A Landmark-Based Technique for Determining an Isometric Femoral Attachment Site for Lateral Extraarticular Tenodesis...

Area of Science:

• Orthopedic surgery
• Biomechanical analysis
• Surgical techniques

Background:

• Lateral extra-articular tenodesis (LET) is a common surgical procedure.
• Accurate femoral fixation is crucial for LET success.
• Current landmark-based techniques may lack precision.

Purpose of the Study:

• To evaluate the reliability and accuracy of using anatomic landmarks for femoral fixation in LET.
• To determine if a specific landmark-based method places fixation within the safe isometric zone.

Main Methods:

• Cadaveric specimens were used to identify the safe isometric area for LET femoral fixation.
• A pilot study located the center of this area relative to the fibular collateral ligament (FCL) origin.
• 10 additional specimens were used to place K-wires at the identified landmark and a point 20 mm proximal, followed by radiographic assessment.

Main Results:

• Excellent intrarater and inter-rater reliability were observed for radiographic measurements.
• However, the landmark-based technique resulted in K-wire placement outside the safe isometric area in 50% of specimens.
• Specifically, 40% of placements were anterior to the posterior cortical extension line (PCEL).

Conclusions:

• The landmark-based technique for femoral fixation in LET, referencing the FCL origin, is inaccurate.
• This method frequently fails to place fixation within the desired radiographic safe isometric area.
• Intraoperative imaging is advised to ensure accurate femoral fixation placement during LET.