Popliteofibular ligament reconstruction for posterolateral external rotation instability of the knee

Abstract

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.

Morphological Features of the Popliteus Tendon, Popliteofibular and Lateral (Fibular) Collateral Ligaments

“…Our finding about the length of LCL was similar to previous studies, as shown in Table II (Maynard et al, 1996;Ishigooka et al, 2004;Espregueira-Mendes & da Silva;Zhang et al, 2009;Jung et al;Osti et al). In most of the cases, LCL was wider at the upper part and narrower at the lower part, in accordance with the findings of Takeda et al In these literatures, width of LCL was given from the midportion or at the level of articular line.…”

“…It was stated that PT attached 0.84-18.5 mm anterior to the LCL (Bartonícek, 2005;Brinkman et al;Kim et al). In some other studies, PT has been expressed to locate in three positions: posteroinferior, just inferior or posterior to the LCL in extension position of the knee (Ullrich et al, 2002;Zhang et al;Jung et al). Additionally, in the study of Zeng et al, it was stated that PT was overlapped by LCL.…”

Anatomic study of popliteus complex of the knee in a Chinese population

“…Many surgical methods recommend a tunnel anteroinferior to the LCL attachment on the femur condyle (Nau et al 2005;Zhang et al 2009;LaPrade et al 2003LaPrade et al , 2010. Whereas, according to research by Jung et al (2010) and Yang et al (2011), if the original site of the PT cannot be seen, a posteroinferior site femoral tunnel, as with the LCL attachment, is recommended.…”

“…Despite its important clinical significance, PLS injuries are still frequently undiagnosed and left untreated clinically due to its complex structures and variations in anatomy (Covey 2001;LaPrade et al 2003;Nau et al 2005;Zhang et al 2009). The structures of the PLS can be divided into two primary components: the lateral collateral ligament (LCL) and the popliteus complex (PC; Ullrich et al 2002;Zantop et al 2007;Gadikota et al 2010;Jung et al 2010;Yang et al 2011).…”

Posterolateral and Posteromedial Corner Injuries of the Knee

“…53 Surgical reconstruction of a disrupted popliteofibular ligament has been found to be beneficial in patients with posterolateral external rotatory instability of the knee. 65 …”