Operative Treatment of Posterolateral Instability of the Knee

Veltri, Daniel M.; Warren, Russell F.

doi:10.1016/s0278-5919(20)30313-6

Cited by 143 publications

(55 citation statements)

References 13 publications

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“…However, this was based on anatomic studies involving serial sectioning of posterolateral structures. 3,14,26,37,39 It is important to recognize that although the method of selective sectioning provides critical information about knee stability, the results obtained from this method are dependent on the sequence in which the structures are cut. 24 Although helpful, this classification of PLC knee injuries is not fully representative of normal knee kinematics or the injury characteristics at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

The Pathoanatomy of Posterolateral Corner Ligamentous Disruption in Multiligament Knee Injuries Is Predictive of Peroneal Nerve Injury

et al. 2020

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Background: A description of the precise locations of ligamentous and myotendinous injury patterns of acute posterolateral corner (PLC) injuries and their associated osseous and neurovascular injuries is lacking in the literature. Purpose: To characterize the ligamentous and myotendinous injury patterns and zones of injury that occur in acute PLC injuries and determine associated rates of peroneal nerve palsies and vascular injuries, as well as fracture and dislocation. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively identified all patients treated for an acute multiligament knee injury (MLKI) at our level 1 trauma center from 2001 to 2018. From this cohort, all patients with PLC injuries were identified. Demographics, involved ligaments and tendons, neurovascular injury, and presence of fracture and dislocation were compared with the larger multiligament knee cohort. Incidence and location of injury of PLC structures—from proximal to midsubstance and distal injury—were recorded. Results: A total of 100 knees in 100 patients were identified as having MLKIs. A total of 74 patients (74%) had lateral-sided ligament injuries. Of these, 23 (31%) had a peroneal nerve palsy associated with their injury; 10 (14%), a vascular injury; and 23 (31%), a fracture. Patients with PLC injuries had higher rates of peroneal nerve injury as compared with those having acute MLKIs without a PLC injury (31% vs 4%; P = .005). Patients with a complete peroneal nerve palsy (n = 17) were less likely to regain function than those with a partial peroneal nerve palsy (n = 6; 12% vs 100%; P < .0001). Complete injury to the lateral collateral ligament (LCL) occurred in 71 of 74 (96%) PLC injuries, with 3 distinct patterns of injury demonstrated. Fibular avulsion of the LCL was the most common zone of injury (65%), followed by femoral avulsion (20%) and midsubstance tear (15%). Location of injury to the LCL was associated with the rate of peroneal nerve injury, with midsubstance tears and fibular avulsions associated with higher rates of peroneal nerve injury. Conclusion: MLKIs with involvement of the PLC are more likely to suffer peroneal nerve injury. The LCL is nearly always involved, and its location of injury is predictive of peroneal nerve injury. Patients with a complete peroneal nerve palsy at presentation are much less likely to regain function.

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Section: Discussionmentioning

confidence: 99%

The Pathoanatomy of Posterolateral Corner Ligamentous Disruption in Multiligament Knee Injuries Is Predictive of Peroneal Nerve Injury

et al. 2020

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“…Recent studies have postulated several drawbacks for tibial-fibular-based techniques, including increased technical difficulty and potential overconstraint of external and varus rotations of the knee [ 14 , 15 ]. Veltri and Warren have advocated reconstruction of PFL and LCL as sufficient to adequately control posterolateral instability such as posterior tibial translation and external and varus rotations [ 17 , 18 ], which may support our modified Larson’s method. Moreover, as the popliteus constitutively possesses a muscle belly and acts as a dynamic ligament, it is disputable that popliteus is reconstructed as a static ligament using ST tendon.…”

Section: Discussionmentioning

confidence: 75%

A modified Larson’s method of posterolateral corner reconstruction of the knee reproducing the physiological tensioning pattern of the lateral collateral and popliteofibular ligaments

Niki¹,

Matsumoto²,

Otani³

et al. 2012

BMC Sports Sci Med Rehabil

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BackgroundConsensus has been lacking as to how to reconstruct the posterolateral corner (PLC) of the knee in patients with posterolateral instability. We describe a new reconstructive technique for PLC based on Larson's method, which reflects the physiological load-sharing pattern of the lateral collateral ligament (LCL) and popliteofibular ligament (PFL).FindingsSemitendinosus graft is harvested, and one limb of the graft comprises PFL and the other comprises LCL. Femoral bone tunnels for the LCL and popliteus tendon are made at their anatomical insertions. Fibular bone tunnel is prepared from the anatomical insertion of the LCL to the proximal posteromedial portion of the fibular head, which corresponds to the insertion of the PFL. The graft end for popliteus tendon is delivered into the femoral bone tunnel and secured on the medial femoral condyle. The other end for LCL is passed through the fibular tunnel from posterior to anterior. While the knee is held in 90 of flexion, the graft is secured in the fibular tunnel using a 5 mm interference screw. Then, the LCL end is passed into the femoral bone tunnel and secured at the knee in extension.ConclusionsDifferential tension patterns between LCL and PFL is critical when securing these graft limbs. Intrafibular fixation of the graft using a small interference screw allows us to secure these two graft limbs independently with intended tension at the intended flexion angle of the knee.

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“…The posterolateral corner of the knee has received relatively little attention because there is no consensus regarding the exact structures that are damaged in the case of injuries in this region ( 1 , 2 ). The involvement of these complex structures can lead to instabilities or to a severe derangement of the joint ( 3 - 6 ).…”

Section: Introductionmentioning

confidence: 99%

“…The treatment is controversial in the literature, and various surgical techniques have been proposed ( 7 , 8 ), ranging from a surgical repair in the acute phase to a complete reconstruction of injured structures. Currently, the anatomical reconstruction of the posterolateral corner of the knee is advocated ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of chronic lesions in the posterolateral corner of the knee with autologous biceps femoralis and fascia lata grafts

Oliveira

Severino

Kawano

2012

Clinics

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OBJECTIVE:The aim of this study was to evaluate the treatment of patients with chronic lesions in the posterolateral corner of the knee with reconstruction of the fibular collateral ligament, popliteus tendon and popliteofibular ligament and with autografts of the biceps femoris and fascia lata.METHOD:A total of 129 patients with injuries of the posterolateral corner of the knee that lasted for more than three weeks and were associated with the lesion of at least one of the cruciate ligaments were included. All of the patients were operated on consecutively in the same hospital between March 2004 and April 2009. Clinical evaluation using the Lyshom scale and the International Knee Documentation Committee (IKDC, item 4, assessment ligament) protocol was performed in 114 patients for whom there were complete data available.RESULTS:There was significant improvement in the Lyshom score and improved stability according to the IKDC protocol in the pre- compared to postoperative varus stress test at 30 degrees and the posterolateral rotation test.CONCLUSIONS:Surgical reconstruction of the posterolateral corner of the knee with biceps femoris tendon and fascia lata autografts is effective in stabilizing the posterolateral corner of the knee.

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Operative Treatment of Posterolateral Instability of the Knee

Cited by 143 publications

References 13 publications

The Pathoanatomy of Posterolateral Corner Ligamentous Disruption in Multiligament Knee Injuries Is Predictive of Peroneal Nerve Injury

The Pathoanatomy of Posterolateral Corner Ligamentous Disruption in Multiligament Knee Injuries Is Predictive of Peroneal Nerve Injury

A modified Larson’s method of posterolateral corner reconstruction of the knee reproducing the physiological tensioning pattern of the lateral collateral and popliteofibular ligaments

Reconstruction of chronic lesions in the posterolateral corner of the knee with autologous biceps femoralis and fascia lata grafts

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