A Biomechanical Comparison of the Arciero and LaPrade Reconstruction for Posterolateral Corner Knee Injuries

Abstract

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.

Open Anatomic Reconstruction of the Posterolateral Corner: The Arciero Technique

“…A recent biomechanical study looking at the biomechanics of the Arciero reconstruction technique and the LaPrade reconstruction technique showed that both techniques were equally effective in restoring stability to knees with PLC injuries. 14 The authors recommend, as do we, that surgeons should select a reconstruction technique based on their experience and training to address these injuries. 14 …”

“…A recent biomechanical study looking at the biomechanics of the Arciero reconstruction technique and the LaPrade reconstruction technique showed that both techniques were equally effective in restoring stability to knees with PLC injuries. 14 The authors recommend, as do we, that surgeons should select a reconstruction technique based The graft should be tensioned in slight valgus and 30 of flexion Passing sutures can be left in the fibular tunnel after drilling to facilitate graft passage A Cobb elevate can be placed posterior to the fibular head while drilling to prevent common peroneal nerve injury…”

“…Advantages and Disadvantages Advantages Disadvantages Oblique transfibular tunnel better recreates normal anatomy Anterolateral-to-posteromedial trajectory of the fibular tunnel decreases risk of common peroneal nerve injury Reproduces 2 ligamentous structures with a single graft Decreases risk of fracture by not using an interference screw in the fibular head Care must be taken to appropriately tension graft with aperture fixation Technically demanding OPEN ANATOMIC RECONSTRUCTION OF THE PLC e1413on their experience and training to address these injuries 14. …”

Editorial Commentary: Those Who Don't Know History Are Condemned to Repeat It—What Are the Next Steps to Improve Posterolateral Knee Outcomes?

“…6,14,21 Ultimately, the top of the research pyramid is our clinical outcome studies, [22][23][24][25][26] which we believe have significantly improved the treatment of injuries to the posterolateral corner to the point at which it is no longer considered the dark side of the knee. 27,28 Other authors have validated our anatomic-based posterolateral knee reconstruction clinically, 29 and Treme et al 30 biomechanically compared this technique with other techniques. Franciozi et al 31 reported a clinical study using a hamstring autograft technique that was very similar to the anatomic-based reconstruction technique presented in the study by Vezeridis et al 1 Overall, we believe that refining anatomic-based reconstruction procedures should be the next research topic to improve posterolateral corner reconstruction.…”

Advances and trends in multiligament injuries of the knee relevant to low-resource settings

“…PLC reconstructions can be performed using techniques described by LaPrade or Arciero. A recent biomechanical study [46] showed these to be equally effective; however, the Arciero reconstruction requires only a single semitendinosus graft, whereas LaPrade's technique requires an additional gracilis graft. Another option for the PLC is performing a biceps tenodesis.…”