Document Title: Nau-AJSM-Dec05.shtml
Article Title: Comparison of 2 Surgical Techniques of Posterolateral Corner Reconstruction of the Knee
Authors: Thomas Nau, MD, Yan Chevalier, MSc, Nicola Hagemeister, PhD, Jacques A. deGuise, PhD, and Nicolas Duval, MD, MSc
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: December 2005
Volume 33, pages 1838-1845
Keywords: posterolateral corner, posterolateral structures (PLC, not to be confused with PCL), reconstruction, reconstructive surgery, posterolateral knee, popliteus complex, knee kinematics.

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Comments: Posterolateral corner (also known as posterolateral-structures or PLC) reconstruction makes considerable technical demands on the surgeon. This cadaver-based study looked at two different surgical methods. Method A entailed reconstructing the tibial and fibular attachments of the popliteus tendon, as well as the lateral collateral ligament (LCL). This method resulted in an abnormal internal tibial rotation during dynamic testing. Method B, which entailed reconstructing the LCL and the popliteofibular ligament, brought good results in dynamic testing.

ABSTRACT

Background: Various surgical techniques to treat posterolateral knee instability have been described. To date, the recommended treatment is an anatomical form of reconstruction, in which the 3 key structures of the posterolateral corner are addressed: the lateral collateral ligament, the popliteofibular ligament, and the popliteus tendon.

Hypothesis: Two methods of surgical reconstruction will restore posterolateral knee instability, in terms of static laxity as well as dynamic 6 degrees of freedom kinematics, to statistically significant levels compared with the intact state.

Study Design: Controlled laboratory study.

Methods: Two surgical techniques (A and B) were used to reconstruct the posterolateral structures in 10 cadaveric knees. Static tests were performed on the intact, sectioned, and reconstructed knees at 30° and 90° of flexion for anterior-posterior laxity and external rotational laxity, as well as at 0° and 30° of flexion for varus laxity; dynamic 6 degrees of freedom kinematic testing, through a path of motion from 90° of flexion to full extension, was also performed.

Results: For the static varus tests, external rotation and varus laxity were significantly increased after the posterolateral structures were cut. Both reconstruction techniques restored external rotation and varus laxity to levels not significantly different from the intact state. For technique B, dynamic testing did not show any significant difference for all degrees of freedom kinematics compared with the intact state. However, for technique A, a significant internal tibial rotation was observed throughout the entire path of motion from 0° to 90° of knee flexion.

Conclusions: Both surgical techniques for anatomical posterolateral corner reconstruction showed good results in the static laxity tests. The anatomical reconstruction of all structures, including the popliteus tendon, resulted in an abnormal internal tibial rotation during dynamic testing.

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