Sung-Jae Kim1, Sung-Hwan Kim1, Hee-Don Han1, In-Sung Lee1, Sung-Guk Kim1, Yong-Min Chun1. 1. Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University Health System, CPO Box 8044, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea. E-mail address for S.-J. Kim: sungjaekim@yuhs.ac. E-mail address for S.-H. Kim: orthohwan@yuhs.ac. E-mail address for H.-D. Han: yaedrra@daum.net. E-mail address for I.-S. Lee: domlee1975@naver.com. E-mail address for S.-G. Kim: p10001@hanmail.net. E-mail address for Y.-M. Chun: min1201@hanmail.net.
Abstract
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.
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.
Authors: John A Bergfeld; Scott M Graham; Richard D Parker; Antonio D C Valdevit; Helen E Kambic Journal: Am J Sports Med Date: 2005-05-11 Impact factor: 6.202
Authors: James P Stannard; Stephen L Brown; Rory C Farris; Gerald McGwin; David A Volgas Journal: Am J Sports Med Date: 2005-04-12 Impact factor: 6.202