They developed an anatomic method of reconstructing the static stabilizers of the PLC, but the ‘‘popliteofibular ligament’’ part of the anatomic PLC reconstruction they showed appeared to stabilise the tibi- By continuing you agree to the use of cookies. Background: Recently, posterolateral corner (PLC) reconstruction techniques have been developed based on an anatomic study of cadaveric dissections. Anatomic Collateral Ligament Reconstruction Once the minimally invasive or open incision is made and proper soft tissue windows are established, the Fibular, Tibial, and/or Femoral Collateral Marking Hooks are used for anatomic precision and osseous measurements when drilling the appropriate reconstruction tunnels. T he posterolateral corner (PLC) of the knee consists Posterolateral corner injuries represent a complex injury pattern, with damage to important coronal and rotatory stabilizers of the knee. a retrospective case series after isolated PLC recon-struction using a novel PLC reconstruction technique that addresses both LCL and popliteal tendon ligaments. Patients frequently complain of pain over the posterolateral aspect of the knee, and instability with normal walking, twisting, and cutting2. We use cookies to help provide and enhance our service and tailor content and ads. the opinion that an ‘anatomic’ reconstruction of the PLC is necessary to improve the clinical results of PLC recon-struction. METHODS Patients From October 1997 to April 2005, a total of 40 patients with isolated lateral and posterolateral insta-bility had combined LCL and PLC reconstruction. As reconstruction gradually began to focus on the specific anatomic structures of the PLC, Muller 58 was one of the first to advocate separate reconstruction of both the LCL and popliteus with his popliteal bypass. After discussing all treatment options, the patient elected to proceed with surgery immediately, including an ACL reconstruction and an anatomic-based PLC reconstruction. ◊ Marca comercial de Smith & Nephew, Video Collection: Vail International Complex Knee Symposium 2017, Surgical Demonstration: Anatomic LCL Reconstruction. Anatomic reconstruction of the PLC addresses the 3 key functional structures that restrain varus and external rotation laxity: the FCL, the popliteus, and the PFL. The semitendinosus graft used in the previous reconstruction was reused. The Anatomic Posterolateral Corner Reconstruction Technique. As the anatomy and biomechanics of the posterolateral corner (PLC) of the knee have become better understood, the importance of the PLC's proper function has become a more frequently raised subject. This complex of ligaments and tendons functions as the primary restraint to varus and posterolateral rotation of the knee. 13, 14, 15 The purpose of this article is to describe an anatomic reconstruction technique of the 3 major stabilizers of the PLC using a split Achilles tendon allograft. An anatomic PLC reconstruction technique using autografts was successful in improving subjective outcomes and objective stability in patients with a chronic multi- ligamentous knee injury involving the PLC; relying just on a semitendinosus and a gracilis autografts, augmented by a strip of the biceps, when necessary, avoiding the need of contra-lateral side knee autografts … 0 Comments. Posterolateral corner (PLC) knee injuries commonly result from a force directed at the anteromedial aspect of the knee with the foot planted firmly on the ground1. anatomy is essential for surgical treatment of this pathology. In this surgical demonstration, Dr Robert LaPrade and Dr Lars Engebretsen discuss the anatomical detail and surgical considerations for posterolateral knee reconstruction. The original description of this technique by LaPrade et al.11 advocated the use of 2 allografts for the reconstruction. Nevertheless a recent systematic review of the literature report favorable outcome result in 90% of the cases regardless the anatomic surgical technique employed at an average follow-up between 2 and 16 years. The anatomic PCL reconstruction was designed to reconstruct the lateral collateral ligament, popliteus tendon and the popliteofibular ligament complex (Fig. Anatomic FCL, PFL, popliteus ligament reconstruction, using Smith&Nephew guides. The Larson s reconstruction is commonly used, but is not an anatomic procedure [5,6]. Anatomic reconstruction can be broadly separated into fibular-based and combined tibial-fibular-based reconstructions. This is because untreated PLC deficiency has been reported PLC Reconstruction. surgical step of PLC (Posterolateral corner injury reconstruction)Dr Rajeev Raman Anatomic PLC reconstruction using a single fibular sling method is an effective and relatively simple procedure for most patients with posterolateral rotatory instability, with the exception of those with severe multiple injuries. PLC repairs have been reported to have a higher reoperation rate when compared with reconstructive techniques.13 As a result, reconstruction is recommended for grade III injuries. Login to view comments. Posterolateral corner injuries represent a complex injury pattern, with damage to important coronal and rotatory stabilizers of the knee. Grade III posterolateral corner injuries result in significant instability and have poor outcomes when treated nonoperatively. SURGICAL TECHNIQUE: POSTEROLATERAL CORNER RECONSTRUCTION The following technical note provides a diagnostic approach, postoperative management, and details of a technique for anatomic reconstruction of the 3 main static stabilizers of the posterolateral corner of the knee. Conclusions In conclusion, the audience is invited to ask questions. Dr Robert LaPrade (US) & Dr Lars Engebretsen (NO). Biomechanical studies evaluating ACLRs in the setting of a deficient PLC has emphasized the need for an anatomic PLC reconstruction (PLCR ) to restore native knee kinematics and protect the integrity of the ACLR graft (5-7). Injury to the PLC can result in chronic instability, a varus-thrust gait, and early arthrosis of the medial compartment of the knee if left untreated. Most injuries to the PLC occur in combination with disruption of the posterior cruciate ligament (PCL) or, to a lesser extent, the … These lesions commonly occur in association with other ligament injuries, making decisions regarding treatment challenging. By Rob LaPrade 14 Videos. We present a modification of this technique, which allows for the use of a single semitendinosus autograft but still allows differential tensioning of the FCL and PFL/popliteus component of the reconstruction. Multiple surgical approaches to PLC injuries have been described, many of which involve the use of a graft either from the patient or from a donor. Abstract. In this surgical demonstration, Dr Robert LaPrade and Dr Lars Engebretsen discuss the anatomical detail and surgical considerations for posterolateral knee reconstruction. kinematics for anatomic PLC reconstruction [3,4]. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Anatomic Posterolateral Corner Reconstruction, © 2016 by the Arthroscopy Association of North America, https://doi.org/10.1016/j.eats.2016.02.006. 3). The posterolateral corner (PLC) is an important stabilizer of the knee. Anatomic PLC reconstruction potentially has a biomechanical advantage over nonanatomic techniques. However, it requires a long graft, limiting its indication to clinical settings in which allograft tissue is available. The LaPrade technique reproduces all 3 main stabilizers. November 26, 2011. Anatomic posterolateral corner reconstruction reproduces 3 main structures: the lateral collateral ligament, the popliteofibular ligament, and the popliteus tendon. It is understood that anatomic reconstruction is superior to extra-anatomic techniques, leading to better clinical results. receives support from Arthrex, Smith & Nephew, and Ossur. As a result, reconstruction is advocated. clinical and a biomechanical perspective, which type of anatomic PLC reconstruction is superior. Several open PLC reconstruction techniques have been published. Hypothesis: The anatomic single fibular sling method for PLC reconstruction would be sufficiently strong to control … Consequently, the term non- Copyright © 2021 Elsevier B.V. or its licensors or contributors. Treatment for patients with combined grade III posterolateral injuries is quite similar to that of isolated PLC injuries. The femoral tunnels from the previous reconstruction were obliterated with bone cement. An anatomically based posterolateral corner (PLC) reconstruction has emerged as a viable and clinically effective surgical technique for midsubstance ligamentous injuries in both the acute and chronic settings. Click here to Login. After outlining differences between acute and chronic reconstruction, they conduct the procedure on a cadaveric specimen whilst discussing the use and fixation of grafts. We hypothesized that our anatomic PLC reconstruction would give better stability to external rotatory and varus load than Larson s reconstruction. Repair or anatomic reconstruction of the posterolateral structures should be scheduled within 3 weeks of the initial injury. However, the best operative method for various anatomic reconstructions remains controversial. The authors report the following potential conflicts of interest or sources of funding: R.F.L. 1–3, 17 However, in some cases, it can be difficult to perform an optimal physical exam on the acutely injured, painful knee. Injuries to the posterolateral corner (PLC) of the knee have received increased attention in recent years, with its elusive diagnosis, and potential surgical approaches to guide repair and/or reconstruction are still highly debated. These injuries are notoriously difficult to diagnose, treat and understand due to the complex anatomy comprising the Misdiagnosed chronic posterolateral instability may lead to serious consequences, including cruciate ligament reconstruction graft failure. Once the minimally invasive or open incision is made and proper soft tissue windows are established, the Fibular, Tibial, and/or Femoral Collateral Marking Hooks are used for anatomic precision and osseous measurements when drilling the appropriate reconstruction tunnels. LARS PLC Contents Posterolateral corner pathology 3 LARS™ overview 4 LARS™ material overview 4 LARS™ general considerations 4 Indications 4 Contraindications 4 Surgical approach 5 Best practice guidelines 5 LARS™ anatomic PLC reconstruction technique summary 6 ‘Anatomic’ reconstruction using LARS™ PPLY 100 8 1. combined PLC injury (1,4). We have developed a new 4-strand anatomic PLC reconstruction. The following technical note provides a diagnostic approach, postoperative management, and details of a technique for anatomic reconstruction of the 3 main static stabilizers of the posterolateral corner of the knee. A thorough knowledge of the anatomy is essential for surgical treatment of this pathology. Recorded at:VICKS - Vail International Complex Knee SymposiumVail, CO, USA14-16 June, 2018, 2008 - 2021 Smith & Nephew Plc. atomic reconstruction of the lateral collateral ligament and popliteofibular ligament using a free soft-tissue graft through a transfibular tunnel, but recreating the insertion sites of the lateral collateral ligament and popliteus on the femur using a dual femoral socket technique. After outlining differences between acute and chronic reconstruction, they conduct the procedure on a cadaveric specimen whilst discussing the use and fixation of grafts. An open, anatomic, fibula-based technique for reconstruction to address lateral and rotational instability has been described. the authors believe the term anatomical PLC reconstruction should be reserved for the techniques reproducing the three main structures of the PLC and its anatomic footprints (2,5,6,29). In addition, it has been demonstrated that an anatomic PLC reconstruction requires a PFL reconstruction through a tibial tunnel (30). Depending on severity, PLC injuries may be treated conservatively or surgically. She also consented to undergo any additional repairs or reconstructions that were deemed necessary during the exam under anesthesia and arthroscopic evaluation. When grade III injuries to the PLC can be diagnosed acutely, direct anatomic repair of all injured structures within 3 weeks offers the most optimal results. Modular Anatomic Reconstruction Market, by Product Type (Implants, Graft Materials and Others), by Location (Hip, Knee, Shoulder, Elbow, Foot & Ankle and Hand & Wrist and Others), by End User (Hospital, Surgical Centers/ Ambulatory Surgical Centers and Orthopedic Hospitals) and by Region (North America, Latin America, Europe, Asia Pacific, Middle East, and Africa) – Size, …
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