Tollefson Luke V, Banovetz Mark T, Homan Morgan D, Kennedy Nicholas I, LaPrade Robert F
Twin Cities Orthopedics, Edina, Minnesota, USA.
University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Video J Sports Med. 2024 Apr 4;4(2):26350254231212234. doi: 10.1177/26350254231212234. eCollection 2024 Mar-Apr.
The popliteus tendon is a primary stabilizer of external knee rotation and has been described as the "fifth ligament of the knee." Injuries involving the posterolateral corner of the knee commonly involve the popliteus tendon; isolated injury to the popliteus tendon is relatively rare and usually involves a rotatory injury mechanism and symptoms of instability and pain. In this patient, there was a concomitant injury to the proximal tibiofibular joint.
Popliteus tendon reconstruction is indicated for patients with abnormal external rotation on examination and symptoms of pain and instability. Proximal tibiofibular joint reconstruction is indicated for patients with instability of the tibiofibular joint.
Preoperative examination under anesthesia is essential to determine the extent of external rotation and assess for additional posterolateral pathology. The popliteus tendon procedure begins with a meticulous common peroneal nerve neurolysis to minimize nerve irritation and decrease the risk of a postoperative foot drop. Semitendinosus and gracilis graft harvest is performed with at least 16 cm of graft length followed by tunnel reaming of the popliteus tendon femoral attachment and tibia tunnel identification and reaming. The femoral attachment of the popliteus tendon is secured, and the semitendinosus graft is anatomically oriented along the native path and passed from posterior to anterior through the femoral tunnel. The gracilis graft for anatomic proximal tibiofibular joint reconstruction requires an anterior to posterior tunnel through the fibular head. Finally, both grafts are secured in the tibial tunnel with the application of an anterior traction force.
A cadaveric study by LaPrade et al reported that an anatomic popliteus tendon reconstruction with a semitendinosus autograft significantly reduced external rotation laxity compared with the sectioned state. In addition, popliteus tendon reconstruction resulted in significantly decreased varus laxity, anterior tibial translation, and internal rotation.
This is a technique that effectively restores external rotation knee stability utilizing an anatomically oriented reconstruction of the popliteus tendon and tibiofibular joint. The popliteus tendon serves as a primary stabilizer to external rotation and facilitates static function of the knee. The proximal tibiofibular joint reconstruction restores the function of the posterior proximal tibiofibular joint ligaments.
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.
腘肌腱是膝关节外旋的主要稳定结构，被描述为“膝关节的第五韧带”。涉及膝关节后外侧角的损伤通常累及腘肌腱；腘肌腱的孤立损伤相对少见，通常涉及旋转损伤机制以及不稳定和疼痛症状。在该患者中，还伴有胫腓近端关节损伤。
对于检查时出现异常外旋以及有疼痛和不稳定症状的患者，需进行腘肌腱重建。对于胫腓关节不稳定的患者，需进行胫腓近端关节重建。
麻醉下的术前检查对于确定外旋程度和评估是否存在其他后外侧病变至关重要。腘肌腱手术首先要仔细进行腓总神经松解，以尽量减少神经刺激并降低术后足下垂的风险。取半腱肌和股薄肌移植物，移植物长度至少为16厘米，随后对腘肌腱股骨附着点进行隧道扩孔，并确定和扩孔胫骨隧道。固定腘肌腱的股骨附着点，将半腱肌移植物沿天然路径进行解剖定位，并从后向前穿过股骨隧道。用于解剖学胫腓近端关节重建的股薄肌移植物需要通过腓骨头从前向后建立隧道。最后，在施加向前的牵引力的情况下，将两根移植物固定在胫骨隧道中。
LaPrade等人的一项尸体研究报告称，与切断状态相比，采用半腱肌自体移植物进行解剖学腘肌腱重建可显著降低外旋松弛度。此外，腘肌腱重建还可显著降低内翻松弛度、胫骨前移和内旋。
这是一种通过对腘肌腱和胫腓关节进行解剖学定向重建来有效恢复膝关节外旋稳定性的技术。腘肌腱是外旋的主要稳定结构，有助于膝关节的静态功能。胫腓近端关节重建可恢复胫腓近端关节后韧带的功能。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可被识别，作者已随本投稿附上患者的豁免声明或其他书面批准形式以供发表。
