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The treatment of posterolateral knee instability with combined arthroscopic popliteus bypass and PCL reconstruction provides good-to-excellent clinical results in the mid-term follow-up

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to evaluate the clinical outcomes of patients who were treated with an arthroscopic popliteus bypass (PB) technique, in cases of a posterolateral rotational instability (PLRI) and a concomitant posterior cruciate ligament (PCL) injury of the knee.

Methods

This was a retrospective case series in which 23 patients were clinically evaluated after a minimum of 2 years following arthroscopic PB and combined PCL reconstruction. Lysholm, Tegner and Knee Injury and Osteoarthritis Outcome scores as well as visual analog scales (VAS) for joint function and pain were evaluated. Posterior laxity was objectified with stress radiography and a Rolimeter examination. Rotational instability was graded with the dial test.

Results

23 patients were available for follow-up, 46.0 ± 13.6 months after surgery. The median time interval from the initial injury to the surgery was 6.0 (3.5;10.5) months. The postoperative Lysholm Score was 95.0 (49–100); the Tegner Score changed from 6.0 (3–10) before the injury to 5.0 (0–10) at the follow-up examination (p = 0.013). The side-to-side difference on stress radiography (SSD) of posterior translation changed from 10.4 (6.6–14.8) mm before the injury to 4.0 (0.2–5.7) mm postoperatively (p < 0.01). Rotational instability was reduced to grade A (82.6%) or B (17.4%) (IKDC). The Rolimeter SSD was 2.0 (0–3) mm at the follow-up examination. VAS Function 0 (0–5), VAS pain 0 (0–6).

Conclusions

The arthroscopic PB graft technique provided good-to-excellent clinical results in the mid-term follow-up in patients with type A PLRI and concomitant PCL injury. However, an exact differentiation of lateral, rotational and dorsal instabilities of posterolateral corner (PLC) injuries is crucial, for the correct choice of therapy, as cases with lateral instabilities require more complex reconstruction techniques. Arthroscopic posterolateral corner reconstruction is a safe procedure with a high success rate in the mid-term follow-up.

Level of evidence

IV.

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Abbreviations

IKDC:

International Knee Documentation Committee

KOOS:

Knee Injury and Osteoarthritis Outcome Score

LCL:

Lateral collateral ligament

PB:

Popliteus bypass

PCL:

Posterior cruciate ligament

PLC:

Posterolateral corner

PLRI:

Posterolateral rotational instability

PTT:

Posterior tibial translation

SD:

Standard deviation

SSD:

Side-to-side difference

References

  1. Chahla J, James EW, Cinque ME, LaPrade RF (2018) Midterm outcomes following anatomic-based popliteus tendon reconstructions. Knee Surg Sports Traumatol Arthrosc 26:812–818

    Article  PubMed  Google Scholar 

  2. Chahla J, Williams BT, LaPrade RF (2020) Editorial Commentary: Shedding Light on the Posterolateral Corner of the Knee: Can We Do it With the Scope? Is There a Real Benefit? Arthroscopy 36:1132–1134

    Article  PubMed  Google Scholar 

  3. Domnick C, Frosch KH, Raschke MJ, Vogel N, Schulze M, von Glahn M et al (2017) Kinematics of different components of the posterolateral corner of the knee in the lateral collateral ligament-intact state: A Human Cadaveric Study. Arthroscopy 10:1821–1830

    Article  Google Scholar 

  4. Drenck TC, Preiss A, Domnick C, Herbort M, Frings J, Akoto R et al (2020) The Popliteus Bypass provides superior biomechanical properties compared to the Larson technique in the reconstruction of combined posterolateral corner and posterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 29:732–741

    Article  PubMed  Google Scholar 

  5. Fanelli GC (2020) PCL transtibial tunnel reconstruction. Sports Med Arthrosc Rev 28:8–13

    Article  PubMed  Google Scholar 

  6. Franciozi CE, Albertoni LJB, Kubota MS, Abdalla RJ, Luzo MVM, Cohen M et al (2019) A hamstring-based anatomic posterolateral knee reconstruction with autografts improves both radiographic instability and functional outcomes. Arthroscopy 35:1676–1685

    Article  PubMed  Google Scholar 

  7. Frings J, Kolb JP, Drenck TC, Krause M, Alm L, Akoto R et al (2019) Anatomic reconstruction of the posterolateral corner: an all-arthroscopic technique. Arthrosc Tech 8:153–161

    Article  Google Scholar 

  8. Frosch KH, Akoto R, Drenck T, Heitmann M, Pahl C, Preiss A (2016) Arthroscopic popliteus bypass graft for posterolateral instabilities of the knee : A new surgical technique. Oper Orthop Traumatol 28:193–203

    Article  PubMed  Google Scholar 

  9. Frosch KH, Akoto R, Heitmann M, Enderle E, Giannakos A, Preiss A (2015) Arthroscopic reconstruction of the popliteus complex: accuracy and reproducibility of a new surgical technique. Knee Surg Sports Traumatol Arthrosc 23:3114–3120

    Article  PubMed  Google Scholar 

  10. Gelber PE, Drager J, Maheshwer B, Leyes M, Barenius B, Robinson J et al (2020) Large variability exists in the management of posterolateral corner injuries in the global surgical community. Knee Surg Sports Traumatol Arthrosc 7:2116–2123

    Article  Google Scholar 

  11. Grimm NL, Levy BJ, Jimenez AE, Bell R, Arciero RA (2020) Open anatomic reconstruction of the posterolateral corner: the arciero technique. Arthrosc Tech 9:1409–1414

    Article  Google Scholar 

  12. Hermanowicz K, Góralczyk A, Malinowski K, Jancewicz P (2018) Arthroscopic posterolateral corner stabilization with popliteus tenodesis. Arthrosc Tech 6:669–674

    Article  Google Scholar 

  13. Hoher J, Akoto R, Helm P, Shafizadeh S, Bouillon B, Balke M (2015) Rolimeter measurements are suitable as substitutes to stress radiographs in the evaluation of posterior knee laxity. Knee Surg Sports Traumatol Arthrosc 23:1107–1112

    Article  PubMed  Google Scholar 

  14. James EW, Williams BT, LaPrade RF (2014) Stress radiography for the diagnosis of knee ligament injuries: a systematic review. Clin Orthop Relat Res 472:2644–2657

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kolb JP, Frings J, Krause M, Hartel M, Frosch KH (2019) An all-arthroscopic technique for complex posterolateral corner reconstruction. Arthrosc Tech 8:999–1006

    Article  Google Scholar 

  16. LaPrade RF (2019) Editorial commentary: arthroscopic outcomes are equal to open popliteus tendon reconstructions, but do not forget that the goal is a stable posterior cruciate ligament reconstruction. Arthroscopy 35:2410–2411

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. Lee D-Y, Park Y-J, Kim D-H, Kim H-J, Nam D-C, Park J-S et al (2018) The role of isolated posterior cruciate ligament reconstruction in knees with combined posterior cruciate ligament and posterolateral complex injury. Knee Surg Sports Traumatol Arthrosc 26:2669–2678

    Article  PubMed  Google Scholar 

  19. Li Y, Zhang H, Zhang J, Li X, Zheng T, Zhang Z et al (2019) The clinical outcome of arthroscopic versus open popliteal tendon reconstruction combined with posterior cruciate ligament reconstruction in patients with type a posterolateral rotational instability. Arthroscopy 35:2402–2409

    Article  PubMed  Google Scholar 

  20. Liu P, Gong X, Zhang J, Ao Y (2020) Anatomic, all-arthroscopic reconstruction of posterolateral corner of the knee: a cadaveric biomechanical study. Arthroscopy 36:1121–1131

    Article  PubMed  Google Scholar 

  21. Moulton SG, Geeslin AG, LaPrade RF (2016) A systematic review of the outcomes of posterolateral corner knee injuries, part 2: surgical treatment of chronic injuries. Am J Sports Med 44:1616–1623

    Article  PubMed  Google Scholar 

  22. Pache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C et al (2018) Posterior cruciate ligament: current concepts review. Arch Bone Joint Surg 6:8

    PubMed  PubMed Central  Google Scholar 

  23. Rios CG, Leger RR, Cote MP, Yang C, Arciero RA (2010) Posterolateral corner reconstruction of the knee: evaluation of a technique with clinical outcomes and stress radiography. Am J Sports Med 38:1564–1574

    Article  PubMed  Google Scholar 

  24. Schlumberger M, Schuster P, Eichinger M, Mayer P, Mayr R, Immendörfer M et al (2020) Posterior cruciate ligament lesions are mainly present as combined lesions even in sports injuries. Knee Surg Sports Traumatol Arthrosc 28:2091–2098

    Article  PubMed  Google Scholar 

  25. Song GY, Zhang H, Zhang J, Li Y, Feng H (2015) Anatomical popliteofibular ligament reconstruction of the knee joints: an all-arthroscopic technique. Knee Surg Sports Traumatol Arthrosc 23:2925–2929

    Article  PubMed  Google Scholar 

  26. Tisherman R, Wilson K, Horvath A, Byrne K, De Groot J, Musahl V (2019) Allograft for knee ligament surgery: an American perspective. Knee Surg Sports Traumatol Arthrosc 27:1882–1890

    Article  PubMed  Google Scholar 

  27. Treme G, Ortiz G, Gill GK, Menzer HM, Johnson PJ, Salas C et al (2017) A biomechanical comparison of knee stability after posterolateral corner reconstruction: Arciero vs LaPrade. Orthop J Sports Med. https://doi.org/10.1177/2325967117S00267

    Article  PubMed Central  Google Scholar 

  28. Weiler A, Frosch K-H, Gwinner C, Strobel MJ, Lobenhoffer P (2020) The posterolateral Instability score (PoLIS) of the knee joint: a guideline for standardized documentation, classification, and surgical decision-making. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06044-y

    Article  PubMed  PubMed Central  Google Scholar 

  29. Weiss S, Krause M, Frosch KH (2020) Posterolateral corner of the knee: a systematic literature review of current concepts of arthroscopic reconstruction. Arch Orthop Trauma Surg 140:2003–2012

    Article  PubMed  PubMed Central  Google Scholar 

  30. Winkler PW, Zsidai B, Wagala NN, Hughes JD, Horvath A, Senorski EH et al (2021) Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 1: anatomy, biomechanics and diagnostics. Knee Surg Sports Traumatol Arthrosc 29:672–681

    Article  PubMed  Google Scholar 

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Acknowledgements

T.C.D. was supported by a research fellowship from Asklepios Clinic Group. The study was supported by albrecht© (Bernau, Germany). K.-H.F. received grants and is member of the Arthrex Advisory Board.

Funding

The study was supported by Albrecht® (Bernau, Germany).

Author information

Author notes

  1. Tobias C. Drenck and Jannik Frings are contributed equally.

Authors and Affiliations

  1. Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany

    Tobias C. Drenck, Ralph Akoto, Lena Alm & Karl-Heinz Frosch

  2. Department of Trauma and Orthopaedic Surgery, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Jannik Frings, Matthias Krause & Karl-Heinz Frosch

  3. University of Witten/Herdecke, Cologne Merheim Medical Centre, Cologne, Germany

    Ralph Akoto

  4. Helios ENDO-Klinik Hamburg, Hamburg, Germany

    Achim Preiss

  5. Asklepios Campus Hamburg, Semmelweis University Budapest, Hamburg, Germany

    Maximilian Muellner

Authors
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Corresponding author

Correspondence to Karl-Heinz Frosch.

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Ethical approval

IRB approval was given by the ethics committee of the Medical Chamber Hamburg, Germany (ID PV 7068).

Conflict of interest

T.C.D. was supported by a research fellowship from Asklepios Clinic Group. K.-H.F. received grants and is member of the Arthrex Advisory Board. The other authors declare to have no conflict of interest.

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Drenck, T.C., Frings, J., Preiss, A. et al. The treatment of posterolateral knee instability with combined arthroscopic popliteus bypass and PCL reconstruction provides good-to-excellent clinical results in the mid-term follow-up . Knee Surg Sports Traumatol Arthrosc 30, 1414–1422 (2022). https://doi.org/10.1007/s00167-021-06590-z

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