Knee Posterolateral Corner Reconstruction with a Single Tendon

ABSTRACT: Knee posterolateral corner (PLC) injuries are troublesome conditions and are always involved in complicated knee-ligament injuries. Various surgical techniques have been reported to address these conditions, in either an open or an arthroscopic manner. However, a simple and effective method is still being pursued. We introduce a mini-invasive PLC reconstruction technique in which a single tendon is used to reconstruct the lateral collateral ligament, the popliteofibular ligament and the popliteal tendon simultaneously. The critical points of this technique are proper location and creation of the tibial, fibular and femoral tunnels, proper passing and setting of the tendon graft, as well as protection of the peroneal nerve. Our clinical experience indicates that this technique is easy to perform and effective. We consider that the introduction of this technique will provide more reasonable options when PLC reconstruction is indicated. Technique Video Video 1 Knee Posterolateral Corner Reconstruction With a Single Tendon This procedure is performed in the right knee. An incision is made on the posterolateral side of the knee. Separation is performed medially through the incision to reach the posterior side of the proximal tibiofibular joint. The iliotibial band is incised longitudinally from a site 5 mm posterior to the tip of the lateral femoral epicondyle distally to reach the midpoint of the native insertion of the lateral collateral ligament and the popliteal tendon. A 5 mm-long incision is made over the anterolateral fibular styloid. A fibular tunnel is created from the anterolateral fibular styloid to the posteromedial side of the fibular head. An incision is made over the anteromedial side of the Gerdy tubercle. A tibial tunnel is created from the distal medial edge of the Gerdy tubercle to the posterolateral corner of the proximal tibia. The femoral tunnel is located at the posterodistal site of the tip of the lateral femoral epicondyle and created. The tendon string is passed through the fibular tunnel with a folded steel wire. Both ends of the tendon are passed through the underside of the iliotibial band proximally and out of the iliotibial band incision. The proximal fixation tape or sutures are folded, and their free ends are passed through the femoral tunnel. One end of the tendon is tied to the loop of the proximal fixation tape or sutures. The other end of the tendon is passed through the loop and folded. The 3-stranded tendon structure is pulled into the femoral tunnel. The proximal fixation tape or sutures are fixed onto a cortical suspensory fixation button. The free graft end is passed through the underside of the iliotibial band to the posterior side of the proximal tibiofibular joint. The free graft end is pulled into the tibial tunnel with a folded steel wire and fixed by suspension fixation anteriorly.

SUBMITTER: Tang J 

PROVIDER: S-EPMC8626666 | biostudies-literature |

REPOSITORIES: biostudies-literature