Beel Wouter, Papakostas Emmanouil, Getgood Alan
The Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.
Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar.
Video J Sports Med. 2023 Sep 11;3(5):26350254231160432. doi: 10.1177/26350254231160432. eCollection 2023 Sep-Oct.
In cases of complex arthroscopic knee surgery in the lateral compartment, such as performing lateral meniscus repair or transplantation, a tight lateral compartment can jeopardize the best possible care and could lead to iatrogenic cartilage injury. This technique shows a way to increase arthroscopic working space in a tight lateral compartment by performing an osteotomy of the femoral insertion of the lateral collateral ligament (LCL), utilizing a novel adjustable loop refixation technique.
The femoral LCL insertion osteotomy can be performed if increased visualization and working space of the lateral compartment are needed during the complex arthroscopic knee surgery.
After identification of the LCL femoral insertion, a 2-mm drill is passed through the LCL insertion to prepare for an anatomic reduction. The osteotomy is performed by taking a small bone plug together with the complete LCL insertion. Increased visualization and working space in the lateral compartment are obtained without damaging the intrinsic LCL structure. For reinsertion, the bone plug and proximal LCL is whipstitched with a high-strength suture and fixated to an adjustable loop Ultrabutton. The adjustable loop is shuttled through a predrilled 4.5-mm femoral tunnel and flipped on the medial side. The adjustable button is tensioned in 30° of flexion until the bone plug is anatomically reduced.
We present 1 patient who underwent a femoral LCL osteotomy during arthroscopic lateral meniscus allograft transplantation. The osteotomy healed without any issues, and there was no residual LCL laxity; which was confirmed with varus stress radiographs.
DISCUSSION/CONCLUSION: A femoral LCL insertion osteotomy can release a tight lateral compartment without damaging the intrinsic LCL structure. The adjustable loop fixation avoids the use of more traditional screw and washer fixation techniques, which tend to be more prominent and have the potential to back out. An osteotomy is more invasive than the "pie-crusting" technique of the medial collateral ligament for a tight medial compartment. However, it is required due to the poor intrinsic healing capacity of the LCL. Care should be taken to anatomically reduce the bone plug to avoid iatrogenic creation of LCL laxity.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
在膝关节外侧间室进行复杂的关节镜手术时，如进行外侧半月板修复或移植，外侧间室狭窄可能会影响最佳治疗效果，并可能导致医源性软骨损伤。本技术展示了一种通过对外侧副韧带（LCL）股骨附着点进行截骨术，并采用新型可调袢重新固定技术，来增加狭窄外侧间室关节镜操作空间的方法。
如果在复杂的膝关节镜手术中需要增加外侧间室的视野和操作空间，可进行LCL股骨附着点截骨术。
确定LCL股骨附着点后，将一根2毫米的钻头穿过LCL附着点，为解剖复位做准备。截骨时，连同完整的LCL附着点一起取下一个小骨块。这样在不损伤LCL固有结构的情况下，可增加外侧间室的视野和操作空间。为了重新固定，用高强度缝线对骨块和近端LCL进行褥式缝合，并固定在一个可调袢Ultrabutton上。将可调袢穿过预先钻好的4.5毫米股骨隧道，并在内侧翻转。在屈膝30°时拉紧可调纽扣，直到骨块达到解剖复位。
我们展示了1例在关节镜下外侧半月板同种异体移植手术中进行LCL股骨截骨术的患者。截骨愈合良好，没有任何问题，且没有残留的LCL松弛，内翻应力X线片证实了这一点。
讨论/结论：LCL股骨附着点截骨术可以松解狭窄的外侧间室，而不损伤LCL的固有结构。可调袢固定避免了使用更传统的螺钉和垫圈固定技术，后者往往更突出且有可能松动。对于狭窄的内侧间室，截骨术比内侧副韧带的“馅饼皮”技术更具侵入性。然而，由于LCL的自身愈合能力较差，所以需要进行截骨术。应注意将骨块进行解剖复位，以避免医源性造成LCL松弛。
作者证明已从本出版物中出现的任何患者处获得同意。如果个体可能被识别，作者已在本次提交发表的内容中包含了患者的豁免声明或其他书面批准形式。
