Abstract
Introduction
A novel technique using an adjustable-loop cortical suspension toggle device for reduction of a fibular head avulsion fracture (arcuate fracture) in posterolateral corner (PLC) reconstruction is described. Results of clinical follow-up are presented.
Materials and methods
9 patients were retrospectively identified who underwent posterolateral corner reconstruction using an adjustable-loop cortical suspension toggle device. Radiographic examination was used to evaluate the successful healing of the avulsed fibular head fragments post-operatively.
Results
7 patients reported satisfactory results with their clinical outcome with no feelings of knee instability or objective instability on exam at final follow-up. Post-operative radiographs obtained > 6 months following reconstruction demonstrated well reduced and healed fracture in 5 of 6 patients, with 1 patient demonstrating maintained reduction but incomplete fracture union at 6 months.
Conclusion
This novel surgical technique for PLC reconstruction with an avulsed fibular head fracture is a viable alternative to previously described methods. The majority of patients report subjective satisfaction with a stable knee post-operatively.
Level of evidence
IV.
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References
Nannaparaju M, Mortada S, Wiik A, Khan W, Alam M (2018) Posterolateral corner injuries: Epidemiology, anatomy, biomechanics and diagnosis. Injury 49(6):1024–1031
Shon O-J, Park J-W, Kim B-J (2017) Current concepts of posterolateral corner injuries of the knee. Knee Surg Relat Res 29(4):256–268
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 Surgery, Sport Traumatol Arthrosc 23(10):3114–3120. https://doi.org/10.1007/s00167-014-3000-y
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(12):2003–2012. https://doi.org/10.1007/s00402-020-03607-z
Zhang H, Hong L, Wang X-S, Zhang J, Liu X, Feng H (2011) All-arthroscopic repair of arcuate avulsion fracture with suture anchor. Arthroscopy 27(5):728–734
Crespo B, James EW, Metsavaht L, Laprade RF (2015) Injuries to posterolateral corner of the knee: a comprehensive review from anatomy to surgical treatment. Rev Bras Ortop 50(4):363–370
Frings J, Weiß S, Kolb J, Behrendt P, Frosch KH, Krause M (2021) Arthroscopic anatomy of the posterolateral corner of the knee: anatomic relations and arthroscopic approaches. Arch Orthop Trauma Surg 142(3):443–453. https://doi.org/10.1007/s00402-021-03864-6
Hohmann E, Van Zyl R, Glatt V, Tetsworth K, Keough N (2021) The anatomical relationship of the common peroneal nerve to the proximal fibula and its clinical significance when performing fibular-based posterolateral reconstructions. Arch Orthop Trauma Surg 141(3):437–445. https://doi.org/10.1007/s00402-020-03708-9
Heideken JV, Mikkelsson C, Windhamre HB, Janarv P-M (2011) Acute injuries to the posterolateral corner of the knee in children. Am J Sports Med 39(10):2199–2205
Kovack TJ, Jacob PB, Tesner R, Papp G (2011) Periosteal avulsion of the posterolateral corner of the knee in an adolescent: an unreported case. Orthopedics 34(10):791–794
Geeslin AG, Laprade RF (2011) Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries. J Bone Joint Surg Am 93(18):1672–1683
Gilmer BB. Double-Row Suture Anchor Repair of Posterolateral Corner Avulsion Fractures. Arthrosc Tech 2017;6(4)
Oh HK, Kim JH, Lee CS, Singh PK, Wang KH, Nha KW (2011) Isolated avulsion fracture of the fibular head: a new fixation technique using a suture anchor. Orthopedics 34(2):100–104
Mattugini V, Citarell C, Cosseddu F et al (2018) Complex fibular head avulsion fracture: surgical management of a case. Surg Technol Int 1(32):257–260
Vojdani S, Fernandez L, Jiao J, et al. Novel Spiked-Washer Repair Is Biomechanically Superior to Suture and Bone Tunnels for Arcuate Fracture Repair. J Orthop Trauma 2017;31(3)
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381
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Wohler, A.D., Trofa, D.P., Meade, J.D. et al. Adjustable-loop cortical suspension device for posterolateral corner reconstruction in the setting of fibular avulsion fracture: a case series and novel technique description. Arch Orthop Trauma Surg 143, 1981–1987 (2023). https://doi.org/10.1007/s00402-022-04412-6
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DOI: https://doi.org/10.1007/s00402-022-04412-6