Dulas Matthew, Lee Cody, Liu Margaret, Athiviraham Aravind
University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
Department of Orthopaedic Surgery and Rehabilitation, University of Chicago Medicine, Chicago, Illinois, USA.
Video J Sports Med. 2024 Feb 19;4(1):26350254231199523. doi: 10.1177/26350254231199523. eCollection 2024 Jan-Feb.
The posterolateral corner (PLC) is an important knee stabilizer that resists varus stress, external tibial rotation, and posterior tibial translation. Untreated PLC injuries have been shown to increase failure rates of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions and lead to degenerative changes. Our modified Arciero technique reconstructs the femoral insertion site and functionality of the lateral collateral ligament (LCL) and popliteal fibular ligament, components of the PLC, with an internal brace and tensionable loops.
The primary indication for PLC reconstruction is identified PLC injury. Patients often have a feeling of knee instability and a varus thrust gait. PLC injury should be confirmed with imaging.
We employed a modified Arciero technique via LCL reconstruction with tensionable loops and internal brace. We used a semitendinosus allograft truncated at 240-millimeters to avoid the graft bottoming out. A suture augment was incorporated into the graft to reinforce the LCL reconstruction construct during graft tensioning and early rehabilitation. The graft construct was then passed through the transfibular tunnel to femoral sockets at the LCL and popliteus insertions. The graft construct is then affixed to the opposite femoral cortex. The graft was then tensioned with the knee in approximately 30° of flexion, neutral to 10° of internal rotation, and a valgus force applied. This restored excellent valgus stability.
Fibular and tibiofibular-based constructs are common procedures for PLC reconstruction. Our LCL reconstruction with tensionable loops technique and the Arciero technique are fibular-based constructs. The fibular-based construct and the tibiofibular-based construct have been found to be biomechanically equivalent at restoring knee stability. However, fibular-based constructs, such as our LCL reconstruction with tensionable loops, were found to be less technically demanding than tibiofibular-based constructs, used fewer grafts, and required a smaller surgical approach.
Given similar clinical outcomes, it was concluded that fibular-based constructs, such as our modified Arciero technique, may be more advantageous because of the ability to avoid some of the pitfalls of tibiofibular-based constructs.
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.
后外侧角（PLC）是膝关节的重要稳定结构，可抵抗内翻应力、胫骨外旋和胫骨后移。未经治疗的PLC损伤已被证明会增加前交叉韧带（ACL）和后交叉韧带（PCL）重建的失败率，并导致退行性改变。我们改良的阿西埃罗技术通过使用内部支撑和可张紧环来重建PLC的组成部分外侧副韧带（LCL）和腘腓韧带的股骨附着点及功能。
PLC重建的主要适应证是确诊的PLC损伤。患者通常会感到膝关节不稳定，并有内翻推力步态。PLC损伤应通过影像学检查来确诊。
我们采用改良的阿西埃罗技术，通过使用可张紧环和内部支撑进行LCL重建。我们使用了一段截断至240毫米的半腱肌同种异体移植物，以避免移植物陷入底部。在移植物张紧和早期康复过程中，将缝线增强物纳入移植物，以加强LCL重建结构。然后将移植物结构穿过经腓骨隧道，到达LCL和腘肌附着处的股骨承窝。然后将移植物结构固定到对侧股骨皮质上。然后在膝关节屈曲约30°、中立至内旋10°并施加外翻力的情况下对移植物进行张紧。这恢复了极佳的外翻稳定性。
基于腓骨和胫腓骨的结构是PLC重建的常用方法。我们的带可张紧环的LCL重建技术和阿西埃罗技术是基于腓骨的结构。已发现基于腓骨的结构和基于胫腓骨的结构在恢复膝关节稳定性方面生物力学等效。然而，发现基于腓骨的结构，如我们的带可张紧环的LCL重建，在技术上比基于胫腓骨的结构要求更低，使用的移植物更少，并且所需的手术入路更小。
鉴于临床结果相似，得出的结论是，基于腓骨的结构，如我们改良的阿西埃罗技术，可能更具优势，因为它能够避免基于胫腓骨的结构的一些缺陷。
作者证明已获得本出版物中出现的任何患者的同意。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形式的批准。
