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

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          Abstract

          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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          Most cited references 97

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          An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique.

          To date, no surgical technique to treat posterolateral knee instability anatomically reconstructs the 3 major static stabilizing structures of the posterolateral knee: the fibular collateral ligament, the popliteus tendon, and the popliteofibular ligament. Static varus and external rotatory stability would be restored to the reconstructed knee with a posterolateral knee injury. The anatomical locations of the original fibular collateral ligament, popliteus tendon, and popliteofibular ligament were reconstructed using a 2-graft technique. Ten cadaveric specimens were tested in 3 states: intact knee, knee with the 3 structures cut to simulate a grade III injury, and the reconstructed knee. For the varus loading tests, joint stability was significantly improved by the posterolateral reconstruction compared to the cut state at 0 degrees, 30 degrees, 60 degrees, and 90 degrees of flexion. There were no significant differences between the intact and reconstructed knees at 0 degrees, 60 degrees, and 90 degrees for varus translation. For the external rotation torque tests, external rotation was significantly higher for the cut state than for the intact or reconstructed posterolateral knee. There was no significant difference in external rotation between the intact and reconstructed posterolateral knees at any flexion angle. This 2-graft technique to reconstruct the primary static stabilizers of the posterolateral knee restored static stability, as measured by joint translation in response to varus loading and external rotation torque, to knees with grade III posterolateral injuries.
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            The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon.

            Quantitative descriptions of the attachment sites of the main posterolateral knee structures have not been performed. To qualitatively and quantitatively determine the anatomic attachment sites of these structures and their relationships to pertinent bony landmarks. Cadaveric study. Dissections were performed and measurements taken on 10 nonpaired fresh-frozen cadaveric knees. The fibular collateral ligament had an average femoral attachment slightly proximal (1.4 mm) and posterior (3.1 mm) to the lateral epicondyle. Distally, it attached 8.2 mm posterior to the anterior aspect of the fibular head. The popliteus tendon had a constant broad-based femoral attachment at the most proximal and anterior fifth of the popliteal sulcus. The popliteus tendon attachment on the femur was always anterior to the fibular collateral ligament. The average distance between the femoral attachments of the popliteus tendon and fibular collateral ligament was 18.5 mm. The popliteofibular ligament had two divisions-anterior and posterior-in all cases. The average attachment of the posterior division was 1.6 mm distal to the posteromedial aspect of the tip of the fibular styloid process and the anterior division attached 2.8 mm distal to the anteromedial aspect of the tip of the fibular styloid process. These structures had a consistent attachment pattern. This information will prove useful in the study of anatomic repair and reconstruction of the posterolateral structures of the knee.
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              Outcomes of an anatomic posterolateral knee reconstruction.

              Chronic posterolateral knee injuries often result in substantial patient morbidity and functional instability. The clinical stability and functional outcomes following anatomic reconstructions in patients with a chronic posterolateral knee injury have not been determined, to our knowledge. A two-center outcomes study of sixty-four patients with grade-3 chronic posterolateral instability was performed. The patients were evaluated subjectively with the modified Cincinnati and International Knee Documentation Committee (IKDC) subjective scores and objectively with the IKDC objective score. Eighteen patients had an isolated posterolateral knee reconstruction, and forty-six patients underwent a single-stage multiple-ligament reconstruction that included reconstruction of one or both cruciate ligaments along with the posterolateral knee reconstruction. The average duration of follow-up was 4.3 years. The fifty-four patients who were available for follow-up had an average total Cincinnati score of 65.7 points. A significant improvement was found between the preoperative and postoperative IKDC objective scores for varus opening at 20 degrees, external rotation at 30 degrees, reverse pivot shift, and single-leg hop. An anatomic posterolateral reconstruction resulted in improved clinical outcomes and objective stability for patients with a grade-3 posterolateral knee injury.
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                Author and article information

                Journal
                Clinics (Sao Paulo)
                Clinics (Sao Paulo)
                Clinics
                Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                1807-5932
                1980-5322
                June 2012
                : 67
                : 6
                : 597-602
                Affiliations
                [I ]Santa Casa de Misericórdia de São Paulo, São Paulo/SP, Brazil.
                [II ]Centro Médico Kawano, São Paulo/SP, Brasil.
                Author notes

                Oliveira MG participated in the study design, data collection, manuscript writing, and final revision. Severino NR participated in the study design, critical revision of the manuscript, and revision of the final version. Kawano CT participated in the data collection, data interpretation and final revision of the text.

                E-mail: mguio@ 123456ig.com.br Tel.: 55 11 5579-3272
                Article
                cln_67p597
                10.6061/clinics/2012(06)09
                3370311
                22760898
                Copyright © 2012 Hospital das Clínicas da FMUSP

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Counts
                Pages: 6
                Categories
                Clinical Science

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