Arthroscopic-Assisted Posterolateral Corner Reconstruction of the Knee: Novel Technique, Classification, Surgical Algorithm, and Midterm Results

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

2 Department of Sports and Exercise Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

3 Milad Hospital, Tehran, Iran

4 ETH Zurich, Empa Materials Science and Technology, Max Planck Institute of Colloids and Interfaces, Technical University of Berlin

5 Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

6 Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran

Abstract

Objectives: This study aimed to introduce a new arthroscopic method to reconstruct the popliteus tendon (PT). This minimally invasive technique is performed through the posterolateral corner (PLC) of the knee, which can reconstruct the posterolateral rotary instability (PLRI) of the knee. Methods: Thirty-nine patients (8 females, 31 males) with PLC injury and normal knee alignment underwent arthroscopic PT reconstruction. Among them, 27 patients had combined ACL and PLC injuries, and 9 had been involved in PCL and PLRI. In 3 of them, injuries involved ACL, PCL, and PLC. Physical examination, imaging, and arthroscopic evaluation were performed to assess instability stages. In grade I instability, when the PT had not been injured, the patient was treated with the modified Larson technique and semitendinosus autograft. With grade II injury involving the PT component, arthroscopic reconstruction of the PT was the preferred technique. In grade III injuries, arthroscopic PT reconstruction and the modified Larson technique were used concurrently. Results: All patients were followed up for 58 ± 1 months postoperatively. Varus and external rotation instability were restored with arthroscopic PLC reconstruction. All patients gained near-normal knee stability and significant improvement with pain, along with improved ability to carry out daily activities. In cases of varus instability, a significant improvement was observed in external rotation and reverse pivot shift. There were no cases of arthrofibrosis or limitations in knee motion. Conclusion: Arthroscopic reconstruction of the PT, using our protocol for PLC reconstruction of the knee (with midterm follow-up), showed encouraging results while minimizing surgical morbidity. Level of evidence: IV

Keywords

Main Subjects

References

  1. Chahla J, Moatshe G, Dean C, LaPrade R. Posterolateral Corner of the Knee:Current Concepts. Arch Bone Jt Surg. 2016; 4(2):97-103. doi:10.22038/abjs.2016.6435.
  2. Noyes FR, Barber-Westin SD. Posterolateral Ligament Injuries: Diagnosis, Operative Techniques, and Clinical Outcomes. In: Noyes’ Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes. 2th ed. Noyes FR, Barber-Westin SD, eds. Elsevier; 2017.
  3. Maniar AR, White AE, Musahl V, Ranawat A. Posterolateral Corner of the Knee: An Update on Current Evaluation and Management Strategies. J Am Acad Orthop Surg. 2024 Jan 1; 32(1):e13-e23. doi: 10.5435/JAAOS-D-23-00278.
  4. Simonetta R, Russo A, Palco M, Costa GG, Mariani PP. Meniscus tears treatment: The good, the bad and the ugly-patterns classification and practical guide. World J Orthop. 2023; 14(4):171. doi: 10.5312/wjo.v14.i4.171.
  5. Papalia R, Simonetta R, Di Vico G, et al. Tears of popliteomeniscal fascicles, diagnostic and clinical implications. A review of the evidence. J Biol Regul Homeost Agents. 2016; 30(4 Suppl 1):99-106.
  6. Grassi A, Pizza N, Lucidi GA, Macchiarola L, Mosca M, Zaffagnini S. Anatomy, magnetic resonance and arthroscopy of the popliteal hiatus of the knee: normal aspect and pathological conditions. EFORT Open Rev. 2021;6(1):61-74. doi: 10.1302/2058-5241.6.200089.
  7. Hughston JC, Andrews JR, Cross MJ, Moschi A. Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am. 1976;58(2):173-179.
  8. Fanelli GC, Larson R V. Practical management of posterolateral instability of the knee. Arthroscopy. 2002 Feb;18(2 Suppl 1):1-8. doi: 10.1053/jars.2002.31779.
  9. LaPrade RF, Terry GC. Injuries to the Posterolateral Aspect of the Knee: Association of Anatomic Injury Patterns with Clinical Instability. Am J Sports Med. 1997;25(4):433-438. doi: 10.1177/036354659702500403.
  10. LaPrade RF. Arthroscopic Evaluation of the Lateral Compartment of Knees With Grade 3 Posterolateral Knee Complex Injuries. Am J Sports Med. 1997;25(5):596-602. doi: 10.1177/036354659702500502.
  11. Kannus P. Nonoperative treatment of grade II and III sprains

 

of the lateral ligament compartment of the knee. Am J Sports Med. 1989; 17(1):83-88. doi: 10.1177/036354658901700114.

  1. LaPrade RF, eds. Posterolateral Knee Injuries: Anatomy, Evaluation, and Treatment. 1st ed. E-Book (EPUB), Thieme; 2006.
  2. 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. Am J Sports Med. 2004; 32(6):1405-1414. doi: 10.1177/0363546503262687.
  3. LaPrade RF, Johansen S, Engebretsen L. LaPrade RF, Johansen S, Engebretsen L. Outcomes of an Anatomic Posterolateral Knee Reconstruction. J Bone Joint Surg Am. 2011:93 Suppl 1:10-20. doi: 10.2106/JBJS.J.01243.
  4. Hughston JC, Norwood LA. The posterolateral drawer test and external rotational recurvatum test for posterolateral rotatory instability of the knee. Clin Orthop Relat Res. 1980 ;( 147):82-87.
  5. Devitt BM, Whelan DB. Physical Examination and Imaging of the Lateral Collateral Ligament and Posterolateral Corner of the Knee. Sports Med Arthrosc Rev2015; 23(1):10-6. doi: 10.1097/JSA.0000000000000046.
  6. LaPrade RF, Heikes C, Bakker AJ, Jakobsen RB. The Reproducibility and Repeatability of Varus Stress Radiographs in the Assessment of Isolated Fibular Collateral Ligament and Grade-III Posterolateral Knee Injuries: An in Vitro Biomechanical Study. JBJS. 2008; 90(10):2069-76. doi: 10.2106/JBJS.G.00979.
  7. Noyes FR, Barber-Westin SD. Surgical Reconstruction of Severe Chronic Posterolateral Complex Injuries of the Knee Using Allograft Tissues. Am J Sports Med. 1995; 23(1):2-12. doi:10.1177/036354659502300102.
  8. 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(2):259-273. doi:10.1177/0363546506293704.
  9. Chahla J, Murray IR, Robinson J, et al. Posterolateral corner of the knee: an expert consensus statement on diagnosis, classification, treatment, and rehabilitation. Knee Surg Sports Traumatol Arthrosc. 2019; 27(8):2520-2529. doi: 10.1007/s00167-018-5260-4.
  10. 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(2):110-116.
  11. 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(3):360-369. doi:10.1177/0363546504268039.
  12. 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(9):2247-2254. doi:10.1007/s11999-008-0319-z.
  13. Sharma A, Saha P, Bandyopadhyay U. Reconstruction of the Posterolateral Corner of the Knee Using LaPrade and Modified Larson Technique: A Prospective Study. Indian J Orthop. 2022; 56(1):125-132. doi:10.1007/s43465-021-00435-0.
  14. Boksh K, Ghosh A, Narayan P, Divall P, Aujla R. Fibular- Versus Tibiofibular-Based Reconstruction of the Posterolateral Corner of the Knee: A Systematic Review and Meta-analysis. Am J Sports Med. 2023; 51(14):3880-3892. doi:10.1177/03635465221138548.
  15. Weiss S, Krause M, Frosch KH. Clinical results after arthroscopic reconstruction of the posterolateral corner of the knee: A prospective randomized trial comparing two different surgical techniques. Arch Orthop Trauma Surg. 2023; 143(2):967-975. doi:10.1007/s00402-022-04403-7.
  16. Larson R V. Isometry of the lateral collateral and popliteofibular ligaments and techniques for reconstruction using a free semitendinosus tendon graft. Oper Tech Sports Med. 2001; 9(2):84-90. doi: 10.1053/otsm.2001.21765.
  17. Terry GC, LaPrade RF. The Posterolateral Aspect of the Knee: Anatomy and Surgical Approach. Am J Sports Med. 1996; 24(6):732-739. doi:10.1177/036354659602400606.
  18. Azar FM, Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics, 4-Volume Set. 14 st ed. E-Book. Elsevier Health Sciences; 2020.
  19. Hughston JC, Jacobson KE. Chronic posterolateral rotatory instability of the knee. J Bone Joint Surg Am. 1985; 67(3):351-9.
  20. Clancy WG, Timmerman LA. Arthroscopically assisted posterior cruciate ligament reconstruction using autologous patellar tendon graft. Oper Tech Sports Med. 1993; 1(2):129-135. doi:10.1016/S1060-1872(10)80043-7.
  21. Feng H, Hong L, Geng X su, Zhang H, Wang X song, Zhang J. Posterolateral sling reconstruction of the popliteus tendon: an all-arthroscopic technique. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2009; 25(7):800-805. doi: 10.1016/j.arthro.2008.12.019.

 

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 11
November 2024
Pages 746-753

Files

History

  • Receive Date: 12 March 2024
  • Revise Date: 19 June 2024
  • Accept Date: 26 August 2024

Share

How to cite

Statistics