Femoral Fixation Sites for Optimum Isometry of Posterolateral Reconstruction*

Sigward, Susan M.; Markolf, Keith L.; Graves, Benjamin R.; Chacko, Jacob M.; Jackson, Steven R.; McAllister, David R.

doi:10.2106/jbjs.f.01132

Cited by 15 publications

(9 citation statements)

References 24 publications

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“…A majority of the studies on graft isometry has been performed on cruciate ligament reconstructions, and only recently have studies evaluated graft isometry on the posterolateral corner [18]. Graft isometry is important for any ligament reconstruction in order to effectively stabilize the joint during the entire range of motion.…”

Section: Discussionmentioning

confidence: 99%

Isometry of medial collateral ligament reconstruction

Feeley

Muller²,

Allen

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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The purpose of this study was to determine the femoral and tibial fixation sites that would result in the most isometric MCL reconstruction technique. Seven cadaveric knees were used in this study. A navigation system was utilized to determine graft isometry continuously from 08 to 908. Five points on the medial side of the femur and four on the tibia were tested. A graft positioned in the center of the MCL femoral attachment (F C ) and attached in the center of the superficial MCL attachment on the tibia led to the best isometry (2.7 ± 1.1 mm). Movement of the origin superiorly only 4 mm (F S ) led to graft excursion of greater than 10 mm (P \ 0.01). MCL reconstruction performed with the origin of the MCL within the femoral footprint and the insertion in tibial footprint of the superficial MCL results in the least graft excursion when the knee is cycled between 08 and 908. Although the MCL often heals without surgical intervention, surgical reconstruction is occasionally in Grade III MCL and combined ligamentous injuries to the knee. This study demonstrates the optimal position of the MCL reconstruction to reproduce the kinematics of the native knee.

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Section: Discussionmentioning

confidence: 99%

Isometry of medial collateral ligament reconstruction

Feeley

Muller²,

Allen

et al. 2009

Knee Surg Sports Traumatol Arthrosc

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“…Regarding the length changes reported, the shortening of the posterior graft strand in the Arciero and LaPrade techniques restores varus and rotational stability in flexion as demonstrated biomechanically in previous studies. 10 , 27 Sigward et al 24 investigated the isometry of the PLC and found similar results for the FCL graft strand. They found that the most isometric femoral insertion for the FCL graft strand was in direct proximity (<2 mm) to the anatomic insertion, which could be confirmed by our findings.…”

Section: Discussionmentioning

confidence: 78%

“…This contradicts our findings and previous biomechanical findings that intend a taught PFL and PLT graft strand in flexion and suggested a tensioning in 30° 2 and 60°. 10 The contradicting finding is most likely the result of the chosen definition of the femoral popliteus insertion posterior to the FCL insertion by Sigward et al 24 …”

Section: Discussionmentioning

confidence: 99%

“…They found that the most isometric femoral insertion for the FCL graft strand was in direct proximity (<2 mm) to the anatomic insertion, which could be confirmed by our findings. Regarding the PFL and PLT graft strands, Sigward et al 24 found an overconstraint during knee extension and slackening during flexion. This contradicts our findings and previous biomechanical findings that intend a taught PFL and PLT graft strand in flexion and suggested a tensioning in 30° 2 and 60°.…”

Section: Discussionmentioning

confidence: 99%

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Elongation Patterns of Posterolateral Corner Reconstruction Techniques: Results Using 3-Dimensional Weightbearing Computed Tomography Simulation

Hodel

Hasler

Fürnstahl

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: The isometric characteristics of nonanatomic and anatomic posterolateral corner (PLC) reconstruction techniques under weightbearing conditions remain unclear. Purpose: To (1) simulate graft elongation patterns during knee flexion for 3 different PLC reconstruction techniques (Larson, Arciero, and LaPrade) and (2) compute the most isometric insertion points of the fibular collateral ligament (FCL) graft strands for each technique and report quantitative radiographic landmarks. Study Design: Descriptive laboratory study. Methods: The authors performed a 3-dimensional simulation of 10 healthy knees from 0° to 120° of flexion using weightbearing computed tomography (CT) scans. The simulation was used to calculate ligament length changes during knee flexion for the PLC reconstruction techniques of Larson (nonanatomic single-bundle fibular sling reconstruction), Arciero (anatomic reconstruction with additional popliteofibular ligament graft strand), and LaPrade (anatomic reconstruction with popliteofibular ligament graft strand and popliteus tendon graft strand). The most isometric femoral insertion points for the FCL graft strands were computed within a 10-mm radius around the lateral epicondyle (LE), using an automatic string generation algorithm (0 indicating perfect isometry). Radiographic landmarks for the most isometric points were reported. Results: Median graft lengthening during knee flexion was similar for the anterior graft strands of all 3 techniques. The posterior graft strands demonstrated significant differences, from lengthening for the Arciero (9.9 mm [range, 6.7 to 15.9 mm]) and LaPrade (10.2 mm [range, 4.1 to 19.7 mm]) techniques to shortening for the Larson technique (−17.1 mm [range, −9.3 to −22.3 mm]; P < .0010). The most isometric point for the FCL graft strands of all techniques was located at a median of 2.2 mm (range, −2.2 to 4.5 mm) posterior and 0.3 mm (range, −1.8 to 3.7 mm) distal to the LE. Conclusion: Overconstraint can be avoided by tensioning the posterior graft strands in the Larson technique in extension, and in the Arciero and LaPrade techniques at a minimum of 60° of knee flexion. The most isometric point was located posterodistal to the LE. Clinical Relevance: The described isometric behavior of nonanatomic and anatomic PLC reconstruction techniques can guide optimal surgical reconstruction and prevent graft lengthening and overconstraint of the lateral compartment in knee flexion. Repetitive graft lengthening has been found to be associated with graft failure, and overconstraint favors lateral compartment pressure and cartilage degeneration.

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“…Sigward et al (27) determined the ideal isometric location for the grafts of the fibular collateral ligament, popliteus tendon and popliteofibular ligament in the lateral femoral condyle using the foot-print of the fibular collateral ligament and popliteus tendon, in accordance with the studies of Fanelli and Larson (26). We therefore believe that the anatomical reconstruction agrees with the concepts of isometry, and together, these ideas can provide the best results in reconstructions of the posterolateral corner of the knee.…”

Section: Discussionmentioning

confidence: 98%

Reconstruction of chronic lesions in the posterolateral corner of the knee with autologous biceps femoralis and fascia lata grafts

Oliveira

Severino

Kawano

2012

Clinics

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OBJECTIVE:The aim of this study was to evaluate the treatment of patients with chronic lesions in the posterolateral corner of the knee with reconstruction of the fibular collateral ligament, popliteus tendon and popliteofibular ligament and with autografts of the biceps femoris and fascia lata.METHOD:A total of 129 patients with injuries of the posterolateral corner of the knee that lasted for more than three weeks and were associated with the lesion of at least one of the cruciate ligaments were included. All of the patients were operated on consecutively in the same hospital between March 2004 and April 2009. Clinical evaluation using the Lyshom scale and the International Knee Documentation Committee (IKDC, item 4, assessment ligament) protocol was performed in 114 patients for whom there were complete data available.RESULTS:There was significant improvement in the Lyshom score and improved stability according to the IKDC protocol in the pre- compared to postoperative varus stress test at 30 degrees and the posterolateral rotation test.CONCLUSIONS:Surgical reconstruction of the posterolateral corner of the knee with biceps femoris tendon and fascia lata autografts is effective in stabilizing the posterolateral corner of the knee.

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Femoral Fixation Sites for Optimum Isometry of Posterolateral Reconstruction*

Cited by 15 publications

References 24 publications

Isometry of medial collateral ligament reconstruction

Isometry of medial collateral ligament reconstruction

Elongation Patterns of Posterolateral Corner Reconstruction Techniques: Results Using 3-Dimensional Weightbearing Computed Tomography Simulation

Reconstruction of chronic lesions in the posterolateral corner of the knee with autologous biceps femoralis and fascia lata grafts

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