Zielinski Kyle P, Wieland Mark D, Sequeira Sean B, Gould Heath P, Dreese James C
Georgetown University School of Medicine, Washington, DC, USA.
MedStar Orthopaedic Institute, Union Memorial Hospital, Baltimore, Maryland, USA.
Am J Sports Med. 2025 May;53(6):1524-1534. doi: 10.1177/03635465241266264. Epub 2025 Jan 7.
Surgical reconstruction is the standard treatment for injuries to the posterolateral corner (PLC) of the knee and can be performed using either a fibular-based or combined tibiofibular-based technique. Although some comparative studies have been performed, there is no consensus regarding the reconstructive approach that confers optimal biomechanical properties of the PLC.
To perform a systematic review and meta-analysis to evaluate the biomechanical properties of the knee after PLC reconstruction with fibular-based and tibiofibular-based techniques.
Meta-analysis; Level of evidence, 4.
A systematic review was performed by searching the PubMed, Cochrane Library, and Embase databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify studies that analyzed the biomechanical properties of PLC reconstruction techniques. Evaluated outcomes included varus laxity and external rotation laxity. The pooled biomechanical data were analyzed by random-effects models and heterogeneity was assessed using the statistic.
Eleven studies met the inclusion criteria; 74 cadaveric specimens were included. Seven studies (54 specimens) evaluated the fibular-based Larson reconstruction technique, 3 studies (22 specimens) evaluated a modified fibular-based Larson reconstruction, and 1 study (7 specimens) evaluated the fibular-based Arciero reconstruction. Five studies (45 specimens) evaluated the tibiofibular-based LaPrade reconstruction technique and 2 studies (20 specimens) evaluated a modified LaPrade reconstruction. Data were pooled for fibular-based reconstructions (Larson, modified Larson, and Arciero) and tibiofibular-based reconstructions (LaPrade, modified LaPrade). Pooled analysis revealed no significant difference in varus laxity and external rotation laxity between fibular and tibiofibular reconstructions at 0°, 30°, 60°, and 90° of flexion (all > .05).
No difference in varus laxity and external rotation laxity was observed between fibular-based and tibiofibular-based techniques for PLC reconstruction. Moreover, there was no difference in varus laxity and external rotation laxity observed between the Larson, modified Larson, and LaPrade reconstructions. These results suggest that biomechanical stability after fibular- and tibiofibular-based PLC reconstructions is similar. Further clinical investigation is warranted to validate these cadaveric findings.
手术重建是膝关节后外侧角（PLC）损伤的标准治疗方法，可采用基于腓骨或胫腓骨联合的技术进行。尽管已经进行了一些比较研究，但对于能赋予PLC最佳生物力学特性的重建方法尚无共识。
进行系统评价和荟萃分析，以评估采用基于腓骨和胫腓骨联合技术进行PLC重建后膝关节的生物力学特性。
荟萃分析；证据等级，4级。
按照PRISMA（系统评价和荟萃分析的首选报告项目）指南，通过检索PubMed、Cochrane图书馆和Embase数据库进行系统评价，以识别分析PLC重建技术生物力学特性的研究。评估的结果包括内翻松弛度和外旋松弛度。采用随机效应模型分析汇总的生物力学数据，并使用统计量评估异质性。
11项研究符合纳入标准；共纳入74个尸体标本。7项研究（54个标本）评估了基于腓骨的拉森重建技术，3项研究（22个标本）评估了改良的基于腓骨的拉森重建，1项研究（7个标本）评估了基于腓骨的阿西埃罗重建。5项研究（45个标本）评估了基于胫腓骨的拉普雷德重建技术，2项研究（20个标本）评估了改良的拉普雷德重建。对基于腓骨的重建（拉森、改良拉森和阿西埃罗）和基于胫腓骨的重建（拉普雷德、改良拉普雷德）的数据进行了汇总。汇总分析显示，在0°、30°、60°和90°屈曲时，腓骨重建和胫腓骨重建之间在内翻松弛度和外旋松弛度方面无显著差异（所有P>0.05）。
在PLC重建中，基于腓骨和基于胫腓骨的技术在内翻松弛度和外旋松弛度方面无差异。此外，拉森、改良拉森和拉普雷德重建之间在内翻松弛度和外旋松弛度方面也无差异。这些结果表明，基于腓骨和胫腓骨的PLC重建后的生物力学稳定性相似。有必要进行进一步的临床研究以验证这些尸体研究结果。
