Comparison of posterolateral corner reconstructions using computer-assisted navigation.

摘要

PURPOSE: This study evaluated different fibular-based reconstruction techniques for grade III posterolateral corner (PLC) injuries. METHODS: Seven fresh-frozen cadaveric knees were used in this study. A surgical navigation system was used to determine varus opening and external rotation at 0 degrees , 30 degrees , and 60 degrees with a 9.8-Nm varus stress and 5-Nm external rotation stress applied to the tibia. Intact and disrupted PLC knees were used as controls. Four different fibular-based reconstruction techniques were evaluated. The femoral attachments consisted of a single- or double-tunnel technique, and the fibula attachment consisted of an anteroposterior or oblique tunnel technique. RESULTS: Sectioning of the PLC resulted in an increase in varus and external rotation at all flexion angles. All reconstruction techniques restored varus and external rotation stability compared with the PLC-deficient state, but the single-femoral tunnel reconstruction with an anteroposterior fibular tunnel did not restore varus or external rotation stability at 30 degrees and 60 degrees . No reconstruction technique overconstrained the knee at any flexion angle. CONCLUSIONS: A double femoral tunnel with an oblique fibular tunnel best restored native knee kinematics to the lateral side of the knee. CLINICAL RELEVANCE: Although there are many different techniques to reconstruct the PLC-deficient knee, this study suggests that a single-graft, fibular-based reconstruction that replicates the femoral insertions of the lateral collateral ligament and popliteus will be able to restore varus and external rotation stability to the knee.