The insertion geometry of the posterolateral corner of the knee (original) (raw)
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Reconstruction of the Posterolateral Corner of the Knee
Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2005
To date, there is no consensus on the best technique to repair injured posterolateral structures of the knee. We evaluated the effects of a fibular head based isometric reconstruction of the posterolateral knee corner with a double bundle semitendinosus tendon. From February 2001 to February 2005, 18 isometric reconstructions of a chronic posterolateral corner (PLC) injury of the knee were performed using the semitendinosus tendon. The average age of the patients was 39 years, ranging from 19 to 52 years. Twelve were male and 6 female. The time interval between injury and treatment ranged from 1.5 to 14 months. Three patients had simple PLC injuries, 10 had combined PLC-posterior cruciate ligament (PCL) injuries and two of them had undergone a PCL reconstruction elsewhere 6.5 months prior to referral. Three other patients had an associated anterior cruciate ligament (ACL) injury and two had a combination of PLC with ACL and PCL injury. A doubled semitendinosus tendon was threaded through bony tunnels in the fibular head running from the insertion of the lateral collateral ligament (LCL) to the fibular insertion of the popliteo-fibular ligament and both ends were fixed proximally into bony tunnels of the lateral femoral condyle at their respective isometric point. The varus stress test and the posterolateral rotation test were used to evaluate stability of the posterolateral structures. Isometry was optimal between the femoral attachment site of the popliteal tendon to the anatomical insertion of the popliteofibular ligament at the fibular head. The fibular insertion of the LCL is isometric to the anterior or antero-inferior 8-10 mm of the femoral insertion of the LCL. The average follow-up period was 32 months (30-42 months). There was no varus knee instability in full extension. At 30° of flexion two cases demonstrated a grade I varus instability. A fibular head based isometric reconstruction is a reproducible and reliable technique for reconstruction of the posterolateral corner of the knee.
Anatomical variations in the anatomy of the posterolateral corner of the knee
Knee Surgery, Sports Traumatology, Arthroscopy, 2007
This cadaveric study of 22 knees described the anatomy of the deeper structures of the posterolateral corner, the popliteus-tendon complex, arcuate ligament complex, the popliteofibular ligament, and the coronary ligament. Most variations occurred in the popliteofibular ligament; the variations and the different nomenclatures used in the literature for these structures make it difficult to diagnose and repair injuries to them. Untreated injuries may result in chronic functional instability to the posterolateral corner of the knee.
An anatomical three-dimensional study of the posteromedial corner of the knee
Knee Surgery, Sports Traumatology, Arthroscopy, 2011
Purpose For many years, the anatomy of the medial knee corner has been reported. However, it is not exactly clear how all these structures function together. The purpose of this study is to identify and try to understand the relationship between the posteromedial corners of the knee using three-dimensional visualization techniques. Materials and methods This study comprises of 10 knees from adult corpses. Images were acquired from the dissection of different layers of the posteromedial compartment of the knee using a camera Nikon D40 and AF-S Nikkor 18-55 mm (Nikon Corp., Japan) placed on a slide bar. The pair of images was processed using Callipyan 3D or Anabuilder software (Ana builder, France) that trans-forms the two different images of the same structure with the intrapupillary distance proportion into one anaglyphic image. Results During knee dissection, pictures were taken and transformed into three-dimensional images that become more realistic with the use of special glasses. The images were made during the dissection of the three layers of the posteromedial compartment of the knees. Conclusions Posteromedial corner ligament structures are quite complex and are not always clearly described in the literature. Three-dimensional images of these structures can help better understanding its anatomy.
The Posterolateral Aspect of the Knee: Anatomy and Surgical Approach
The American Journal of Sports Medicine, 1996
Thirty cadaveric knees were dissected to obtain a detailed understanding of the anatomic structures of the posterolateral aspect of the knee, and a dependable surgical approach to evaluate injuries to these structures was developed and used on 71 consecutive patients who were operated on for posterolateral knee injuries. Three fascial incisions and one lateral midcapsular incision were used to provide surgical access. The following individual anatomic structures were identified : the layers of the iliotibial tract, long and short heads of the biceps femoris muscle, fibular collateral ligament, midthird lateral capsular ligament, fabellofibular ligament, posterior arcuate ligament, popliteus muscle complex, lateral coronary ligament, and posterior capsule. This study increased our understanding of the individual anatomic structures and the relationships between these components. The surgical approach provided for the evaluation of these anatomic structures should aid the surgeon in properly assessing the injuries before surgical repair. This information should also stimulate more anatomic, biomechanical, and clinical studies of the posterolateral aspect of the knee.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2010
This study presents clinical results of a case series of isolated reconstruction of the posterolateral corner (PLC) with a new technique that aims to reconstruct the lateral collateral ligament (LCL), popliteus tendon, and popliteofibular ligament. Methods: From 1997 to 2005, 27 patients available for follow-up with isolated posterolateral instability were treated with primary reconstruction of the LCL and PLC. The median age was 28 years, and there were 16 male patients. Of the patients, 26% had remaining instability after anterior or posterior cruciate ligament reconstruction. All underwent reconstruction with a novel technique addressing both the LCL and the PLC by use of hamstring autografts. Follow-up was more than 24 months, and patients were examined by an independent observer using the International Knee Documentation Committee objective measures and subjective Knee Injury and Osteoarthritis Outcome Scores. Results: In our series 95% of patients with isolated lateral rotatory instability had rotatory stability after PLC reconstruction. On the basis of International Knee Documentation Committee scoring, 71% were normal or nearly normal. Subjective Knee Injury and Osteoarthritis Outcome Scores were comparable to scores in patients after meniscectomy. One patient had a deep infection, but none had any peroneal nerve injury. Conclusions: This case series presents a new method for combined reconstruction of the LCL and the PLC. Despite the extensiveness of procedure, complications were low. The technique restores lateral stability clinically at 2 years' follow-up. Level of Evidence: Level IV, therapeutic case series.
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...
Easy Surgical Approach of the Posterolateral Corner of the Knee
Video Journal of Sports Medicine, 2021
Background: The anatomy of the posterolateral corner (PLC) of the knee is complex. The approach of the PLC can be a challenging and stressful surgical time. Indications: The indications are posterolateral meniscal repair, open lateral meniscus allograft transplantation, posterolateral tibial plateau fracture, and PLC reconstruction for grade III sprains. Technique Description: The skin incision is straight, realized with the knee positioned at 90° of flexion, passing slightly posterior to the lateral epicondyle, anterior to the fibular head (FH), and ending on Gerdy’s tubercle. The subcutaneous tissues are dissected posteriorly so as to expose the FH and the biceps femoris (BF) tendon. The aponeurosis of the peroneus muscles is incised vertically opposite to the anterior side of the FH. The common fibular nerve is exposed at the neck of the fibula. Metzenbaum scissors are then inserted subaponeurotically, posteriorly, and parallel to the BF tendon, superficially to the nerve. An inc...
The American journal of sports medicine
Quantitative descriptions of the attachment sites of the main posterolateral knee structures have not been performed. To qualitatively and quantitatively determine the anatomic attachment sites of these structures and their relationships to pertinent bony landmarks. Cadaveric study. Dissections were performed and measurements taken on 10 nonpaired fresh-frozen cadaveric knees. The fibular collateral ligament had an average femoral attachment slightly proximal (1.4 mm) and posterior (3.1 mm) to the lateral epicondyle. Distally, it attached 8.2 mm posterior to the anterior aspect of the fibular head. The popliteus tendon had a constant broad-based femoral attachment at the most proximal and anterior fifth of the popliteal sulcus. The popliteus tendon attachment on the femur was always anterior to the fibular collateral ligament. The average distance between the femoral attachments of the popliteus tendon and fibular collateral ligament was 18.5 mm. The popliteofibular ligament had two...