Schoell Kyle, Haratian Aryan, Fathi Amir, Bolia Ioanna K, Hasan Laith K, Petrigliano Frank A, Weber Alexander E, Hatch George F Rick
USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA.
Video J Sports Med. 2022 Jul 26;2(4):26350254221093082. doi: 10.1177/26350254221093082. eCollection 2022 Jul-Aug.
Lateral collateral ligament (LCL) injuries are implicated in varus instability of the knee. Often, these accompany other ligamentous injuries including anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) tears, and injury to the anterolateral capsular complex (ALCC). Use of internal brace augmentation with anatomic repair is an alternative to reconstruction to improve patient outcomes and facilitate early range of motion and weight bearing.
We present a case of an anatomic repair of a LCL and an ALCC injury with internal brace augmentation.
A curvilinear incision centered over the lateral epicondyle is used. The avulsed LCL and biceps tendon was exposed and a placed #5 FiberWire was placed into the distal LCL, biceps tendon, and the popliteofibular ligament. A split was made in the iliotibial (IT) band and a second #5 FiberWire was placed proximally in the LCL/biceps tendon for additional fixation. A tunnel was made in the fibular head and tibia using a 2.4-mm beath pin and the two #5 FiberWires were passed to the anteromedial tibia. The FiberWires were fixed to the tibia using a 14-mm attachable button system (ABS) manhole cover for suspensory fixation. Repair and internal bracing of the anterolateral capsular complex was accomplished with 2 interlocked TightRopes and a #2 FiberTape. This fixation method achieved repair by compressing the anterolateral capsular complex onto its tibial origin. The suture devices also served to augment the repair and were fixed proximally to the femur using another 14-mm ABS manhole cover. The FiberTape was fixed to the anterolateral tibia distally with a 4.5 mm SwiveLock. The TightRopes were passed through a tunnel to the anterolateral tibia and secured using an ABS Dog Bone. The construct was tensioned in near full extension and gapping was matched fluoroscopically to the contralateral knee.
Patient was cleared for full return to sports 9 months postoperatively. At the final follow up visit, the patient had excellent strength, stability, and 135° range of motion on the operative knee. Patient had returned to exercise at home but was unable to return to sports due to COVID-19 restrictions.
Anatomic repair of the LCL and the ALCC with internal brace augmentation can serve as an effective alternative to reconstruction and demonstrates excellent patient outcomes regarding restoring stability, ROM, and return to preoperative sports.
外侧副韧带（LCL）损伤与膝关节内翻不稳有关。这些损伤通常还伴有其他韧带损伤，包括前交叉韧带（ACL）、后交叉韧带（PCL）撕裂以及前外侧关节囊复合体（ALCC）损伤。采用解剖修复并结合内支撑增强术是重建手术的一种替代方法，可改善患者预后，并有助于早期进行活动范围和负重训练。
我们介绍一例采用内支撑增强术对LCL和ALCC损伤进行解剖修复的病例。
采用以外侧髁为中心的曲线形切口。暴露撕脱的LCL和肱二头肌肌腱，将一根5号FiberWire缝线置入LCL远端、肱二头肌肌腱和腘腓韧带。在髂胫束（IT）上做一个切口，将另一根5号FiberWire缝线近端置入LCL/肱二头肌肌腱以进行额外固定。使用2.4毫米的导针在腓骨头和胫骨上制作隧道，将两根5号FiberWire缝线穿过隧道至胫骨前内侧。使用14毫米可附着纽扣系统（ABS）人孔盖将FiberWire缝线固定于胫骨，以进行悬吊固定。使用2根互锁的TightRopes缝线和一根2号FiberTape缝线完成前外侧关节囊复合体的修复和内支撑。这种固定方法通过将前外侧关节囊复合体压向其胫骨附着点来实现修复。缝线装置还起到增强修复的作用，并使用另一个14毫米ABS人孔盖近端固定于股骨。FiberTape缝线远端使用4.5毫米旋转锁定装置固定于胫骨前外侧。TightRopes缝线穿过隧道至胫骨前外侧，并使用ABS狗骨进行固定。在接近完全伸直位对结构进行张力调整，并通过透视将间隙调整至与对侧膝关节匹配。
患者术后9个月被允许完全恢复运动。在最后一次随访时，患者手术膝关节的力量、稳定性极佳，活动范围达135°。患者已在家中恢复锻炼，但由于新冠疫情限制无法恢复运动。
采用内支撑增强术对LCL和ALCC进行解剖修复可作为重建手术的有效替代方法，在恢复稳定性、活动范围以及恢复术前运动方面显示出极佳的患者预后。
