treated for an acute multiligament knee injury (MLKI) at our level 1 trauma center from 2001 to 2018. From this cohort, all patients with PLC injuries were identified. Demographics, involved ligaments and tendons, neurovascular injury, and presence of fracture and dislocation were compared with the larger multiligament knee cohort. Incidence and location of injury of PLC structures—from proximal to midsubstance and distal injury—were recorded. Results: A total of 100 knees in 100 patients were identified as having MLKIs. A total of 74 patients (74%) had lateral-sided ligament injuries. Of these, 23 (31%) had a peroneal nerve palsy associated with their injury; 10 (14%), a vascular injury; and 23 (31%), a fracture. Patients with PLC injuries had higher rates of peroneal nerve injury as compared with those having acute MLKIs without a PLC injury (31% vs 4%; P = .005). Patients with a complete peroneal nerve palsy (n = 17) were less likely to regain function than those with a partial peroneal nerve palsy (n = 6; 12% vs 100%; P < .0001). Complete injury to the lateral collateral ligament (LCL) occurred in 71 of 74 (96%) PLC injuries, with 3 distinct patterns of injury demonstrated. Fibular avulsion of the LCL was the most common zone of injury (65%), followed by femoral avulsion (20%) and midsubstance tear (15%). Location of injury to the LCL was associated with the rate of peroneal nerve injury, with midsubstance tears and fibular avulsions associated with higher rates of peroneal nerve injury. Conclusion: MLKIs with involvement of the PLC are more likely to suffer peroneal nerve injury. The LCL is nearly always involved, and its location of injury is predictive of peroneal nerve injury. Patients with a complete peroneal nerve palsy at presentation are much less likely to regain function.

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.

The Pathoanatomy of Posterolateral Corner Ligamentous Disruption in Multiligament Knee Injuries Is Predictive of Peroneal Nerve Injury: Response

2021 ◽  
Vol 49 (7) ◽  
pp. NP27-NP28
Author(s):  
Joseph Kahan ◽  
Don Li ◽  
Christopher Schneble ◽  
Patrick Huang ◽  
Jack Porrino ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Peroneal Nerve ◽  
Knee Injuries ◽  
Posterolateral Corner ◽  
Injury Response ◽  
Peroneal Nerve Injury ◽  
Multiligament Knee Injuries

scholarly journals Measurement of femoral posterior condylar offset and posterior tibial slope in normal knees based on 3D reconstruction

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Liangxiao Bao ◽  
Shengwei Rong ◽  
Zhanjun Shi ◽  
Jian Wang ◽  
Yang Zhang
Keyword(s):  
Three Dimensional ◽  
Surgical Techniques ◽  
Inverse Correlation ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Lateral Side ◽  
Posterior Condylar Offset ◽  
Posterior Tibial ◽  
Significant Difference ◽  
Posterior Condylar

Abstract Background Femoral posterior condylar offset (PCO) and posterior tibial slope (PTS) are important for postoperative range of motion after total knee arthroplasty (TKA). However, normative data of PCO and PTS and the correlation between them among healthy populations remain to be elucidated. The purpose of this study was to determine PCO and PTS in normal knees, and to identify the correlation between them. Methods Eighty healthy volunteers were recruited. CT scans were performed followed by three-dimensional reconstruction. PCO and PTS were measured and analyzed, as well as the correlation between them. Results PTS averaged 6.78° and 6.11°, on the medial and lateral side respectively (P = 0.002). Medial PCO was greater than lateral (29.2 vs. 23.8 mm, P <  0.001). Both medial and lateral PCO of male were larger than female. On the contrary, male medial PTS was smaller than female, while there was no significant difference of lateral PTS between genders. There was an inverse correlation between medial PCO and PTS, but not lateral. Conclusions Significant differences exhibited between medial and lateral compartments, genders, and among individuals. An inverse correlation exists between PCO and PTS in the medial compartment. These results improve our understanding of the morphology and biomechanics of normal knees, and subsequently for optimising prosthetic design and surgical techniques.

scholarly journals Anterior Tibial Tendon Side-to-Side Tenorrhaphy after Posterior Tibial Tendon Transfer: A Technique to Improve Reliability in Drop Foot after Common Peroneal Nerve Injury

2021 ◽  
Author(s):  
Miguel Estuardo Rodríguez-Argueta ◽  
Carlos Suarez-Ahedo ◽  
César Alejandro Jiménez-Aroche ◽  
Irene Rodríguez-Santamaria ◽  
Francisco Javier Pérez-Jiménez ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Tendon Transfer ◽  
Common Peroneal Nerve ◽  
Posterior Tibial Tendon ◽  
Drop Foot ◽  
Posterior Tibial ◽  
Anterior Tibial ◽  
Anterior Tibial Tendon ◽  
Peroneal Nerve Injury ◽  
Improve Reliability

Displacement of the common peroneal nerve in posterolateral corner injuries of the knee

2005 ◽  
Vol 87-B (9) ◽  
pp. 1225-1226 ◽  
Author(s):  
N. Bottomley ◽  
A. Williams ◽  
R. Birch ◽  
A. Noorani ◽  
A. Lewis ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Posterolateral Corner ◽  
The Common

Surgical Technique of a Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch for the Treatment of Peroneal Nerve Injury

2012 ◽  
Vol 69 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Jennifer L. Giuffre ◽  
Allen T. Bishop ◽  
Robert J. Spinner ◽  
Alexander Y. Shin
Keyword(s):  
Surgical Technique ◽  
Nerve Injury ◽  
Tibialis Anterior ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Nerve Transfer ◽  
Motor Branch ◽  
Peroneal Nerve Injury

Isokinetic cross-training effect in foot drop following common peroneal nerve injury

2015 ◽  
Vol 23 (1) ◽  
pp. 17-20 ◽  
Author(s):  
Andrea Manca ◽  
Francesco Pisanu ◽  
Enzo Ortu ◽  
Edoardo De Natale ◽  
Francesca Ginatempo ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Training Effect ◽  
Cross Training ◽  
Peroneal Nerve Injury

Iatrogenic common peroneal nerve injury during harvesting of semitendinosus tendon for anterior cruciate ligament reconstruction

2021 ◽  
Vol 14 (4) ◽  
pp. e240736
Author(s):  
Raf Mens ◽  
Albert van Houten ◽  
Roy Bernardus Gerardus Brokelman ◽  
Roy Hoogeslag
Keyword(s):  
Anterior Cruciate Ligament ◽  
Nerve Injury ◽  
Peroneal Nerve ◽  
Cruciate Ligament ◽  
Common Peroneal Nerve ◽  
Peroneal Nerve Injury ◽  
The Common ◽  
Anterior Cruciate ◽  
Incision Technique

We present a case of iatrogenic injury to the common peroneal nerve (CPN) occurring due to harvesting of a hamstring graft, using a posterior mini-incision technique. A twitch of the foot was noted on retraction of the tendon stripper. After clinically diagnosing a CPN palsy proximal to the knee, the patient was referred to a neurosurgeon within 24 hours. An electromyography (EMG) was not obtained since it cannot accurately differentiate between partial and complete nerve injury in the first week after injury. Because the nerve might have been transacted by the tendon stripper, surgical exploration within 72 hours after injury was indicated. An intraneural haematoma was found and neurolysis was performed to decompress the nerve. Functioning of the anterior cruciate ligament was satisfactory during follow-up. Complete return of motor function of the CPN was observed at 1-year follow-up, with some remaining hypoaesthesia.

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