Anatomical reconstruction of posterolateral corner and combined injuries of the knee

Wal, Wybren A. van der; Heesterbeek, Petra J.C.; Tienen, T.G. van; Busch, Vincent; Ochten, Johannes H.M. van; Wymenga, A. B.

doi:10.1007/s00167-014-3369-7

Cited by 32 publications

(27 citation statements)

References 41 publications

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“…A recently published series by van der Wal et al of 16 patients who underwent the LaPrade two-tailed technique for lateral-sided reconstruction was prospectively reviewed. 28 At 2 to 5-year follow-up, varus laxity was significantly improved from pre-reconstruction value, 9.6 (6.6-17.1) to 6.3 degrees (0.3-16.1); however, varus laxity was not restored to the contralateral uninjured state. All clinical outcome scores demonstrated a statistically significant increase.…”

Section: Biomechanical and Clinical Resultsmentioning

confidence: 87%

Posterolateral Reconstruction of the Knee: Two-Tailed Surgical Techniques

et al. 2015

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Reconstruction of the posterolateral corner of the knee using two-tailed techniques involved grafts originating from the femur and inserting on the proximal tibia and fibular head. This method reconstructs the fibular collateral ligament, popliteofibular ligament, and popliteus tendon using anatomically placed grafts. This article describes the history, anatomy, indications, and authors' preferred technique for a two-tailed posterolateral corner reconstruction. In addition, biomechanical and clinical outcomes of this technique will be compared.

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Section: Biomechanical and Clinical Resultsmentioning

confidence: 87%

Posterolateral Reconstruction of the Knee: Two-Tailed Surgical Techniques

et al. 2015

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“…The mean IKDC score of 73.1 is slightly higher than the previous three reports evaluating this surgical technique despite including only patients with MKLIs. [17][18][19] This may be attributable to the relatively fewer female patients in this study (4/20, 20%), given that females have been shown to have lower IKDC scores following KD. 29 Alternatively, the difference may be related to the time interval from injury to surgery.…”

Section: Discussionmentioning

confidence: 87%

“…This technique has demonstrated satisfactory International Knee Documentation Committee (IKDC), Lysholm, and Cincinnati functional scores. [17][18][19] However, more than a third of patients (33-43%) in each of these previous cohorts had undergone isolated FCL/PLC reconstruction. Although injury to the PLC can occur in isolation, most PLC injuries present as a component of a multiligament knee injury (MKLI).…”

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confidence: 99%

Posterolateral Corner Reconstruction Using the Anatomical Two-Tailed Graft Technique: Clinical Outcomes in the Multiligament Injured Knee

et al. 2018

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Injury to the posterolateral corner (PLC) of the knee can lead to both varus and rotational instability. Multiple PLC reconstruction techniques have been described, including one-tailed graft (fibula-based constructs) or two-tailed graft (combined fibula- and tibia-based constructs). The purpose of our study was to evaluate the clinical outcomes of anatomical two-tailed graft reconstruction of the PLC in the setting of multiligament knee injuries (MKLIs) with grade III varus instability. Patients were identified through a prospective MLKI database between 2004 and 2013. Patients who received fibular collateral ligament and PLC reconstructions using a two-tailed graft and had a minimum follow-up of 2 years were included. Patients were assessed for clinical laxity grade, range of motion, and functional outcomes using Lysholm and International Knee Documentation Committee (IKDC) scores. Twenty patients (16 male, 4 female) with a mean age of 30.7 (range: 16-52) and a mean follow-up of 52.2 months (range: 24-93 months) were included. Knee dislocation (KD) grades included: 4 KD-1, 10 KD 3-L, 5 KD-4, and 1 KD-5. No patients had isolated PLC injuries. Mean IKDC and Lysholm score were 73.1 ± 25.8 and 78 ± 26, respectively. Mean range of motion was -1.1 to 122.8. In full extension, two patients (10%) had grade 1 laxity to varus stress. In 30 degrees of knee flexion, five (25%) patients had grade 1 laxity, and two (10%) had grade 2 laxity. Anatomical two-tailed PLC reconstruction can reliably restore varus stability when performed on patients with MLKIs and type C posterolateral instability with hyperextension external rotation recurvatum deformity. Satisfactory functional outcome scores were achieved in the majority of patients. This study supports the use of an anatomical two-tailed PLC reconstruction in the multiligament injured knee. The level of evidence is IV, case series.

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“…The authors' experience and the peer-reviewed literature support two-tailed techniques in terms of providing the most consistent stability and anatomic restoration of the key structures. [1][2][3]9 However, there are deficiencies of the two-tailed techniques that ideally should be addressed. A recent prospective outcomes study by van der Wal et al-reporting on the use of the technique described by LaPrade et al-showed that varus stability was improved but not completely restored to match that in the contralateral, uninjured knee in patients at 5-year follow-up.…”

Section: Surgical Techniquementioning

confidence: 99%

“…A recent prospective outcomes study by van der Wal et al-reporting on the use of the technique described by LaPrade et al-showed that varus stability was improved but not completely restored to match that in the contralateral, uninjured knee in patients at 5-year follow-up. 1,9 In addition, the use of a screw and spiked washer for graft fixation can be associated with complications and morbidity. In the senior author's practice, approximately 25% of patients have undergone removal of the screw and washer due to pain and iliotibial band (IT) band irritation.…”

Section: Surgical Techniquementioning

confidence: 99%

Repair or Reconstruction in Acute Posterolateral Instability of the Knee: Decision Making and Surgical Technique Introduction

Stannard

2015

J Knee Surg

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Complex knee injury surgeons must frequently decide whether to repair or reconstruct an acute posterolateral corner (PLC) injury. If repair is not feasible or fails, reconstruction is often necessary. Several studies have found that reconstruction has better outcomes and lower failure rates. Careful studies of the anatomy of the corner have led to the development of "two-tailed" reconstruction techniques which are becoming widely used in the field. Repair should not be completely disregarded as there are times when it is necessary, especially when no donor allograft tissue is readily available or when aggressive postoperative rehabilitation will not be performed. Optimally, if the patient has high quality tissue available for repair, it is best to combine reconstruction with repair. The authors have developed a new PLC reconstruction technique which applies the functional anatomy that has been increasingly defined. We detail these methods here, which include the use of cortical button suspensory fixation and interference screw fixation of allografts in sockets. This allows for individual and sequential intraoperative tensioning of the grafts to obtain optimal knee stability and motion.

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Anatomical reconstruction of posterolateral corner and combined injuries of the knee

Abstract: Case series with no comparative group, Level IV.

Cited by 32 publications

References 41 publications

Posterolateral Reconstruction of the Knee: Two-Tailed Surgical Techniques

Posterolateral Reconstruction of the Knee: Two-Tailed Surgical Techniques

Posterolateral Corner Reconstruction Using the Anatomical Two-Tailed Graft Technique: Clinical Outcomes in the Multiligament Injured Knee

Repair or Reconstruction in Acute Posterolateral Instability of the Knee: Decision Making and Surgical Technique Introduction

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