A modified Larson’s method of posterolateral corner reconstruction of the knee reproducing the physiological tensioning pattern of the lateral collateral and popliteofibular ligaments
Tóm tắt
Consensus has been lacking as to how to reconstruct the posterolateral corner (PLC) of the knee in patients with posterolateral instability. We describe a new reconstructive technique for PLC based on Larson's method, which reflects the physiological load-sharing pattern of the lateral collateral ligament (LCL) and popliteofibular ligament (PFL). Semitendinosus graft is harvested, and one limb of the graft comprises PFL and the other comprises LCL. Femoral bone tunnels for the LCL and popliteus tendon are made at their anatomical insertions. Fibular bone tunnel is prepared from the anatomical insertion of the LCL to the proximal posteromedial portion of the fibular head, which corresponds to the insertion of the PFL. The graft end for popliteus tendon is delivered into the femoral bone tunnel and secured on the medial femoral condyle. The other end for LCL is passed through the fibular tunnel from posterior to anterior. While the knee is held in 90 of flexion, the graft is secured in the fibular tunnel using a 5 mm interference screw. Then, the LCL end is passed into the femoral bone tunnel and secured at the knee in extension. Differential tension patterns between LCL and PFL is critical when securing these graft limbs. Intrafibular fixation of the graft using a small interference screw allows us to secure these two graft limbs independently with intended tension at the intended flexion angle of the knee.
Tài liệu tham khảo
Clancy WG, Shelbourne KD, Zoeliner GB, Keene JS, Reider B, Rosenberg TD: Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. Report of a new procedure. J Bone Joint Surg Am. 1983, 65: 310-322.
Fanelli GC, Giannotti BF, Edson CJ: Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction. Arthroscopy. 1996, 12: 521-530. 10.1016/S0749-8063(96)90189-9.
Hughston JC, Jacobson KE: Chronic posterolateral instability of the knee. J Bone Joint Surg Am. 1985, 67: 351-359.
Noyes FR, Barber-Westin SD: Surgical restoration to treat chronic deficiency of the posterolateral complex and cruciate ligaments of the knee joint. Am J Sports Med. 1996, 24: 415-426. 10.1177/036354659602400404.
Albright JP, Brown AW: Management of chronic posterolateral rotatory instability of the knee: Surgical technique for the posterolateral corner sling procedure. Instr Course Lect. 1998, 47: 369-378.
Sekiya JK, Christopher AK: Posterolateral corner reconstruction of the knee: surgical technique utilizing a bifid Achilles tendon allograft and a double femoral tunnel. Arthroscopy. 2005, 21: 1400.e1-1400.e.5. 10.1016/j.arthro.2005.08.024.
Noyes FR, Barber-Westin SD: Posterolateral knee reconstruction with an anatomical bone-patellar tendon-bone reconstruction of the fibular collateral ligament. Am J Sports Med. 2007, 35: 259-273.
Yoon KH, Bae DK, Ha JH, Park SW: Anatomic reconstructive surgery for posterolateral instability of the knee. Arthroscopy. 2006, 22: 159-165. 10.1016/j.arthro.2005.12.003.
LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A: An analysis of an anatomical posterolateral knee reconstruction. An in vitro biomechanical study and development of a surgical technique. Arthroscopy. 2004, 32: 1405-1414.
Sidles JA, Larson RV, Garbini JL, Downey DJ, Matsen FA: Ligament length relationships in the moving knee. J Orthop Res. 1988, 6: 593-610. 10.1002/jor.1100060418.
Sekiya JK, Haemmerle MJ, Stabile KJ, Vogrin TM, Harner CD: Biomechanical analysis of a combined double-bundle posterior cruciate ligament and posterolateral corner reconstruction. Am J Sports Med. 2005, 33: 360-369. 10.1177/0363546504268039.
Mauro CS, Sekiya JK, Stabile KJ, Haemmerle MJ, Harner CD: Double-bundle PCL and posterolateral corner reconstruction components are codominant. Clin Orthop Relat Res. 2008, 466: 2247-2254. 10.1007/s11999-008-0319-z.
Suda Y, Seedhom BB, Matsumoto H, Otani T: Reconstructive treatment of posterolateral rotatory instability of the knee. A biomechanical study. Am J Knee Surg. 2000, 13: 110-116.
Nau T, Chevalier Y, Hagemeister N, DeGuise JA, Duval N: Comparison of 2 surgical techniques of posterolateral corner reconstruction of the knee. Am J Sports Med. 2005, 33: 1838-1845. 10.1177/0363546505278302.
Markolf KL, Graves BR, Sigward SM, Jackson SR, McAllister DR: How well do anatomical reconstructions of the posterior corner restore varus stability to the posterior cruciate ligament-reconstructed knee?. Am J Sports Med. 2007, 35: 1117-1122. 10.1177/0363546507299240.
Hoher J, Harner CD, Vogrin TM, Baek GH, Carlin GJ, Woo SLY: In situ forces in the posterolateral structures of the knee under posterior tibial loading in the intact and posterior cruciate ligament-deficient knee. J Orthop Res. 1998, 16: 675-681. 10.1002/jor.1100160608.
Veltri DM, Warren RF: Operative treatment of posterolateral instability of the knee. Clin Sports Med. 1994, 13 (3): 615-627.
Veltri DM, Warren RF: Posterolateral instability of the knee. J Bone Joint Surg Am. 1994, 76: 460-472.