Abstract
Background
To date, various surgical techniques to treat posterolateral knee instability have been described. Recent studies recommended an anatomical and isometric reconstruction of the posterolateral corner addressing the key structures, such as lateral collateral ligament (LCL), popliteus tendon (POP) and popliteofibular ligament (PFL). Two clinical established autologous respective local reconstruction methods of the posterolateral complex were tested for knot-bone cylinder press-fit fixation to assess efficacy of each reconstruction technique in comparison to the intact knee.
Null hypothesis
The knot-bone cylinder press-fit fixation for both anatomic and isometric reconstruction techniques of the posterolateral complex shows equal biomechanical stability as the intact posterolateral knee structures.
Study design
This was a controlled laboratory study.
Methods
Two surgical techniques (Larson: fibula-based semitendinosus autograft for LCL and PFL reconstruction/Kawano: biceps femoris and iliotibial tract autograft for LCL, PFL and POP reconstruction) with press-fit fixation were used for restoration of posterolateral knee stability. Seven cadaveric knees (66 ± 3.4 years) were tested under three conditions: intact knee, sectioned state and reconstructed knee for each surgical technique. Biomechanical stress tests were performed for every state at 30° and 90° knee flexion for anterior–posterior translation (60 N), internal–external and varus–valgus rotation (5 Nm) at 0°, 30° and 90° using a kinemator (Kuka robot).
Results
At 30° and 90° knee flexion, no significant differences between the four knee states were registered for anterior–posterior translation loading. Internal–external and varus–valgus rotational loading showed significantly higher instability for the sectioned state than for the intact or reconstructed posterolateral structures (p < 0.05). There were no significant differences between the intact and reconstructed knee states for internal-external rotation, varus–valgus rotation and anterior–posterior translation at any flexion angles (p > 0.05). Comparing both reconstruction techniques, significant higher varus–/valgus stability was registered for the fibula-based Larson technique at 90° knee flexion (p < 0.05).
Conclusions
Both PLC reconstructions showed equal biomechanical stability as the intact posterolateral knee structures when using knot-bone cylinder press-fit fixation. We registered restoration of the rotational and varus–valgus stability with both surgical techniques. The anterior–posterior translational stability was not influenced significantly. The Larson technique showed significant higher varus/valgus stability in 90° flexion. The latter is easier to perform and takes half the preparation time, but needs grafting of the semitendinosus tendon. The Kawano reconstruction technique is an interesting alternative in cases of missing autografts.
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References
LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A (2004) An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med 32:1405–1414. doi:10.1177/0363546503262687
LaPrade RF, Ly TV, Wentorf FA, Engebretsen L (2003) The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med 31:854–860
LaPrade RF, Spiridonov SI, Coobs BR, Ruckert PR, Griffith CJ (2010) Fibular collateral ligament anatomical reconstructions: a prospective outcomes study. Am J Sports Med 38:2005–2011. doi:10.1177/0363546510370200
Laprade RF, Wentorf FA, Olson EJ, Carlson CS (2006) An in vivo injury model of posterolateral knee instability. Am J Sports Med 34:1313–1321. doi:10.1177/0363546506286785
LaPrade RF, Wozniczka JK, Stellmaker MP, Wijdicks CA (2010) Analysis of the static function of the popliteus tendon and evaluation of an anatomic reconstruction: the “fifth ligament” of the knee. Am J Sports Med 38:543–549. doi:10.1177/0363546509349493
Apsingi S, Eachempati KK, Shah GK, Kumar S (2011) Posterolateral corner injuries of the knee–a review. J Indian Med Assoc 109:400–403
Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study. J Bone Joint Surg Am 69:233–242
Apsingi S, Nguyen T, Bull AM, Unwin A, Deehan DJ, Amis AA (2008) Control of laxity in knees with combined posterior cruciate ligament and posterolateral corner deficiency: comparison of single-bundle versus double-bundle posterior cruciate ligament reconstruction combined with modified Larson posterolateral corner reconstruction. Am J Sports Med 36:487–494. doi:10.1177/0363546508314415
Hoher J, Harner CD, Vogrin TM, Baek GH, Carlin GJ, Woo SL (1998) In situ forces in the posterolateral structures of the knee under posterior tibial loading in the intact and posterior cruciate ligament-deficient knee. J Orthop Res 16:675–681. doi:10.1002/jor.1100160608
Cooper JM, McAndrews PT, LaPrade RF (2006) Posterolateral corner injuries of the knee: anatomy, diagnosis, and treatment. Sports Med Arthrosc 14:213–220. doi:10.1097/01.jsa.0000212324.46430.60
Noyes FR, Barber-Westin SD (2005) Posterior cruciate ligament revision reconstruction, part 1: causes of surgical failure in 52 consecutive operations. Am J Sports Med 33:646–654. doi:10.1177/0363546504271210
Larsen MW, Moinfar AR, Moorman CT 3rd (2005) Posterolateral corner reconstruction: fibular-based technique. J Knee Surg 18:163–166
LaPrade RF, Johansen S, Agel J, Risberg MA, Moksnes H, Engebretsen L (2010) Outcomes of an anatomic posterolateral knee reconstruction. J Bone Joint Surg Am 92:16–22. doi:10.2106/JBJS.I.00474
Apsingi S, Nguyen T, Bull AM, Unwin A, Deehan DJ, Amis AA (2009) A comparison of modified Larson and ‘anatomic’ posterolateral corner reconstructions in knees with combined PCL and posterolateral corner deficiency. Knee Surg Sports Traumatol Arthrosc 17:305–312. doi:10.1007/s00167-008-0696-6
Feeley BT, Muller MS, Sherman S, Allen AA, Pearle AD (2010) Comparison of posterolateral corner reconstructions using computer-assisted navigation. Arthroscopy 26:1088–1095. doi:10.1016/j.arthro.2009.12.014
Nau T, Chevalier Y, Hagemeister N, Deguise JA, Duval N (2005) Comparison of 2 surgical techniques of posterolateral corner reconstruction of the knee. Am J Sports Med 33:1838–1845. doi:10.1177/0363546505278302
Noyes FR, Barber-Westin SD (2007) Posterolateral knee reconstruction with an anatomical bone-patellar tendon-bone reconstruction of the fibular collateral ligament. Am J Sports Med 35:259–273. doi:10.1177/0363546506293704
Fink C, Zapp M, Benedetto KP, Hackl W, Hoser C, Rieger M (2001) Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy 17:138–143. doi:10.1053/jars.2001.21509
Paessler HH, Mastrokalos DS (2003) Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. A new and innovative procedure. Orthop Clin North Am 34:49–64
Jagodzinski M, Behfar V, Hurschler C, Albrecht K, Krettek C, Bosch U (2004) Femoral press-fit fixation of the hamstring tendons for anterior cruciate ligament reconstruction. Am J Sports Med 32:1723–1730
Fanelli GC, Larson RV (2002) Practical management of posterolateral instability of the knee. Arthroscopy 18:1–8 (aar018001b[pii])
Terry GC, LaPrade RF (1996) The posterolateral aspect of the knee. Anatomy and surgical approach. Am J Sports Med 24:732–739
Kawano CT, Bispo RZ Jr, de Oliveira MG, Soejima AT, Apostolopoulos Sde B (2007) Posterolateral knee instability: an alternative proposal for surgical treatment. Clinics (Sao Paulo) 62:371–374 (S1807-59322007000300027 [pii])
Covey DC (2001) Injuries of the posterolateral corner of the knee. J Bone Joint Surg Am 83-A:106–118
Lasmar RC, Marques de Almeida A, Serbino JW Jr, Mota Albuquerque RF, Hernandez AJ (2010) Importance of the different posterolateral knee static stabilizers: biomechanical study. Clinics (Sao Paulo) 65:433–440. doi:10.1590/S1807-59322010000400013
Suda Y, Seedhom BB, Matsumoto H, Otani T (2000) Reconstructive treatment of posterolateral rotatory instability of the knee: a biomechanical study. Am J Knee Surg 13:110–116
Hertel P, Behrend H, Cierpinski T, Musahl V, Widjaja G (2005) ACL reconstruction using bone-patellar tendon-bone press-fit fixation: 10-year clinical results. Knee Surg Sports Traumatol Arthrosc 13:248–255. doi:10.1007/s00167-004-0606-5
Simonian PT, Erickson MS, Larson RV, O’Kane JW (2000) Tunnel expansion after hamstring anterior cruciate ligament reconstruction with 1-incision EndoButton femoral fixation. Arthroscopy 16:707–714. doi:10.1053/jars.2000.4635
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Panzica, M., Janzik, J., Bobrowitsch, E. et al. Biomechanical comparison of two surgical techniques for press-fit reconstruction of the posterolateral complex of the knee. Arch Orthop Trauma Surg 135, 1579–1588 (2015). https://doi.org/10.1007/s00402-015-2319-2
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DOI: https://doi.org/10.1007/s00402-015-2319-2