Kennedy Nicholas I, Therrien Erik, Marx Robert G, Stuart Michael J, Levy Bruce A
Mayo Clinic, Rochester, Minnesota, USA.
University of Montreal, Montreal, Quebec, Canada.
Video J Sports Med. 2022 Oct 6;2(5):26350254221114890. doi: 10.1177/26350254221114890. eCollection 2022 Sep-Oct.
The posterolateral corner (PLC) of the knee is a complex anatomic region of the knee comprising the popliteus tendon, the popliteofibular ligament (PFL), and the fibular collateral ligament (FCL). Treatment of PLC injuries is based on the degree of varus and rotational instability on preoperative examination and is recommended in grade 3 injuries..
The key concept of this new surgical technique is to use adjustable loop cortical suspensory fixation implants for initial femoral fixation of the popliteus and the FCL grafts. This allows for individual tensioning of the grafts prior to definitive fixation with an interference screw. An anatomic fibular tunnel is initially created, followed by popliteus and FCL anatomic femoral socket drilling. A TightRope RT implant is attached to the popliteus end of the graft and secured through a bone tunnel on the medial femoral cortex initially. The popliteus end of the graft is then pulled into the femoral socket before tunneling the graft through the fibular tunnel. A second TightRope RT implant is secured to the FCL end of the graft before securing it to the medial femoral cortex through a bone tunnel and pulling the graft into the drilled femoral socket. An interference screw is first used to secure the graft at the fibular tunnel. The knee is then taken to 60° where the TightRope device is used to remove residual creep and optimize final tensioning prior to final fixation with interference screw in femoral socket. With the knee at 30° of flexion, neutral rotation, and slight valgus, the same steps are repeated for FCL graft. A posterolateral capsular shift is completed for additional stability.
Residual posterolateral corner instability or failure after reconstruction surgery has been reported in 6% to 9.4% of surgical reconstruction case. The use of cortical suspensory devices in PLC reconstructions allows independent dialing of optimal graft tension for both the popliteus and FCL reconstruction before final interference screw fixation, therefore presumably limiting any residual creep and allowing for a double femoral fixation of the graft.
We describe a novel technique for posterolateral corner reconstruction which allows for optimal and individual tensioning of the structures of the posterolateral corner. Given the technique still uses well-described and validated graft choices and anatomic landmarks for reconstruction, we expect this new technique to allow for similar if not improved outcomes when compared with current gold standard..
膝关节后外侧角（PLC）是膝关节一个复杂的解剖区域，由腘肌腱、腘腓韧带（PFL）和腓侧副韧带（FCL）组成。PLC损伤的治疗基于术前检查时内翻和旋转不稳定的程度，三级损伤建议进行手术治疗。
这项新手术技术的关键概念是使用可调节环皮质悬吊固定植入物，对腘肌腱和FCL移植物进行初始股骨固定。这允许在使用干涉螺钉进行最终固定之前对移植物进行单独张紧。首先创建一个解剖学腓骨隧道，随后钻出腘肌腱和FCL解剖学股骨窝。将TightRope RT植入物连接到移植物的腘肌腱端，最初通过股骨内侧皮质上的骨隧道固定。然后在将移植物穿过腓骨隧道之前，将移植物的腘肌腱端拉入股骨窝。在将移植物固定到股骨内侧皮质并将其拉入钻出的股骨窝之前，将第二个TightRope RT植入物固定到移植物的FCL端。首先使用干涉螺钉将移植物固定在腓骨隧道处。然后将膝关节置于60°，在此处使用TightRope装置消除残余蠕变，并在使用干涉螺钉在股骨窝进行最终固定之前优化最终张紧。在膝关节屈曲30°、中立旋转和轻度外翻的情况下，对FCL移植物重复相同步骤。完成后外侧关节囊移位以增加稳定性。
在6%至9.4%的手术重建病例中，报告了重建手术后残留的后外侧角不稳定或失败情况。在PLC重建中使用皮质悬吊装置，允许在最终干涉螺钉固定之前，对腘肌腱和FCL重建的移植物进行独立的最佳张紧，因此可能限制任何残余蠕变，并允许对移植物进行双股骨固定。
我们描述了一种用于后外侧角重建的新技术，该技术允许对后外侧角结构进行最佳和个体化张紧。鉴于该技术仍使用已充分描述和验证的移植物选择和解剖标志进行重建，我们预计与当前的金标准相比，这项新技术即使不能改善结果，也能取得相似的结果。
