Moreira da Silva Andre Giardino, Gobbi Riccardo Gomes, Bonadio Marcelo Batista, Angelini Fabio Janson, Pécora José Ricardo, Helito Camilo Partezani
Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Hospital Sírio-Libanês, São Paulo, Brazil.
Video J Sports Med. 2023 Nov 6;3(6):26350254231195374. doi: 10.1177/26350254231195374. eCollection 2023 Nov-Dec.
Posterolateral knee injuries can occur in 16% of patients with acute ligament injuries, and up to 70% have a combined anterior cruciate ligament (ACL) tear. Studies have shown that, in different populations, the distance between the insertion of the popliteus tendon and the lateral collateral ligament (LCL) may be smaller than the 18.5 mm previously reported in the literature. When we have an associated injury of the ACL and the posterolateral corner (PLC), the confluence of tunnels in the lateral femoral condyle can be a potential problem during reconstruction surgery.
The indication of this technique is the combined injury of the ACL and the PLC.
The reconstruction is performed with 2 semitendinosus tendons and 1 gracilis tendon. The technique consists of making a tunnel in the lateral wall of the femur, from the outside-in, at the isometric point between the origin of the LCL and insertion of the popliteus tendon, and emerging in the inner wall of the lateral femoral condyle at the anatomic point of the ACL. The graft is passed from the tibia to the femur with the doubled gracilis tendon and the 2 simple semitendinosus tendons for the ACL graft. The remaining portions of the semitendinosus tendons are left for reconstruction of the PLC structures, with one of them going straight to the posterolateral tibial tunnel (reconstructing the popliteus tendon), and the other passing through the fibular head tunnel (reconstructing the LCL) and continuing from the fibular head to the posterolateral tibial tunnel (reconstructing the popliteofibular ligament).
Patients undergoing this technique achieved good functional outcomes and a failure rate similar to that reported in the literature for combined ACL and PLC reconstruction.
DISCUSSION/CONCLUSION: This technique is an excellent option for patients with the combined injury of the ACL and the PLC, avoiding the confluence of tunnels in the lateral femoral condyle. It presents good results and acceptable complication rates, compatible with the severity of this lesion.
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.
在急性韧带损伤患者中，16%会发生膝关节后外侧损伤，其中高达70%合并前交叉韧带（ACL）撕裂。研究表明，在不同人群中，腘肌腱附着点与外侧副韧带（LCL）之间的距离可能小于文献先前报道的18.5毫米。当我们遇到ACL和后外侧角（PLC）联合损伤时，股骨外侧髁隧道的汇合在重建手术中可能是一个潜在问题。
该技术的适应症是ACL和PLC联合损伤。
重建采用2条半腱肌腱和1条股薄肌腱。该技术包括在股骨外侧壁从外向内在LCL起点与腘肌腱附着点之间的等长点处制作隧道，并在ACL的解剖点处从股骨外侧髁内壁穿出。移植物通过双股股薄肌腱和2条单股半腱肌腱从胫骨传递至股骨，用于ACL移植物。半腱肌腱的其余部分留作PLC结构的重建，其中一条直接进入胫骨后外侧隧道（重建腘肌腱），另一条穿过腓骨头隧道（重建LCL）并从腓骨头延续至胫骨后外侧隧道（重建腘腓韧带）。
接受该技术治疗的患者取得了良好的功能结果，失败率与文献报道的ACL和PLC联合重建的失败率相似。
讨论/结论：该技术对于ACL和PLC联合损伤的患者是一个极佳的选择，避免了股骨外侧髁隧道的汇合。它呈现出良好的结果和可接受的并发症发生率，与该损伤的严重程度相符。
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，作者已随本提交发表物附上患者的豁免声明或其他书面批准形式。
