Skip to main content
SpringerLink
Log in

Popliteofibular ligament reconstruction for posterolateral external rotation instability of the knee

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

Abstract

The aim of this study was to assess the clinical outcome of popliteofibular ligament (PFL) reconstruction for posterolateral external rotation instability of the knee. PFL reconstruction was performed consecutively in 22 patients with chronic external rotation instability of the knee. The inclusion criterion for surgery was tibial external rotation of 10° more than the contralateral uninjured knee without varus laxity. A double bone tunnel was created at the PFL insertion of the fibular head through the lateral incision of the knee joint and a single bone tunnel at the popliteus tendon insertion on the femoral side. A semitendinosus autograft tendon or tibialis anterior allograft tendon was introduced through the fibular tunnel as a loop, then both free ends of the graft were introduced through the femoral tunnel and a bioabsorbable interference screw was used to fix the graft. The minimum follow-up was 2 years. Clinical review included the International Knee Documentation Committee (IKDC) scale and tibial external rotation assessment. All patients’ preoperational tibial external rotation averaged 15° more than the contralateral uninjured knee. operatively the tibial external rotation was decreased, average −3° compared with the contralateral side. This difference was statistically significant. The final IKDC grades were: 22 cases with grade D preoperatively, and 6 were grade A, 8 were grade B, 7 were grade C and 1 was grade D postoperatively. In this small clinical series, PFL reconstruction technique was shown to correct pathological excessive tibial external rotation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

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

    PubMed  CAS  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. Arciero RA (2005) Anatomic posterolateral corner knee reconstruction. Arthroscopy 21:1147e1–1147e5

    Google Scholar 

  4. Csintalan RP, Ehsan A, McGarry MH, Fithian DF, Lee TQ (2006) Biomechanical and anatomical effects of an external rotational torque applied to the knee: a cadaveric study. Am J Sports Med 34:1623–1629

    Article  PubMed  Google Scholar 

  5. Fanelli GC (2006) Surgical treatment of lateral posterolateral instability of the knee using Biceps tendon procedures. Sports Med Arthrosc Rev 14:37–43

    Article  Google Scholar 

  6. Fanelli GC, Edson CJ (2004) Combined posterior cruciate ligament–posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up. Arthroscopy 20:339–345

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  8. Fanelli GC, Feldmann DD (1999) Management of combined ACL/PCL/posterolateral complex injuries of the knee. Oper Tech Sports Med 7:143–149

    Article  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  10. Hughston JC, Norwood LA (1980) The posterolateral drawer test and external rotational recurvatum test for posterolateral rotatory instability of the knee. Clin Orthop Relat Res 147:82–87

    PubMed  Google Scholar 

  11. Ishigooka H, Sugihara T, Shimizu K, Aoki H, Hirata K (2004) Anatomical study of the popliteofibular ligament and surrounding structures. J Orthop Sci 9:51–58

    Article  PubMed  Google Scholar 

  12. Khanduja V, Somayaji HS, Harnett P, Utukuri M, Dowd GS (2006) Combined reconstruction of chronic posterior cruciate ligament and posterolateral corner deficiency A two- to nine-year follow-up study. J Bone Joint Surg Br 88:1169–1172

    PubMed  CAS  Google Scholar 

  13. 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

    PubMed  Google Scholar 

  14. LaPrade RF, Tso A, Wentorf FA (2004) Force measurements on the fibular collateral ligament, popliteofibular ligament, and popliteus tendon to applied loads. Am J Sports Med 32:1695–1701

    Article  PubMed  Google Scholar 

  15. LaPrade RF, Wentorf F (2002) Diagnosis and treatment of posterolateral knee injuries. Clin Orthop Relat Res 402:110–121

    Article  PubMed  Google Scholar 

  16. Lee MC, Park YK, Lee SH, Jo H, Seong SC (2003) Posterolateral reconstruction using split Achilles tendon allograft. Arthroscopy 19:1043–1049

    Article  PubMed  Google Scholar 

  17. Markolf KL, Graves BR, Sigward SM, Jackson SR, McAllister DR (2007) Popliteus bypass and popliteofibular ligament reconstructions reduce posterior tibial translations and forces in a posterior cruciate ligament graft. Arthroscopy 23:482–487

    Article  PubMed  Google Scholar 

  18. McGuire DA, Wolchok JC (2003) Posterolateral corner reconstruction. Arthroscopy 19:790–793

    PubMed  Google Scholar 

  19. Pasque C, Noyes FR, Gibbons M, Levy M, Grood E (2003) The role of the popliteofibular ligament and the tendon of popliteus in providing stability in the human knee. J Bone Joint Surg Br 85:292–298

    Article  PubMed  CAS  Google Scholar 

  20. Sekiya JK, Kurtz CA (2005) Posterolateral corner reconstruction of the knee: surgical technique utilizing a bifid Achilles tendon allograft and a double femoral tunnel. Arthroscopy 21:1400.e1–e5

    Google Scholar 

  21. Strobel MJ, Schulz MS, Petersen WJ, Eichhorn HJ (2006) Combined anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner reconstruction with autogenous hamstring grafts in chronic instabilities. Arthroscopy 22:182–192

    PubMed  Google Scholar 

  22. Tzurbakis M, Diamantopoulos A, Xenakis T, Georgoulis A (2006) Surgical treatment of multiple knee ligament injuries in 44 patients: 2–8 years follow-up results. Knee Surg Sports Traumatol Arthrosc 14:739–749

    Article  PubMed  Google Scholar 

  23. Wentorf FA, LaPrade RF, Lewis JL, Resig S (2002) The influence of the integrity of posterolateral structures on tibiofemoral orientation when an anterior cruciate ligament graft is tensioned. Am J Sports Med 30:796–799

    PubMed  Google Scholar 

  24. Yoon KH, Bae DK, Ha JH, Park SW (2006) Anatomic reconstructive surgery for posterolateral instability of the knee. Arthroscopy 22:159–165

    Article  PubMed  Google Scholar 

  25. Zhao J, He Y, Wang J (2006) Anatomical reconstruction of knee posterolateral complex with the tendon of the long head of biceps femoris. Am J Sports Med 34:1615–1622

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sports Medicine Service, Beijing Jishuitan Hospital, Xin jie kou dong Street 31#, Xi Cheng District, 10035, Beijing, China

    Hui Zhang, Hua Feng, Lei Hong, Xue-song Wang & Jin Zhang

Authors
  1. Hui Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hua Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lei Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xue-song Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hui Zhang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhang, H., Feng, H., Hong, L. et al. Popliteofibular ligament reconstruction for posterolateral external rotation instability of the knee. Knee Surg Sports Traumatol Arthrosc 17, 1070–1077 (2009). https://doi.org/10.1007/s00167-009-0794-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-009-0794-0

Keywords

Search

Navigation