Background:
Injury to the posterolateral corner (PLC) of the knee requires reconstruction
to restore coronal and rotary stability. Two commonly used procedures are
the Arciero reconstruction technique (ART) and the LaPrade reconstruction
technique (LRT). To the authors’ knowledge, these techniques have not been
biomechanically compared against one another.
Purpose:
To identify if one of these reconstruction techniques better restores
stability to a PLC-deficient knee and if concomitant injury to the proximal
tibiofibular joint or anterior cruciate ligament affects these results.
Study Design:
Controlled laboratory study.
Methods:
Eight matched-paired cadaveric specimens from the midfemur to toes were used.
Each specimen was tested in 4 phases: intact PLC (phase 1), PLC sectioned
(phase 2), PLC reconstructed (ART or LRT) (phase 3), and tibiofibular (phase
4A) or anterior cruciate ligament (phase 4B) sectioning with PLC
reconstructed. Varus angulation and external rotation at 0º, 20º, 30º, 60º,
and 90º of knee flexion were quantified at each phase.
Results:
In phase 3, both reconstructions were effective at restoring laxity back to
the intact state. However, in phase 4A, both reconstructions were
ineffective at stabilizing the joint owing to tibiofibular instability. In
phase 4B, both reconstructions had the potential to restrict varus
angulation motion. There were no statistically significant differences found
between reconstruction techniques for varus angulation or external rotation
at any degree of flexion in phase 3 or 4.
Conclusion:
The LRT and ART are equally effective at restoring stability to knees with
PLC injuries. Neither reconstruction technique fully restores stability to
knees with combined PLC and proximal tibiofibular joint injuries.
Clinical Relevance:
Given these findings, surgeons may select their reconstruction technique
based on their experience and training and the specific needs of their
patients.
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