Control of Laxity in Knees with Combined Posterior Cruciate Ligament and Posterolateral Corner Deficiency

Apsingi, Sunil; Nguyễn, Trung Nghĩa; Bull, Anthony M.J.; Unwin, Andrew; Deehan, David J.; Amis, Andrew A.

doi:10.1177/0363546508314415

Cited by 61 publications

(12 citation statements)

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“…Albright and Brown used the sling procedure reconstructing PLC [1], but this method did not reconstruct the LCL or PFL anatomically. In a recent study, Apsingi et al [2] used nine cadaver knees to show that in combined PCL plus PLC‐deficient knees, combined single‐bundle PCL plus modified Larson PLC reconstruction was sufficient to restore posterior drawer, external rotation and varus laxity to normal. Although the attachments are nonanatomic in the modified Larson technique, this procedure is effective to restore the varus and external rotation functions of the knee at time zero post‐reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Popliteofibular ligament reconstruction for posterolateral external rotation instability of the knee

Zhang

Feng

Hong

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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The aim of this study was to assess the clinical outcome of popliteofibular ligament (PFL) reconstruction for posterolateral external rotation instability of the knee. PFL reconstruction was performed consecutively in 22 patients with chronic external rotation instability of the knee. The inclusion criterion for surgery was tibial external rotation of 10 degrees more than the contralateral uninjured knee without varus laxity. A double bone tunnel was created at the PFL insertion of the fibular head through the lateral incision of the knee joint and a single bone tunnel at the popliteus tendon insertion on the femoral side. A semitendinosus autograft tendon or tibialis anterior allograft tendon was introduced through the fibular tunnel as a loop, then both free ends of the graft were introduced through the femoral tunnel and a bioabsorbable interference screw was used to fix the graft. The minimum follow-up was 2 years. Clinical review included the International Knee Documentation Committee (IKDC) scale and tibial external rotation assessment. All patients' preoperational tibial external rotation averaged 15 degrees more than the contralateral uninjured knee. operatively the tibial external rotation was decreased, average -3 degrees compared with the contralateral side. This difference was statistically significant. The final IKDC grades were: 22 cases with grade D preoperatively, and 6 were grade A, 8 were grade B, 7 were grade C and 1 was grade D postoperatively. In this small clinical series, PFL reconstruction technique was shown to correct pathological excessive tibial external rotation.

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Section: Discussionmentioning

confidence: 99%

Popliteofibular ligament reconstruction for posterolateral external rotation instability of the knee

Zhang

Feng

Hong

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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show abstract

“…Sekiya et al [30] found that a combined double‐bundle PCL plus PLC reconstruction was capable of restoring both posterior translation and external rotation laxity to normal values. Apsingi et al [5] reported the same result, and also found that a combined single‐bundle PCL plus PLC reconstruction could restore these laxities to normal.…”

Section: Introductionmentioning

confidence: 67%

The role of PCL reconstruction in knees with combined PCL and posterolateral corner deficiency

Apsingi

Nguyen

Bull

et al. 2007

Knee Surg Sports Traumatol Arthr

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Although many PCL injuries are in combination with posterolateral corner (PLC) injuries, there has been little work done on combined injury reconstruction; the literature includes differing recommendations. It was hypothesised that a double-bundle PCL reconstruction would restore both posterior drawer and external rotation laxities closer to normal than an isolated single-bundle reconstruction in combined PCL plus PLC-deficient knees. However, it was also hypothesised that an isolated PCL reconstruction would still leave abnormal rotation laxity. In this controlled laboratory study, cadaver knee kinematics were measured electromagnetically with posterior drawer, external rotation, varus rotation loads applied, at sequential stages: intact; PCL-deficient; PCL plus PLC-deficient; double-bundle PCL reconstruction; single-bundle PCL reconstruction. The grafts were tensed using a posterior drawer laxity matching protocol. There was no significant difference between single- and double-bundle PCL reconstructions at any angle of flexion: both reconstructions restored posterior drawer to normal; neither reconstruction restored external rotation or varus laxity to normal. We concluded that, in combined PCL plus PLC deficiency, isolated PCL reconstruction only controls tibial posterior drawer, but is not sufficient to restore rotational laxity to normal. Double-bundle PCL reconstruction was not better than single-bundle, so the added complexity of double-bundle reconstruction does not seem to be justified by these results.

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“…2 10 11 18 19 20 21 22 23 24 25 Outros, no entanto, não conseguiram demonstrar a superioridade de uma técnica sobre a outra (um feixe versus dois feixes). 12 13 26 27 28 29 Este cenário nos fez pensar se a comparação deveria ser feita entre um e dois feixes ou se, por outro lado, há um problema com o volume do enxerto, que seria mais bem resolvido com um único feixe mais espesso (e não com vários feixes). Em seguida, identificamos dois pontos-chave para um estudo mais aprofundado: a espessura do enxerto e o segundo túnel femoral.…”

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Enxerto espesso versus técnica de duplo feixe na reconstrução do ligamento cruzado posterior: Estudo experimental biomecânico com cadáveres

et al. 2019

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Objective To evaluate the biomechanical effect of graft thickness compared with the double-bundle technique on posterior cruciate ligament (PCL) reconstruction in human cadaveric knees. Methods A total of 9 human cadaveric knees were tested in 5 conditions: intact knee (INT); single-bundle reconstruction with a 10-mm quadriceps tendon (SB); double-bundle reconstruction with a 10 mm-quadriceps tendon for the anterolateral bundle and a 7-mm doubled semitendinosus tendon for the posteromedial bundle (DB); single-bundle reconstruction with a 10-mm quadriceps tendon plus a 7-mm doubled semitendinosus tendon (SBT); and PCL-deficient (NoPCL). The posterior tibial translation (PTT) was measured in response to a 134-N posterior tibial load at 0 ∘ , 30 ∘ , 60 ∘ e 90 ∘ of knee flexion. Results The PTT values of the DB and SBT techniques were always significantly lower (better stability) than those of the SB technique. The PTT values of the SBT technique were significantly lower than those of the DB technique at 60 ∘ ( p = 0.005) and 90 ∘ ( p = 0.001). Conclusions Graft enlargement improves knee stability in isolated PCL reconstructions, whereas the graft division in the two-bundle technique worsens this stability at 60 ∘ and 90 ∘ of knee flexion. The findings of the present study suggest that knee stability in PCL reconstructions may be improved with the use of thicker grafts in the SB technique rather than performing the DB technique.

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Control of Laxity in Knees with Combined Posterior Cruciate Ligament and Posterolateral Corner Deficiency

Cited by 61 publications

References 50 publications

Popliteofibular ligament reconstruction for posterolateral external rotation instability of the knee

Popliteofibular ligament reconstruction for posterolateral external rotation instability of the knee

The role of PCL reconstruction in knees with combined PCL and posterolateral corner deficiency

Enxerto espesso versus técnica de duplo feixe na reconstrução do ligamento cruzado posterior: Estudo experimental biomecânico com cadáveres

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