Bob's ACL WWWBoard On-Line Knee Library |
------
Document Title: Noyes-AJSM-Feb07.shtml
Article Title: Posterolateral Knee Reconstruction With an Anatomical Bone–Patellar Tendon–Bone Reconstruction of the Fibular Collateral Ligament
Authors: Frank R. Noyes, MD and Sue D. Barber-Westin
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: February 2007
Volume 35, pages 259-273
Keywords: posterolateral corner/structures/ligaments, fibular/lateral collateral ligament, anatomically correct reconstruction, kinematics, biomechanics, kinetics.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: Noyes and Barber-Westin describe the benefits of anatomically-correct reconstruction of the posterolateral structures (also known as posterolateral corner). The lateral collateral ligament (also known as fibular collateral ligament) is best reconstructed with a formal graft, not patched up or sewn together haphazardly. (Also see Noyes-AJSM-Sep06.shtml.)
ABSTRACT
Background: The authors have long advocated a graft reconstruction of the fibular collateral ligament, believing that direct suture repair or augmentation procedures do not provide a stable construct.
Purpose: To describe an operative technique and determine the clinical outcome of a bone–patellar tendon–bone graft anatomical replacement of the fibular collateral ligament in a consecutive series of knees.
Study Design: Case series; Level of evidence, 4.
Methods: A consecutive group of knees undergoing anatomical posterolateral reconstruction that included a fibular collateral ligament reconstruction with a bone–patellar tendon–bone graft was prospectively followed to determine the functional outcome and failure rate. Thirteen patients (14 posterolateral reconstructions) were observed 2 to 13.7 years postoperatively. All major posterolateral structures were surgically restored. The procedure represented a primary reconstruction in 7 patients and a revision in 6 patients. Anterior cruciate ligament ruptures were found in 7 patients and bicruciate ruptures in 5 patients, all of which were reconstructed. The rehabilitation protocol allowed immediate knee motion from 0° to 90° but included protection against lateral joint loads to prevent graft stretching and failure. The results were determined by a knee examination, stress radiography, KT-2000 arthrometer, the Cincinnati Knee Rating System, and the International Knee Documentation Committee Rating System.
Results: Significant improvements were found at follow-up for pain (P = .0001), swelling (P = .02), patient rating of the overall knee condition (P < .001), walking (P < .05), and stair climbing (P < .05). Thirteen of the 14 (93%) reconstructions restored normal or nearly normal lateral joint opening and external tibial rotation and 1 failed. The anterior cruciate ligament reconstructions were normal or nearly normal in 11 knees and abnormal in 1 knee.
Conclusions: The anatomical posterolateral procedure was effective in restoring normal limits to lateral joint opening and external tibial rotation, allowed immediate knee motion, and appeared to protect other soft tissue repairs.
To access the full text of this article, please click here.
There is no charge for viewing articles. However, a password is required.
If you do not already have a password, please e-mail Michael Frind at frind@execulink.com for one.
Prior to requesting a password, please make certain you have read the
Site Terms of Use
pertaining to this site.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Copyright American Journal of Sports Medicine, American Orthopaedic Society for Sports Medicine, February 2007. For details regarding copyright as it applies to this page, please visit the page entitled Site Terms of Use and Aspects of Copyright on this site.
This website was created for the benefit of the world's largest knee-injury community, Bob's ACL WWWBoard (also known as the Kneeboard), accessible to everyone at http://factotem.org.
Documents posted on this site serve merely as a virtual library, and are intended solely for purposes of making access to high-quality peer-reviewed medical-journal articles convenient for all users of the Kneeboard. Knee-injury patients are hereby encouraged to discuss this material with their respective medical teams.
Click here to return to the Main Entrance Page of the Knee Library.
Looking for the Main Index Page of Bob's ACL WWWBoard? Click here!
To find recent postings on Bob's ACL WWWBoard, use the Search Engine.
To find older postings on Bob's ACL WWWBoard, use the On-Line Archive.
Site Terms of Use and Aspects of Copyright