Treatment and outcomes of lateral collateral ligament injury associated with anterior and posterior cruciate ligament injury at 2-year follow-up

Ramos, Leonardo Adeo; Zogbi, Tiago M.; Andrade, Edilson; Oliveira, Gabriel Taniguti de; Nicolini, Alexandre Pedro; Krob, Joseph J.; Yamashita, Jorge; Cohen, Moisés; Astur, Diego Costa

doi:10.1016/j.jor.2019.05.010

Cited by 6 publications

(5 citation statements)

References 21 publications

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“…A study by Moulton et al assessing outcome scores for patients who underwent FCL reconstruction, a large proportion of whom also underwent concomitant ACL reconstruction, found that FCL reconstruction can achieve substantially improved outcome scores, both when performed as an isolated procedure and when performed in concert with other procedures, such as an ACL reconstruction, as demonstrated in this video. 6,8…”

Section: Surgical Techniquesmentioning

confidence: 99%

Anatomic Fibular Collateral Ligament and Anterior Cruciate Ligament Reconstruction With Concomitant Biceps Femoris Avulsion Repair

Banovetz

Braaten

Homan

et al. 2023

Video Journal of Sports Medicine

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Background: Injuries to the fibular collateral ligament (FCL) seldom occur in isolation and may present with a concomitant injury to the biceps femoris tendon and anterior cruciate ligament (ACL). Injuries to structures of the posterolateral corner (PLC) lead to varus and rotational instability of the knee, subjecting the cruciate ligaments to increased forces that may result in graft failure. Therefore, reconstruction of these structures should be performed concurrently with the ACL. Indications: Grade III FCL injuries heal poorly without operative treatment and often result in residual varus instability of the knee that increases medial knee compartment forces, and forces on both the native ACL and the graft status post ACL reconstruction. Therefore, preservation of biomechanical stability and long-term health of the knee are reliant on addressing injuries to the PLC surgically. Technique Description: A key concept of this surgical technique is a meticulous peroneal nerve neurolysis in the setting of altered biceps femoris anatomy, and the proper order of the surgical steps for tunnel creation, graft passage, and fixation and suture anchor insertion to achieve optimal patient outcomes. The described technique involves a lateral surgical approach, peroneal neurolysis, and preparation of fibular and femoral FCL tunnels, followed by a Bone-patellar tendon-bone graft (BTB) graft harvest. Attention is then turned to intra-articular work including the diagnostic arthroscopy, femoral and tibial tunnel preparation, passage of the ACL graft, and fixation of the grafts in femoral tunnels. Last, fixation is achieved in the following order: FCL graft on fibula, ACL graft on tibia, and biceps femoris tendon to fibular head. Results: Compared with the preoperative state, Moulton et al reported significant improvements in the average Lysholm and Western Ontario scores at 2.7 years postoperatively following anatomic FCL reconstrution. Furthermore, Thompson et al reported on primary suture anchor repair of distal biceps femoris in 22 elite athletes and reported that all patients had returned to their preinjury level of sporting activity at 2-year follow-up. Discussion: Anatomic reconstructions of the FCL and ACL, such as the one described in our technique, effectively restore near native knee biomechanics and offer superior clinical outcomes compared with nonanatomic-based FCL reconstructions. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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Section: Surgical Techniquesmentioning

confidence: 99%

Anatomic Fibular Collateral Ligament and Anterior Cruciate Ligament Reconstruction With Concomitant Biceps Femoris Avulsion Repair

Banovetz

Braaten

Homan

et al. 2023

Video Journal of Sports Medicine

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“…In cadaver studies, lateral joint space widening increased with complete FCL/ACL tears compared with isolated FCL injuries. 8,13,14 McDonald et al 14 documented increased lateral laxity of 1.1 mm in isolated ACL sectioning and 2 mm after sectioning both the ACL and FCL. This supports the authors' 2-mm cutoff for combined ACL/FCL reconstruction.…”

Section: See Related Article On Page 944mentioning

confidence: 99%

Editorial Commentary: Autograft Beats Allograft for Most Knee Ligament Surgery

Therrien

Stuart

Levy

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Knee ligament reconstruction can be performed with autograft or allograft. The use of an autograft has been shown to improve outcomes in primary anterior cruciate ligament reconstruction for young, active patients, and also in revision anterior cruciate ligament reconstruction surgery. A systematic review of posterior cruciate ligament reconstruction showed no difference in outcomes between autograft and allograft tissue. There is a paucity of data comparing autograft versus allograft for fibular collateral ligament and posterolateral corner reconstructions, alone or combined with other ligament surgery. Allograft advantages include no donor site morbidity and reduced operative time. Disadvantages include increased cost and higher failure rates in younger patients. Autograft tissue should be considered in younger, active patients whenever possible.

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“…Given the complexity of these injuries, allografts are increasingly used, as they reduce the time spent in harvesting and preparing the grafts, and donor site morbidity [4,7,8,13]. However, access, availability and costs of allografts are limited in several settings [14]. We present a surgical procedure that we have used over the last 18 years to reconstruct combined ACL and LCL injuries, also in patients presenting with a bicruciate ligament injury associated with an LCL tear.…”

Section: Introductionmentioning

confidence: 99%

Combined anterior cruciate and lateral collateral ligaments reconstruction with ipsilateral hamstring autograft: surgical technique

et al. 2022

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Different surgical techniques have been proposed to reconstruct combined anterior cruciate (ACL) and lateral collateral ligaments (LCL). Although these surgical techniques are reliable and reproducible, the number of autologous grafts needed for the reconstruction could be a limiting factor, especially when patients present with multi-ligament knee injuries and the posterior cruciate ligament is also torn. In addition, some of these techniques are not easy to master and have a steep learning curve. We present a surgical procedure that has been used over the last 18 years to reconstruct combined ACL and LCL injuries and has become a reproducible, feasible and time-efficient procedure to approach combined ACL and LCL injuries using an ipsilateral hamstring autograft.

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Treatment and outcomes of lateral collateral ligament injury associated with anterior and posterior cruciate ligament injury at 2-year follow-up

Cited by 6 publications

References 21 publications

Anatomic Fibular Collateral Ligament and Anterior Cruciate Ligament Reconstruction With Concomitant Biceps Femoris Avulsion Repair

Anatomic Fibular Collateral Ligament and Anterior Cruciate Ligament Reconstruction With Concomitant Biceps Femoris Avulsion Repair

Editorial Commentary: Autograft Beats Allograft for Most Knee Ligament Surgery

Combined anterior cruciate and lateral collateral ligaments reconstruction with ipsilateral hamstring autograft: surgical technique

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