Lateral Collateral Ligament Reconstruction With Tensionable Loops and Suture Tape Reinforcement

Area of Science:

• Orthopedic Surgery
• Knee Biomechanics
• Sports Medicine

Background:

• The posterolateral corner (PLC) is crucial for knee stability, resisting varus stress, external tibial rotation, and posterior tibial translation.
• Untreated PLC injuries can compromise anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions, leading to degenerative joint changes.
• A modified Arciero technique using an internal brace and tensionable loops is introduced for PLC reconstruction, addressing the lateral collateral ligament (LCL) and popliteofibular ligament.

Purpose of the Study:

• To describe a modified Arciero technique for reconstructing the PLC, focusing on the LCL and popliteofibular ligament.
• To evaluate the efficacy of a fibular-based construct with an internal brace and tensionable loops for restoring knee stability.

Main Methods:

• A modified Arciero technique involving LCL reconstruction with tensionable loops and an internal brace was employed.
• A semitendinosus allograft was utilized, reinforced with a suture augment.
• The graft was passed through a transfibular tunnel to femoral sockets and tensioned with a valgus force in 30° flexion, restoring valgus stability.

Main Results:

• Fibular-based constructs, including the modified Arciero technique, are biomechanically equivalent to tibiofibular-based constructs for restoring knee stability.
• The modified Arciero technique was found to be less technically demanding, required fewer grafts, and involved a smaller surgical approach compared to tibiofibular-based constructs.

Conclusions:

• Fibular-based PLC reconstructions, such as the modified Arciero technique, may offer advantages over tibiofibular-based constructs.
• This technique provides a potentially more advantageous approach due to its technical simplicity and reduced invasiveness while achieving comparable stability.