Kinematics of the Posterolateral Corner of the Knee: A Cadaveric Study (original) (raw)
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Kinematic Analysis of the Posterior Cruciate Ligament, Part 1
The American Journal of Sports Medicine, 2013
Background: A more thorough understanding of the posterior cruciate ligament (PCL) has led to an increase in awareness and treatment of complex PCL injuries. Controversy exists about whether PCL reconstruction (PCLR) using an anatomic single-bundle (aSB) or anatomic double-bundle (aDB) technique is the most effective. Hypothesis: An aDB PCLR provides significantly better anterior-posterior and rotatory knee stability compared with an aSB PCLR and more closely recreates normal knee kinematics. Study Design: Controlled laboratory study. Methods: A total of 18 match-paired, cadaveric knees (mean age, 54.8 years; range, 51-59 years; 5 male and 4 female pairs) were used to evaluate the kinematics of an intact PCL, an aSB and aDB PCLR, and a complete sectioned PCL. A 6 degrees of freedom robotic system was used to assess knee stability with a 134-N applied posterior tibial load, 5-NÁm external and internal rotation torques, 10-NÁm valgus and varus rotation torques, and a coupled 100-N posterior tibial load and 5-NÁm external rotation torque at 0°, 15°, 30°, 45°, 60°, 75°, 90°, 105°, and 120°. Results: The aDB PCLR had significantly less posterior translation than the aSB PCLR at all flexion angles of 15°and greater. The largest difference in posterior translation was seen at 105°of flexion, where the aSB PCLR had 5.3 mm (P = .017) more posterior translation than the aDB PCLR. The aDB PCLR also had significantly less internal rotation than the aSB PCLR at all tested angles of 90°and greater. Neither reconstruction was able to fully restore native knee kinematics. Conclusion: An aDB PCLR more closely approximated native knee kinematics when compared with an aSB PCLR. Specifically, the aDB PCLR demonstrated significantly more restraint to posterior translation at flexion angles between 15°and 120°and less internal rotational laxity at high flexion angles 90°to 120°. Clinical Relevance: Comparison of the 2 reconstruction techniques illustrates the time-zero kinematic advantage imparted by the addition of the posteromedial bundle reconstruction. The benefit is most pertinent for resistance to posterior translation across a full range of flexion and rotational stability beyond 90°of knee flexion.
Archives of Orthopaedic and Trauma Surgery, 2012
Purpose This cadaveric study assessed the relative role of the lateral collateral ligament (LCL) and popliteofibular ligament (PFL) in limiting tibia external rotation. Methods Eight paired cadaveric knees were divided into two groups. The specimens were mounted on a rotational wheel and 5 Nm external rotation torque was applied before and after cutting the ligaments at 0°-30°-60°-90°k nee flexion. Three cutting steps were applied: (1) PT (popliteus tendon)-, (2) LCL-, (3) PFL in group I, and (1) PT-, (2) PFL-, (3)LCL in group II. Increased external rotation at each step was taken as the ratio of final external rotation at the end of step 3. Repeated measure ANOVA and a Mann-Whitney U test were used for statistical analysis. Results At step 2, the ratio of increased external rotation after cutting the LCL (group I) was similar to the ratio after cutting the PFL (group II) at 0°and 30°flexion, but that of group I was lower than group II at 60°and 90°flexion (p = 0.029 and p = 0.029). At step-3, the ratio after cutting the LCL (group II) was less than the ratio after cutting the PFL (group I) at 90°flexion (p = 0.029). Conclusion The PFL and LCL play equally important roles in limiting external rotation at the knee extended position (0°, 30°) but the LCL contribution becomes smaller than PFL at the flexed position (60°, 90°).
Anatomical Study of the Posterolateral Ligament Complex of the Knee: LCL and Popliteus Tendon
Acta Ortopédica Brasileira, 2021
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...
2003
The aim of this study is to evaluate the effect of combined posterior cruciate ligament (PCL) and postero-lateral corner (PLC) reconstruction on laxity and three-dimensional kinematics of cadaver knees. We performed anatomical double bundle PCL reconstruction, and functional one bundle 'over-the-bottom' PCL reconstruction combined with one type of PLC reconstruction, running from the postero-lateral tibia to an isometric point near the lateral epicondyle of the femur. Our results showed that combined reconstruction was necessary to restore rotatory laxity. PLC reconstruction, according to the technique described, invariably created a shift towards internal rotation of the kinematic curves, compared to the intact knee. ᮊ
Knee Surgery, Sports Traumatology, Arthroscopy, 2013
Purpose To determine the involvement of the posterolateral structures including the lateral collateral ligament, the popliteus muscle-tendon unit, the arcuate ligament (popliteofibular ligament, fabellofibular ligament, popliteomeniscal fascicles, capsular arm of short head of the biceps femoris and anterolateral ligament) and the posterior cruciate ligament in providing restraint to excessive recurvatum, tibial posterior translation and external tibial rotation at 90°of flexion. Methods Ten fresh-frozen cadaveric knees were tested with dial test, posterior drawer test and recurvatum test. The values were collected, using a surgical navigation system, on intact knees, following a serial section of the posterolateral corner (lateral collateral ligament, arcuate ligament and popliteus muscle-tendon unit), followed by the additional section of the posterior cruciate ligament. Results The mean tibial external rotation, recurvatum and posterior drawer were, respectively, measured at 9°± 4°, 2°± 3°and 9 ± 1 mm on intact knees. These values increase to 12°± 5°, 3°± 2°and 9 ± 1 mm after cutting the lateral collateral ligament; 17°± 6°(p \ 0.05), 3°± 2°and 10 ± 1 mm after sectioning the arcuate ligament; 18°± 7°, 3°± 2°and 10 ± 1 mm after sectioning the popliteus muscle-tendon unit and 27°± 6°(p \ 0.05), 5°± 3°(p \ 0.05) and 28 ± 2 mm (p \ 0.05) after the additional section of the posterior cruciate ligament. Conclusion Among the different structures of the posterolateral corner, only the arcuate ligament has a significant role in restricting excessive primary and coupled external rotation. The popliteus muscle-tendon unit is not a primary static stabilizer to tibial external rotation at 90°of knee flexion. The posterior cruciate ligament is the primary restraint to excessive recurvatum and posterior tibial translation. The posterior cruciate ligament and the arcuate ligament have predominant role for the posterolateral stability of the knee. The functional restoration of these ligaments is an important part of the surgical treatment of posterolateral ligamentous injuries.
Biomechanical and Anatomical Effects of an External Rotational Torque Applied to the Knee
American Journal of Sports Medicine, 2006
Isolated posterolateral instability of the knee is relatively uncommon. Posterolateral corner injuries occur more commonly in association with an injury to the anterior or posterior cruciate ligaments. 18,35 O'Brien et al 28 noted that graft failures of anterior cruciate ligament reconstructions might be the result of unrecognized and untreated posterolateral corner injuries of the knee. The anatomy and specific arrangement of the posterolateral corner of the knee has been described in detail. The principal anatomical structures of the posterolateral corner of the knee include the iliotibial band, lateral collateral ligament, the arcuate ligament, the popliteus tendon, the popliteofibular ligament, the short lateral ligament, the fabellofibular ligament, the lateral head of the gastrocnemius muscle, and the posterolateral part of the capsule. 6,23,29,32,35 The popliteofibular ligament has been rediscovered as a key element in posterolateral stability of the knee. 3,22,32 Reliable assessment of all knee ligament injuries at the time of presentation allows appropriate planning for surgical treatment. Recommended tests include posterolateral
The insertion geometry of the posterolateral corner of the knee
The Journal of Bone and Joint Surgery. British volume, 2005
We have quantitatively documented the insertion geometry of the main stabilising structures of the posterolateral corner of the knee in 34 human cadavers. The lateral collateral ligament inserted posterior (4.6 mm, sd 2) and proximal (1.3 mm, sd 3.6) to the lateral epicondyle of the femur and posterior (8.1 mm, sd 3.2) to the anterior point of the head of the fibula. On the femur, the popliteus tendon inserted distally (11 mm, sd 0.8) and either anterior or posterior (mean 0.84 mm anterior, sd 4) to the lateral collateral ligament. The popliteofibular ligament inserted distal (1.3 mm, sd 1.2) and anterior (0.5 mm, sd 2.0) to the tip of the styloid process of the fibula. The ligaments had a consistent pattern of insertion and, despite the variation between specimens, the standard deviations were less than the typical size of drill hole used in reconstruction of the posterolateral corner. The data provided in this study can be used in the anatomical repair and reconstruction of this r...
Experimental evaluation of 3-dimensional kinematic behavior of the cruciate ligaments
Clinics, 2007
PURPOSE: The purpose of this study was to evaluate a low-cost and easily reproducible technique for biomechanical studies in cadavers. In this kind of study, the natural effect of loading of the joint and shear forces are not taken into account. The objective is to describe the plastic deformation of the ligaments into 3-dimensional space. METHOD: For 18 intact human cadaver knees, the cruciate ligaments were divided into 3 fiber bundles, the tibial or femoral fixation points were marked, and 2 perpendicular different x-ray exposures were performed, thus obtaining radiographs of spatial projections of the bundle in 3 anatomic planes (frontal, sagittal, and transversal). From the measurements made on the x-ray films, we obtained the average distance between the 2 fixation points of the cruciate ligaments on the tibia and the femur at 4 different flexion angles. RESULTS: The distance between the fixation points of the medial and lateral fiber bundles of the cruciate ligaments did not change significantly during movement. There were, however, significant variations (P < .05) in the distance between the fixation points of the posterior fiber bundles of the anterior cruciate ligament and the anterior fiber bundles of the posterior cruciate ligament. CONCLUSIONS: This technique was efficient for demonstrating the plastic deformability of the cruciate ligaments. The results proceeding from this type of study can assist in the planning of physical rehabilitation programs.