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Posterolateral corner reconstruction using hamstrings grafts-A comparative biomechanical study of three techniques
Marcos Barbieri Mestriner1, Shuntaro Nejima2, Petra Bonacic Bartolin3
1Department of Orthopedics and Traumatology, Knee Surgery Group, Medical Sciences College of Santa Casa de São Paulo, São Paulo, Brazil.
Summary
The modified LaPrade (LP) technique inadequately restored knee laxity after posterolateral corner (PLC) injury. Both the popliteofibular loop (PFLoop) and modified Arciero (AR) techniques overconstrained external rotation in flexion.
Area of Science:
- Orthopedic surgery
- Biomechanics
- Sports medicine
Background:
- The posterolateral corner (PLC) is crucial for knee stability.
- Injuries to the PLC can lead to significant knee instability.
- Various surgical techniques aim to reconstruct the PLC to restore knee function.
Purpose of the Study:
- To compare the efficacy of three posterolateral corner (PLC) reconstruction techniques: popliteofibular loop (PFLoop), modified LaPrade (LP), and modified Arciero (AR).
- To evaluate the ability of these techniques to restore knee laxity in varus (VR), external tibial rotation (ER), and posterior tibial translation (PTT).
Main Methods:
- A biomechanical study was conducted on nine cadaveric knees.
- Knees were subjected to varus, external rotation, and posterior tibial translation loads at various flexion angles.
- Three conditions were tested: intact, PLC injured, and reconstructed using PFLoop, LP, or AR techniques with hamstring tendon autografts.
Main Results:
- PLC injury significantly increased varus and external rotation laxity.
- The LP technique failed to restore native varus laxity in extension and initial flexion.
- PFLoop and AR techniques were more effective than LP in restoring varus laxity at greater flexion angles.
- All techniques restored external rotation laxity, though PFLoop showed less ER than the native knee in flexion.
- No technique differences were observed for posterior tibial translation.
- LP failed to restore external rotation at 0° flexion, while PFLoop overconstrained external rotation in greater flexion.
Conclusions:
- The LP technique is insufficient for restoring knee laxity in extension and initial flexion following isolated PLC injury.
- The AR and PFLoop techniques demonstrated comparable effectiveness but led to overconstraint of external rotation in greater knee flexion.
- Further research may be needed to optimize PLC reconstruction techniques for comprehensive knee stability restoration.