Banovetz Mark T, Braaten Jacob A, Homan Morgan D, Monson Jill K, Kennedy Nicholas I, LaPrade Robert F
University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Twin Cities Orthopedics, Edina, Minnesota, USA.
Video J Sports Med. 2023 May 22;3(3):26350254231158121. doi: 10.1177/26350254231158121. eCollection 2023 May-Jun.
Injuries to the fibular collateral ligament (FCL) seldom occur in isolation and may present with a concomitant injury to the biceps femoris tendon and anterior cruciate ligament (ACL). Injuries to structures of the posterolateral corner (PLC) lead to varus and rotational instability of the knee, subjecting the cruciate ligaments to increased forces that may result in graft failure. Therefore, reconstruction of these structures should be performed concurrently with the ACL.
Grade III FCL injuries heal poorly without operative treatment and often result in residual varus instability of the knee that increases medial knee compartment forces, and forces on both the native ACL and the graft status post ACL reconstruction. Therefore, preservation of biomechanical stability and long-term health of the knee are reliant on addressing injuries to the PLC surgically.
A key concept of this surgical technique is a meticulous peroneal nerve neurolysis in the setting of altered biceps femoris anatomy, and the proper order of the surgical steps for tunnel creation, graft passage, and fixation and suture anchor insertion to achieve optimal patient outcomes. The described technique involves a lateral surgical approach, peroneal neurolysis, and preparation of fibular and femoral FCL tunnels, followed by a Bone-patellar tendon-bone graft (BTB) graft harvest. Attention is then turned to intra-articular work including the diagnostic arthroscopy, femoral and tibial tunnel preparation, passage of the ACL graft, and fixation of the grafts in femoral tunnels. Last, fixation is achieved in the following order: FCL graft on fibula, ACL graft on tibia, and biceps femoris tendon to fibular head.
Compared with the preoperative state, Moulton et al reported significant improvements in the average Lysholm and Western Ontario scores at 2.7 years postoperatively following anatomic FCL reconstrution. Furthermore, Thompson et al reported on primary suture anchor repair of distal biceps femoris in 22 elite athletes and reported that all patients had returned to their preinjury level of sporting activity at 2-year follow-up.
Anatomic reconstructions of the FCL and ACL, such as the one described in our technique, effectively restore near native knee biomechanics and offer superior clinical outcomes compared with nonanatomic-based FCL reconstructions.
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.
腓侧副韧带（FCL）损伤很少单独发生，可能同时伴有股二头肌腱和前交叉韧带（ACL）损伤。后外侧角（PLC）结构损伤会导致膝关节内翻和旋转不稳定，使交叉韧带承受更大的力，这可能导致移植物失效。因此，这些结构的重建应与ACL重建同时进行。
III级FCL损伤未经手术治疗愈合较差，常导致膝关节残留内翻不稳定，增加膝关节内侧间室的压力，以及对原生ACL和ACL重建术后移植物的压力。因此，保持膝关节的生物力学稳定性和长期健康依赖于手术治疗PLC损伤。
该手术技术的一个关键概念是在股二头肌解剖结构改变的情况下对腓总神经进行细致的神经松解，以及隧道创建、移植物置入、固定和缝合锚钉插入的手术步骤的正确顺序，以实现最佳的患者预后。所描述的技术包括外侧手术入路、腓总神经松解以及腓骨和股骨FCL隧道的准备，随后采集骨-髌腱-骨（BTB）移植物。然后将注意力转向关节内操作，包括诊断性关节镜检查、股骨和胫骨隧道准备、ACL移植物置入以及移植物在股骨隧道中的固定。最后，按以下顺序进行固定：FCL移植物固定于腓骨，ACL移植物固定于胫骨，股二头肌腱固定于腓骨头。
与术前状态相比，莫尔顿等人报告，解剖学FCL重建术后2.7年，平均Lysholm评分和西安大略评分有显著改善。此外，汤普森等人报告了22名精英运动员股二头肌远端的初次缝合锚钉修复情况，并报告所有患者在2年随访时已恢复到受伤前的运动水平。
FCL和ACL的解剖学重建，如我们技术中所描述的，与非解剖学基础的FCL重建相比，能有效恢复接近天然膝关节的生物力学，并提供更好的临床结果。
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。
