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3D kinematic in-vitro comparison of posterolateral corner reconstruction techniques in a combined injury model

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

With the variable injury pattern to the posterolateral structures (PLS) of the knee, a number of reconstructive procedures have been introduced. It was the aim of the present study to evaluate the resulting 3D kinematics following three different surgical techniques of reconstruction in a combined posterior cruciate ligament (PCL)/PLS injury model. In nine human cadaveric knees, 3D kinematics were recorded during the path of flexion–extension using a computer based custom made 6-degree-of-freedom (DOF) testing apparatus. Additional laxity tests were conducted at 30 and 90° of flexion. Testing was performed before and after cutting the PLS and PCL, followed by PCL reconstruction alone. Reconstructing the posterolateral corner, three surgical techniques were compared: (a) the posterolateral corner sling procedure (PLCS), (b) the biceps tenodesis (BT), and (c) a bone patellar-tendon bone (BTB) allograft reconstruction . Posterior as well as rotational laxity were significantly increased after PCL/PLS transection at 30 and 90° of flexion. Isolated PCL reconstruction resulted in a remaining external rotational deficiency for both tested flexion angles. Additional PLS reconstruction closely restored external rotation as well as posterior translation to intact values by all tested procedures. Compared to the intact knee, dynamic testing revealed a significant internal tibial rotation for (b) BT (mean=3.9°, p=0.043) and for (c) BTB allograft (mean=4.3°, p=0.012). (a) The PLCS demonstrated a tendency to internal tibial rotation between 0 and 60° of flexion (mean=2.2°, p=0.079). Varus/valgus rotation as well as anterior/posterior translation did not show significant differences for any of the tested techniques. The present study shows that despite satisfying results in static laxity testing, pathological 3D knee kinematics were not restored to normal, demonstrated by a nonphysiological internal tibial rotation during the path of flexion-extension.

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References

  1. Albright JP, Brown AW (1998) Management of chronic posterolateral rotatory instability of the knee: surgical technique for the posterolateral corner sling procedure. Instr Course Lect 47:369–378

    Google Scholar 

  2. Chen FS, Rokito AS, Pitman MI (2000) Acute and chronic posterolateral rotatory instability of the knee. J Am Acad Orthop Surg 8:97–110

    Google Scholar 

  3. Clancy WG, Sutherland TB (1994) Combined posterior cruciate ligament injuries. Clin Sports Med 13:629–647

    PubMed  Google Scholar 

  4. Covey DC (2001) Current concepts review—injuries of the posterolateral corner of the knee. J Bone Joint Surg 83A:106–118

    Google Scholar 

  5. Fanelli GC, Edson CJ (1995) Posterior cruciate ligament injuries in trauma patients. Part II. Arthroscopy 11:526–529

    Article  CAS  PubMed  Google Scholar 

  6. Fanelli GC, Larson RV (2002) Practical management of posterolateral instability of the knee. Arthroscopy 18:1–8

    Google Scholar 

  7. Fleming RE, Blatz DJ, McCarroll JR (1981) Posterior problems in the knee: posterior cruciate insufficiency and posterolateral rotary insufficiency. Am J Sports Med 9:107–113

    PubMed  Google Scholar 

  8. 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

    Google Scholar 

  9. Harner CD, Höher J Vogrin TM, Carlin GJ, Woo SL (1998) The effects of a popliteus muscle load on in situ forces in the posterior cruciate ligament and on knee kinematics. Am J Sport Med 26:669–673

    Google Scholar 

  10. Harner CD, Vogrin TM, Höher J, Ma CB, Woo SL (2000) Biomechanical analysis of a posterior cruciate ligament reconstruction: defficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med 28:32–39

    CAS  PubMed  Google Scholar 

  11. Höher 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

    Google Scholar 

  12. Hughston JC, Jacobson KE (1985) Chronic posterolateral rotatory instability of the knee. J Bone Joint Surg 67A: 351–359

    Google Scholar 

  13. Kadaba MP, Ramakrishnan HK, Wootten ME (1990) Measurement of lower extremity kinematics during level walking. J Orthop Res 8:383–892

    Google Scholar 

  14. LaPrade RF, Resig S, Wentorf F, Lewis JL (1999) The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. Am J Sport Med 27:469–475

    Google Scholar 

  15. Nielsen S, Helmig P (1986) Posterior instability of the knee joint. An experimental study. Arch Orthop Trauma Surg 105:121–125

    Google Scholar 

  16. Hagemeister N, Duval N, Yahia LH, Krudwig W, Witzel U, de Guise JA (2002) Computer based method for the 3D kinematic analysis of the posterior cruciate and posterolateral corner lesions. Knee 9:301–308

    Google Scholar 

  17. Rubinstein RA, Shelbourne KD, McCarroll JR, VanMetter CD, Rettig AC (1994) The accuracy of the clinical examination in the setting of posterior cruciate ligament injuries. Am J Sports Med 22:550–557

    Google Scholar 

  18. Shahane SA, Ibbotson C, Strachan R, Bickerstaff DR (1999) The popliteofibular ligament: an anatomical study of the posterolateral corner of the knee. J Bone Joint Surg 81B: 636–642

    Google Scholar 

  19. 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

    Google Scholar 

  20. Sugita T, Amis AA (2001) Anatomic and biomechanical study of the lateral collateral and popliteofibular ligaments. Am J Sport Med 29:466–472

    Google Scholar 

  21. Terry GC, LaPrade RF (1996) The posterolateral aspect of the knee: anatomy and surgical approach. Am J Sport Med 24:732–739

    Google Scholar 

  22. Veltri DM, Warren RF (1994) Operative treatment of posterolateral instability o the knee. Clin Sports Med 13:615–627

    Google Scholar 

  23. Wascher DC, Grauer JD, Markoff KL (1993) Biceps tendon tenodesis for posterolateral instabilit of the knee: an in vitro study. Am J Sport Med 21:400–406

    Google Scholar 

  24. Wilson DR, Feikes JD, O‘Connor JJ (1998) Ligaments and articular contact guide passive knee flexion. J Biomech 31:1127–1136

    Google Scholar 

  25. Wilson DR, Feikes JD, Zavatsky AB, O‘Connor JJ (2000) The components of passive knee movement are coupled to flexion angle. J Biomech 33:465–473

    Google Scholar 

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Acknowledgements

The authors thank the NSERC and the Austrian Research Fund for funding this study, the CHUM Research Center for giving us the opportunity to use the equipment, and Gerald Parent, MSc for his assistance during the experiments. This study gained approval from the local ethical committee, University of Montreal Canada, and the experiments comply with the current laws of Canada.

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Authors and Affiliations

  1. Laboratoire de Recherche en Imagerie et Orthopédie, Centre de Recherche du CHUM, Hopital Notre-Dame, Montréal, Canada

    Thomas Nau, Yan Chevalier, Nicola Hagemeister, Nicolas Duval & Jacques A. deGuise

  2. Ludwig Boltzmann Institute of Biomechanics and Cell Biology, University of Vienna Medical School, Waehringer Guertel, 18-20, 1090, Vienna, Austria

    Thomas Nau

  3. École de Technologie Supérieure, Université de Montréal, Montréal, Canada

    Jacques A. deGuise

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  1. Thomas Nau
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  2. Yan Chevalier
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  3. Nicola Hagemeister
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  4. Nicolas Duval
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  5. Jacques A. deGuise
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Correspondence to Thomas Nau.

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Nau, T., Chevalier, Y., Hagemeister, N. et al. 3D kinematic in-vitro comparison of posterolateral corner reconstruction techniques in a combined injury model. Knee Surg Sports Traumatol Arthrosc 13, 572–580 (2005). https://doi.org/10.1007/s00167-004-0586-5

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  • DOI: https://doi.org/10.1007/s00167-004-0586-5

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