Easy Surgical Approach 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.
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.
Posterolateral Corner Injuries of the Knee: Anatomy, Diagnosis, and Treatment
Sports Medicine and Arthroscopy Review, 2006
Injuries to the posterolateral corner of the knee continue to be a complex problem for orthopedic surgeons. Early recognition and treatment are important factors in the patient's long-term outcome. To properly treat these patients, the surgeon must have a clear understanding of the anatomic relationships amongst the structures in the posterolateral knee. This knowledge combined with a thorough physical examination and imaging studies, allows the surgeon to make the correct diagnosis and devise an appropriate treatment plan. This article will discuss the anatomy, diagnosis, and treatment options to improve the surgeon's understanding of posterolateral knee injuries. The senior author's technique for anatomic reconstruction of the posterolateral corner of the knee and the rehabilitation protocol are described.
The Posterolateral Corner of the Knee: Evaluation Under Microsurgical Dissection
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2005
The posterolateral corner (PLC) has been described by several authors, but there are still controversies. We assumed that a microanatomic dissection of this region could answer some of the questions about its complex anatomy. We therefore conducted an anatomic study using microsurgical techniques, aiming at a precise anatomic description of all the structures that form the posterolateral complex. Type of Study: Cadaveric study. Methods: Ten fresh-frozen human adult cadaveric knees were used for the study. Dissection of the knees was performed using microsurgical instruments, magnifying loupes, and an operative microscope. Anatomic variations, ligament shape, separated bundles of the ligaments, and topography of ligament attachments were described and recorded. Results: The rate of the presence of the popliteofibular ligament (PFL), the fabellofibular ligament, and the arcuate ligament were 100%, 40%, and 70%, respectively. The connective attachments of the popliteus muscle to the other posterolateral structures are the PFL and the 2 popliteomeniscal fascicles. Our dissections show that the shape and the fibula attachment of the PFL can vary. Using the surgical microscope, we were able to dissect and identify 2 different fiber groups of the popliteus tendon at its attachment to the lateral femoral condyle. Also, we were able to confirm in 20% of our knees an anatomic variation of the lateral collateral ligament. Conclusions: Our study may answer some of the questions about the complex anatomy of the PLC. The PFL is well established, always recognizable, and significant in size. Clinical Relevance: Being aware of the complex anatomy of the posterolateral corner and its variations may prove useful in repair and reconstruction.
Posterolateral Corner of the Knee: Current Concepts
Injuries to the posterolateral corner (PLC) comprise a significant portion of knee ligament injuries. A high index of suspicion is necessary when evaluating the injured knee to detect these sometimes occult injuries. Moreover, a thorough physical examination and a comprehensive review of radiographic studies are necessary to identify these injuries. In this sense, stress radiographs can help to objectively determine the extent of these lesions. Non-operative and operative treatment options have been reported depending on the extent of the injury. Complete PLC lesions rarely heal with non-operative treatment, and are therefore most often treated surgically. The purpose of this article was to review the anatomy and clinically relevant biomechanics, diagnosis algorithms, treatment and rehabilitation protocols for PLC injuries.
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...
Posterolateral corner knee injuries: a narrative review
EFORT Open Reviews
Limited knowledge of the anatomy and biomechanics of the posterolateral corner (PLC) of the knee, coupled with poor patient outcomes with non-operative management, resulted in the PLC often being labelled as the ‘dark side’ of the knee. In the last two decades, extensive research has resulted in a better understanding of the anatomy and function of the PLC, and has led to the development of anatomic reconstructions that have resulted in improved patient outcomes. Despite considerable attention in the clinical orthopaedic literature (nearly 400 articles published in the last decade), a standardized algorithm for the diagnosis and treatment of the PLC is still lacking, and much controversy remains. Considering the literature review, there is not a reconstruction technique that clearly prevails over the others. As anatomic, biomechanical, and clinical knowledge of PLC injuries continues to progress, finding the balance between re-creating native anatomy and safely performing PLC recons...
Archives of Orthopaedic and Trauma Surgery
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. T...