JBJS essential surgical techniques · 2012
Anatomical Reconstruction for Chronic Posterolateral Instability Combined with Posterior Cruciate Ligament Reconstruction: Surgical Technique.
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Kim Sung-Jae, Kim Sung-Hwan, Han Hee-Don, Lee In-Sung, Kim Sung-Guk, Chun Yong-Min
Аннотация
INTRODUCTION: We present surgical techniques for the anatomical reconstruction of the popliteus tendon and the lateral collateral ligament (LCL) with use of a tibialis posterior allograft for posterolateral corner insufficiency combined with anterolateral transtibial single-bundle posterior cruciate ligament (PCL) reconstruction with use of an Achilles tendon-bone allograft with a one-incision technique.
STEP 1 CREATE THE PORTALS: Use a parapatellar high anteromedial portal, a far anterolateral portal, and a high posteromedial portal.
STEP 2 PREPARE THE TIBIAL TUNNEL AND FEMORAL SOCKET FOR THE PCL RECONSTRUCTION: To reduce the graft/socket divergence, (1) flex the knee >100°, (2) push the proximal part of the tibia backward as much as possible, and (3) introduce the cannulated headed reamer through the far anterolateral portal with a smooth plastic sheath and push up posteriorly to make contact with the lateral femoral condyle.
STEP 3 PREPARE PASS AND FIX THE GRAFT FOR THE PCL RECONSTRUCTION: Tie a 9-mm EndoPearl device securely to the tip of the tendon to improve the fixation strength.
STEP 4 MAKE THE SKIN INCISION AND DEVELOP THE SURGICAL PLANE FOR THE POSTEROLATERAL CORNER RECONSTRUCTION: Create a 7-mm fibular tunnel in a counterclockwise direction to avoid breaking the lateral cortex of the fibular tunnel or injuring the peroneal nerve.
STEP 5 PREPARE PASS AND FIX THE GRAFT FOR THE POSTEROLATERAL CORNER RECONSTRUCTION: Change the patient's position to a lateral or semi-lateral decubitus position to prevent an inappropriate posterolateral corner reconstruction by the posterolateral corner of the knee sagging in the supine position due to gravity.
STEP 6 POSTOPERATIVE REHABILITATION: Immobilize the knee in extension, with the proximal part of the tibia supported with cotton pads to prevent posterior drooping, which may lead to graft stretch or failure.
RESULTS: We performed a two-year follow-up study comparing the procedures described here (Group A) with the same PCL reconstruction technique combined with a modified biceps rerouting tenodesis to address the posterolateral corner deficiency (Group B).
WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
STEP 1 CREATE THE PORTALS: Use a parapatellar high anteromedial portal, a far anterolateral portal, and a high posteromedial portal.
STEP 2 PREPARE THE TIBIAL TUNNEL AND FEMORAL SOCKET FOR THE PCL RECONSTRUCTION: To reduce the graft/socket divergence, (1) flex the knee >100°, (2) push the proximal part of the tibia backward as much as possible, and (3) introduce the cannulated headed reamer through the far anterolateral portal with a smooth plastic sheath and push up posteriorly to make contact with the lateral femoral condyle.
STEP 3 PREPARE PASS AND FIX THE GRAFT FOR THE PCL RECONSTRUCTION: Tie a 9-mm EndoPearl device securely to the tip of the tendon to improve the fixation strength.
STEP 4 MAKE THE SKIN INCISION AND DEVELOP THE SURGICAL PLANE FOR THE POSTEROLATERAL CORNER RECONSTRUCTION: Create a 7-mm fibular tunnel in a counterclockwise direction to avoid breaking the lateral cortex of the fibular tunnel or injuring the peroneal nerve.
STEP 5 PREPARE PASS AND FIX THE GRAFT FOR THE POSTEROLATERAL CORNER RECONSTRUCTION: Change the patient's position to a lateral or semi-lateral decubitus position to prevent an inappropriate posterolateral corner reconstruction by the posterolateral corner of the knee sagging in the supine position due to gravity.
STEP 6 POSTOPERATIVE REHABILITATION: Immobilize the knee in extension, with the proximal part of the tibia supported with cotton pads to prevent posterior drooping, which may lead to graft stretch or failure.
RESULTS: We performed a two-year follow-up study comparing the procedures described here (Group A) with the same PCL reconstruction technique combined with a modified biceps rerouting tenodesis to address the posterolateral corner deficiency (Group B).
WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.