Lateral Collateral Ligament Reconstruction With Tensionable Loops and Suture Tape Reinforcement
Background: The posterolateral corner (PLC) is an important knee stabilizer that resists varus stress, external tibial rotation, and posterior tibial translation. Untreated PLC injuries have been shown to increase failure rates of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2024-02-01
|
| Series: | Video Journal of Sports Medicine |
| Online Access: | https://doi.org/10.1177/26350254231199523 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850038142844796928 |
|---|---|
| author | Matthew Dulas BA Cody Lee MD Margaret Liu BS Aravind Athiviraham MD |
| author_facet | Matthew Dulas BA Cody Lee MD Margaret Liu BS Aravind Athiviraham MD |
| author_sort | Matthew Dulas BA |
| collection | DOAJ |
| description | Background: The posterolateral corner (PLC) is an important knee stabilizer that resists varus stress, external tibial rotation, and posterior tibial translation. Untreated PLC injuries have been shown to increase failure rates of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions and lead to degenerative changes. Our modified Arciero technique reconstructs the femoral insertion site and functionality of the lateral collateral ligament (LCL) and popliteal fibular ligament, components of the PLC, with an internal brace and tensionable loops. Indications: The primary indication for PLC reconstruction is identified PLC injury. Patients often have a feeling of knee instability and a varus thrust gait. PLC injury should be confirmed with imaging. Technique Description: We employed a modified Arciero technique via LCL reconstruction with tensionable loops and internal brace. We used a semitendinosus allograft truncated at 240-millimeters to avoid the graft bottoming out. A suture augment was incorporated into the graft to reinforce the LCL reconstruction construct during graft tensioning and early rehabilitation. The graft construct was then passed through the transfibular tunnel to femoral sockets at the LCL and popliteus insertions. The graft construct is then affixed to the opposite femoral cortex. The graft was then tensioned with the knee in approximately 30° of flexion, neutral to 10° of internal rotation, and a valgus force applied. This restored excellent valgus stability. Results: Fibular and tibiofibular-based constructs are common procedures for PLC reconstruction. Our LCL reconstruction with tensionable loops technique and the Arciero technique are fibular-based constructs. The fibular-based construct and the tibiofibular-based construct have been found to be biomechanically equivalent at restoring knee stability. However, fibular-based constructs, such as our LCL reconstruction with tensionable loops, were found to be less technically demanding than tibiofibular-based constructs, used fewer grafts, and required a smaller surgical approach. Conclusion: Given similar clinical outcomes, it was concluded that fibular-based constructs, such as our modified Arciero technique, may be more advantageous because of the ability to avoid some of the pitfalls of tibiofibular-based constructs. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. |
| format | Article |
| id | doaj-art-a3ae0b8337be4ec8ab81e7c2f3ec9e97 |
| institution | DOAJ |
| issn | 2635-0254 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Video Journal of Sports Medicine |
| spelling | doaj-art-a3ae0b8337be4ec8ab81e7c2f3ec9e972025-08-20T02:56:39ZengSAGE PublishingVideo Journal of Sports Medicine2635-02542024-02-01410.1177/26350254231199523Lateral Collateral Ligament Reconstruction With Tensionable Loops and Suture Tape ReinforcementMatthew Dulas BA0Cody Lee MD1Margaret Liu BS2Aravind Athiviraham MD3University of Chicago Pritzker School of Medicine, Chicago, Illinois, USADepartment of Orthopaedic Surgery and Rehabilitation, University of Chicago Medicine, Chicago, Illinois, USAUniversity of Chicago Pritzker School of Medicine, Chicago, Illinois, USADepartment of Orthopaedic Surgery and Rehabilitation, University of Chicago Medicine, Chicago, Illinois, USABackground: The posterolateral corner (PLC) is an important knee stabilizer that resists varus stress, external tibial rotation, and posterior tibial translation. Untreated PLC injuries have been shown to increase failure rates of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions and lead to degenerative changes. Our modified Arciero technique reconstructs the femoral insertion site and functionality of the lateral collateral ligament (LCL) and popliteal fibular ligament, components of the PLC, with an internal brace and tensionable loops. Indications: The primary indication for PLC reconstruction is identified PLC injury. Patients often have a feeling of knee instability and a varus thrust gait. PLC injury should be confirmed with imaging. Technique Description: We employed a modified Arciero technique via LCL reconstruction with tensionable loops and internal brace. We used a semitendinosus allograft truncated at 240-millimeters to avoid the graft bottoming out. A suture augment was incorporated into the graft to reinforce the LCL reconstruction construct during graft tensioning and early rehabilitation. The graft construct was then passed through the transfibular tunnel to femoral sockets at the LCL and popliteus insertions. The graft construct is then affixed to the opposite femoral cortex. The graft was then tensioned with the knee in approximately 30° of flexion, neutral to 10° of internal rotation, and a valgus force applied. This restored excellent valgus stability. Results: Fibular and tibiofibular-based constructs are common procedures for PLC reconstruction. Our LCL reconstruction with tensionable loops technique and the Arciero technique are fibular-based constructs. The fibular-based construct and the tibiofibular-based construct have been found to be biomechanically equivalent at restoring knee stability. However, fibular-based constructs, such as our LCL reconstruction with tensionable loops, were found to be less technically demanding than tibiofibular-based constructs, used fewer grafts, and required a smaller surgical approach. Conclusion: Given similar clinical outcomes, it was concluded that fibular-based constructs, such as our modified Arciero technique, may be more advantageous because of the ability to avoid some of the pitfalls of tibiofibular-based constructs. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.https://doi.org/10.1177/26350254231199523 |
| spellingShingle | Matthew Dulas BA Cody Lee MD Margaret Liu BS Aravind Athiviraham MD Lateral Collateral Ligament Reconstruction With Tensionable Loops and Suture Tape Reinforcement Video Journal of Sports Medicine |
| title | Lateral Collateral Ligament Reconstruction With Tensionable Loops and Suture Tape Reinforcement |
| title_full | Lateral Collateral Ligament Reconstruction With Tensionable Loops and Suture Tape Reinforcement |
| title_fullStr | Lateral Collateral Ligament Reconstruction With Tensionable Loops and Suture Tape Reinforcement |
| title_full_unstemmed | Lateral Collateral Ligament Reconstruction With Tensionable Loops and Suture Tape Reinforcement |
| title_short | Lateral Collateral Ligament Reconstruction With Tensionable Loops and Suture Tape Reinforcement |
| title_sort | lateral collateral ligament reconstruction with tensionable loops and suture tape reinforcement |
| url | https://doi.org/10.1177/26350254231199523 |
| work_keys_str_mv | AT matthewdulasba lateralcollateralligamentreconstructionwithtensionableloopsandsuturetapereinforcement AT codyleemd lateralcollateralligamentreconstructionwithtensionableloopsandsuturetapereinforcement AT margaretliubs lateralcollateralligamentreconstructionwithtensionableloopsandsuturetapereinforcement AT aravindathivirahammd lateralcollateralligamentreconstructionwithtensionableloopsandsuturetapereinforcement |