1. Anatomic Posterolateral Corner Reconstruction Using a Fibula Cross-Tunnel Technique: A Cadaveric Biomechanical Study
- Author
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Akash Gupta, Thay Q. Lee, Yu-Jen Chen, Ryan J. Quigley, Michelle H. McGarry, Hideya Ishigooka, Sean T. Campbell, and Christopher N.H. Bui
- Subjects
medicine.medical_specialty ,Knee Joint ,Rotation ,Knee flexion ,Knee Injuries ,Transplantation, Autologous ,Tendons ,03 medical and health sciences ,0302 clinical medicine ,Cadaver ,Load to failure ,medicine ,Posterolateral corner ,Humans ,Orthopedics and Sports Medicine ,Range of Motion, Articular ,Fibula ,Aged ,030222 orthopedics ,business.industry ,030229 sport sciences ,Middle Aged ,Biomechanical Phenomena ,Surgery ,Tendon ,medicine.anatomical_structure ,External rotation ,Ligaments, Articular ,business ,Cadaveric spasm ,Nuclear medicine - Abstract
Purpose To compare the biomechanical properties of a fibula cross-tunnel technique for posterolateral corner (PLC) reconstruction with those of intact knees. Methods Seven fresh-frozen cadaveric knees were tested while intact, after PLC tear, and after reconstruction. Testing of the parameters listed above was performed at 0°, 30°, 60°, and 90° of knee flexion. Reconstruction was performed using 2 independent tendon autografts. Afterward, the fibula and graft were loaded to failure. Results Reconstruction restored external rotation (0°: 11.75° ± 2.02° to 9.81° ± 1.81°, P = .57; 30°: 17.91° ± 1.32° to 13.96° ± 2.84°, P = .12; 60°: 15.86° ± 1.68° to 13.26° ± 3.58°, P = .41; 90°: 15.53° ± 1.62° to 14.07° ± 2.95°, P = .54) to the intact state, and posterior translation (0°: 3.66 ± 0.85 mm to 3.31 ± 0.89 mm, P = .87; 60°: 3.15 ± 0.45 mm to 2.96 ± 0.45 mm, P = .73; 90°: 2.74 ± 0.33 mm to 3.05 ± 0.41 mm, P = .41) and varus angulation (0°: 0.92° ± 0.35° to 1.98° ± 0.42°, P = .55; 30°: 2.65° ± 0.27° to 1.09° ± 0.90°, P = .37; 90°: 4.29° ± 0.44° to 2.53° ± 1.13°, P = .19) under most conditions. During load to failure testing, the construct revealed properties similar to those of native structures (yield load: 330.4 ± 45.8 N; ultimate load: 420.9 ± 37.4 N). Conclusions This technique restored external rotation to the intact state after PLC injury in all testing conditions, as well as posterior translation at 0°, 60°, and 90° of flexion, and varus angulation under all conditions tested except 60° of flexion. Clinical Relevance Clinically, this surgical technique may eliminate the need for a tibial tunnel for posterolateral corner reconstruction.
- Published
- 2016