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Minimally Invasive, Arthroscopic-Assisted, Anatomic Posterolateral Corner Reconstruction.

ABSTRACT: As the anatomy and biomechanics of the posterolateral corner (PLC) of the knee have become better understood, the importance of the PLC's proper function has become a more frequently raised subject. Misdiagnosed chronic posterolateral instability may lead to serious consequences, including cruciate ligament reconstruction graft failure. It has been proved that high-grade PLC injuries need to be treated operatively. Surgical approaches vary, and techniques are still developing. Considering avoidance of an extended surgical approach and minimizing the risk of common peroneal nerve or popliteal artery injuries, we developed the minimally invasive, arthroscopic-assisted, anatomic PLC reconstruction.

SUBMITTER: Hermanowicz K

PROVIDER: S-EPMC6470392 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Minimally Invasive, Arthroscopic-Assisted, Anatomic Posterolateral Corner Reconstruction.

Hermanowicz Krzysztof K Malinowski Konrad K Góralczyk Adrian A Guszczyn Tomasz T LaPrade Robert F RF

Arthroscopy techniques 20190211 3

As the anatomy and biomechanics of the posterolateral corner (PLC) of the knee have become better understood, the importance of the PLC's proper function has become a more frequently raised subject. Misdiagnosed chronic posterolateral instability may lead to serious consequences, including cruciate ligament reconstruction graft failure. It has been proved that high-grade PLC injuries need to be treated operatively. Surgical approaches vary, and techniques are still developing. Considering avoida ...[more]

PMID: 31019882

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Arthroscopic Identification of the Knee Posterolateral Corner Structures and Anatomic Arthroscopic Posterolateral Corner Reconstruction: Technical Note - Part 2.

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Arthroscopic Identification of the Knee Posterolateral Corner Structures and Anatomic Arthroscopic Posterolateral Corner Reconstruction: Technical Note - Part 1.

Project description:Arthroscopic assessment of posterior compartments of the knee and the posterior aspect of the proximal tibial and fibula is challenging because of the relative proximity of the neurovascular bundle. This Technical Note describes a reproducible arthroscopic surgical approach in a cadaveric model that aims to identify and expose the popliteus tendon, posterior fibular head, fibular collateral ligament popliteal fibular ligament, biceps femoris tendon, and peroneal nerve.

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Anatomic Posterolateral Corner Reconstruction.

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Anatomic Reconstruction of the Posterolateral Corner: An All-Arthroscopic Technique.

Project description:Injuries of the posterolateral corner (PLC) of the knee lead to chronic lateral and external rotational instability. Successful treatment of PLC injuries requires an understanding of the complex anatomy and biomechanics of the PLC. Several open PLC reconstruction techniques have been published. It is understood that anatomic reconstruction is superior to extra-anatomic techniques, leading to better clinical results. An open, anatomic, fibula-based technique for reconstruction to address lateral and rotational instability has been described. However, when an open technique is used, surgeon and patient are faced with disadvantages, such as soft tissue damage or exposure of vulnerable structures. Few arthroscopic techniques for tibia- or fibula-based reconstruction of rotational posterolateral instability have been described. A complete arthroscopic stabilization of the combined lateral and posterolateral rotational instability of the knee has not yet been described. We therefore present the first all-arthroscopic technique for complete PLC reconstruction, based on an open technique described previously. All relevant landmarks of the PLC can be arthroscopically visualized in detail, allowing safe and effective treatment of PLC injuries.

| S-EPMC6410677 | biostudies-literature

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An All-Arthroscopic Technique for Complex Posterolateral Corner Reconstruction.

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Open Anatomic Reconstruction of the Posterolateral Corner: The Arciero Technique.

Project description:The posterolateral corner (PLC) is an important stabilizer of the knee. This complex of ligaments and tendons functions as the primary restraint to varus and posterolateral rotation of the knee. Injury to the PLC can result in chronic instability, a varus-thrust gait, and early arthrosis of the medial compartment of the knee if left untreated. Several techniques have been designed to address injuries of the PLC. Over the last 30 years, our understanding of the posterolateral corner as well as its operative reconstruction evolved. This evolution has attempted to refine what is an "anatomic" reconstruction. With more improved techniques and new, innovative fixation devices, we hope to make a more favorable repair for recreating the native stability of the posterolateral corner.

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Arthroscopic anatomy of the posterolateral corner of the knee: anatomic relations and arthroscopic approaches.

Project description:IntroductionAlthough open-surgical techniques for the reconstruction of the posterolateral corner (PLC) are well established, the use of arthroscopic procedures has recently increased. When compared with open surgical preparation, arthroscopic orientation in the PLC is challenging and anatomic relations may not be familiar. Nevertheless, a profound knowledge of anatomic key structures and possible structures at risk as well as technical variations of arthroscopic approaches are mandatory to allow a precise and safe surgical intervention.Materials and methodsIn a cadaveric video demonstration, an anterolateral (AL), anteromedial (AM), posteromedial (PM) and posterolateral (PL) portal, as well as a transseptal approach (TSA) were developed. Key structures of the PLC were defined and sequentially exposed during posterolateral arthroscopy. Finally, anatomic relations of all key structures were demonstrated.ResultsAll key structures of the PLC can be visualized during arthroscopy. Thereby, careful portal placement is crucial in order to allow an effective exposure. Two alternatives of the TSA were described, depending on the region of interest. The peroneal nerve can be visualized dorsal to the biceps femoris tendon (BT), lateral to the soleus muscle (SM) and about 3 cm distal to the fibular styloid (FS). The distal attachment of the fibular collateral ligament (FCL) can be exposed on the lateral side of the fibular head (FH). The fibular attachment of the popliteofibular ligament (PFL) is exposed at the tip of the FS.ConclusionArthroscopy of the posterolateral recessus allows full visualization of all key structures of the posterolateral corner, which provides the basis for anatomic and safe drill channel placement in PLC reconstruction. A sufficient exposure of relevant anatomic landmarks and precise portal preparation reduce the risk of iatrogenic vascular and peroneal nerve injury.

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Anatomic Posterolateral Corner Reconstruction With Autogenous Peroneus Longus Y Graft Construct.

Project description:The posterolateral corner of the knee is composed of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament, which provide varus and rotational stability to the knee. An anatomic technique reconstructs these structures through 2 femoral sockets and 1 tibial and 1 fibular tunnel. This reconstruction can be performed using a peroneus longus autograft that is prepared as a Y construct. The peroneus longus autograft is preferred because it provides adequate length and diameter for the entire reconstruction. Initially, the doubled loop of the Y is passed into the tibial tunnel and fixed with an adjustable cortical button. The shorter limb of the Y is used for reconstruction of the popliteus tendon. The longer limb of the Y is passed from posterior to anterior through the fibular tunnel and is fixed in the tunnel with an interference screw to re-create the popliteofibular ligament. The remaining graft is then shuttled deep to the iliotibial band and superficial to the popliteus tendon, into the femoral socket, to re-create the fibular collateral ligament.

| S-EPMC6928377 | biostudies-literature

Anatomic Posterolateral Corner Reconstruction Using Semitendinosus and Gracilis Autografts: Surgical Technique.

Project description:An anatomically based posterolateral corner (PLC) reconstruction has emerged as a viable and clinically effective surgical technique for midsubstance ligamentous injuries in both the acute and chronic settings. There are several surgical techniques for PLC reconstruction; however, the classic anatomic reconstruction technique (LaPrade technique) is now considered the gold standard and was originally described using an Achilles tendon allograft. In this article, we describe a modified LaPrade autograft technique, in which the same tunnel position, graft passage, and fixation are used to reproduce the 3 primary stabilizers of the PLC. Instead of allografts, hamstring autografts are used while tunnel diameters and fixation devices are adapted to them. With the use of autograft tendons, difficulties related to graft length or asymmetry are encountered. We consider this technique a good alternative for an anatomically based PLC reconstruction, especially given the lower availability and higher cost of allograft tissues in several countries.

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