Moran Jay, Tollefson Luke V, LaPrade Christopher M, LaPrade Robert F
Yale School of Medicine, New Haven, Connecticut, U.S.A.
Twin Cities Orthopedics, Edina, Minnesota, U.S.A.
Arthroscopy. 2025 May;41(5):1578-1581. doi: 10.1016/j.arthro.2024.11.053. Epub 2024 Nov 15.
Nearly 2 decades ago, the posterolateral corner (PLC) was commonly referred to as the "dark side" of the knee because of our limited anatomical understanding, no anatomic-based reconstruction techniques, and high rates of clinical failures. During this time, nonanatomic PLC-reconstruction techniques, or "fibular slings," gained popularity early on as a result of the ease of the procedure; however, clinical studies demonstrated residual varus gapping and external rotation laxity associated with these nonanatomic techniques that only reconstructed the fibular (lateral) collateral ligament. The term "anatomic" PLC reconstruction generally refers to a procedure that aims to restore the entirety of the 3 main PLC static stabilizers. Currently, the most commonly used PLC-reconstruction techniques have evolved to be either a complete anatomic reconstruction with a tibiofibular-based (LaPrade and Engebretsen) approach or a partial anatomic reconstruction through a fibular-based (Levy/Marx, Arciero) technique. Both reconstruction approaches incorporate the use of a second femoral tunnel for improved restoration of the femoral attachments of the fibular (lateral) collateral ligament and popliteus tendon and are biomechanically superior compared with the historic nonanatomic techniques. As such, these improved PLC-reconstruction techniques, whether tibiofibular-based or fibular-based, are strongly recommended over nonanatomic reconstruction techniques. Compared with the fibular-based approach, an anatomic tibiofibular-based PLC reconstruction more closely recreates the native architecture of the PLC with recreation of the popliteofibular ligament and use of a tibial tunnel to restore the static function of the popliteus tendon. In addition, certain conditions, such as concurrent proximal tibiofibular joint instability and asymmetric knee hyperextension, are contraindications to using fibular-based reconstructions and should always use a tibial tunnel.
近20年前，由于我们对其解剖结构的了解有限、缺乏基于解剖学的重建技术以及临床失败率高，膝关节后外侧角（PLC）常被称为膝关节的“黑暗面”。在此期间，非解剖学的PLC重建技术，即“腓骨吊带”，因其操作简便而早期受到欢迎；然而，临床研究表明，这些仅重建腓骨（外侧）副韧带的非解剖学技术会导致残留内翻间隙和外旋松弛。“解剖学”PLC重建通常是指旨在恢复PLC全部3个主要静态稳定结构的手术。目前，最常用的PLC重建技术已演变为基于胫腓骨的（LaPrade和Engebretsen）完全解剖重建或通过基于腓骨的（Levy/Marx, Arciero）技术进行部分解剖重建。两种重建方法都采用第二个股骨隧道，以更好地恢复腓骨（外侧）副韧带和腘肌腱的股骨附着点，并且在生物力学上优于传统的非解剖学技术。因此，强烈推荐使用这些改良的PLC重建技术，无论是基于胫腓骨还是基于腓骨的，而不是非解剖学重建技术。与基于腓骨的方法相比，基于胫腓骨的解剖学PLC重建更能重现PLC原有的结构，重建腘腓韧带，并使用胫骨隧道恢复腘肌腱的静态功能。此外，某些情况，如并发近端胫腓关节不稳定和不对称膝关节过度伸展，是使用基于腓骨重建的禁忌证，应始终使用胫骨隧道。
