Anatomic Posterolateral Corner Reconstruction With Autografts

Abstract

Anatomic posterolateral corner reconstruction reproduces 3 main structures: the lateral collateral ligament, the popliteofibular ligament, and the popliteus tendon. The LaPrade technique reproduces all 3 main stabilizers. However, it requires a long graft, limiting its indication to clinical settings in which allograft tissue is available. We propose a surgical procedure that is a modification of the LaPrade technique using the same tunnel placement, hamstring autografts, and biceps augmentation when necessary. It relies on artificial graft lengthening provided by the loop of the suspensory fixation device fixed at the anterior tibial cortex. The final reconstruction reproduces the popliteus tendon with the bulkiest end of the semitendinosus; the popliteofibular ligament with a strand of the semitendinosus and a strand of the gracilis; and the lateral collateral ligament with a strand of the semitendinosus and a strand of the gracilis, which can also be augmented with a biceps strip.

Anatomic Posterolateral Corner Reconstruction Using Single Graft Plus Adjustable-Loop Suspensory Fixation Device

“…A similar modification of the technique, in which a fixed Endobutton device is used, has been described in the literature. 14 When this method is used, all grafts must be tensioned and fixed with the knee in 1 position. The benefit of using an adjustable-loop device is that the PFL and popliteus grafts can be retensioned after initial fixation and cycling of the knee.…”

“… 11 Modifications of the technique, in which 2 separate autografts are used, have been described. 14 However, given that PLC lesions commonly occur in association with other ligament injuries, this may limit graft options.…”

Minimally Invasive, Arthroscopic-Assisted, Anatomic Posterolateral Corner Reconstruction

“…It also reduces the risk of complications such as improper wound healing, wound infections, and arthrofibrosis of soft tissue in comparison with other, open surgical procedures. 6 , 7 Moreover, arthroscopic visualization of the popliteal complex from the anterolateral viewing portal with the creation of 2 additional working portals (midlateral and high midlateral) makes it possible to freely maneuver with instruments in the posterolateral aspect of the knee. In comparison with other arthroscopic techniques, there is no need to create a trans-septal portal and work in the posterior compartment of the knee, where the risk of injury to the popliteal neurovascular bundle is significant.…”

Arthroscopic Popliteus sling Reconstruction using the ‘Popliteus portal’ : An effective way to restore the Posterolateral corner stability A Case Series and Surgical Technique

“…However, the described techniques are basically open surgical procedures, without the advantages of an arthroscopic technique. 4,7,8,9 Open reconstructions require a thorough knowledge of the anatomy of the lateral side of the knee, a rather large exposure of the posterolateral complex through a hockey stick incision, isolation of the common peroneal Nerve and is quite cumbersome. Despite the wide exposure, there is insufficient direct visualization of the deeper posterolateral structures and difficulty in having a complete intraarticular ligament construct for the popliteus.…”