Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleKinematics of Different Components of the Posterolateral Corner of the Knee in the Lateral Collateral Ligament-intact State: A Human Cadaveric Study
Section snippets
Specimen Preparation
Thirteen fresh-frozen human cadaveric knees were tested (median age: 57 years; range: 45-90 years, 5 female and 8 male specimens, 6 right and 7 left knees). Specimens were obtained from the MedCure anatomical tissue bank (MedCure, Portland, OR). No ethics approval for human cadaveric studies was required by the institutional review board of our institute. The knees were stored at –20°C before testing and thawed for 24 hours at room temperature.22, 23 Specimens were evaluated for the excluding
Results
None of the 13 specimens had to be excluded. The results are illustrated in Figure 3 and Table 1. Raw mean values and standard deviations are demonstrated in Appendix Table 1 (available at www.arthroscopyjournal.org). None of the released structures had a significant influence on valgus, internal rotatory, and anterior drawer stability. The results are summarized in the following text (values are rounded to full numbers).
Discussion
The most important finding of this study is that the different structures of the AC (including the PFL) secure the static function of the PLT complex. Without these fibers and ligaments, the static stabilizing function of the PLT is almost lost. This leads primary to an increased external rotatory instability and secondary to an increased PTT instability in a state with a concomitant deficient PCL and an intact LCL. Furthermore, the results of this study show that in the state of an intact LCL
Conclusions
The connecting ligaments/fibers to the PLT act as a primary static stabilizer against external rotatory loads and a secondary stabilizer against posterior tibial loads (when PCL is injured). After releasing these structures, most static stabilizing function of the intact PLT is lost. The PLC has no varus-stabilizing function in the LCL-intact knee.
Acknowledgment
C.D. was supported by a research fellowship from the Faculty of Medicine, Westphalian Wilhelms University Muenster. T.C.D. was supported by a research fellowship from Asklepios Clinic Group. Human cadaveric specimens were donated by Arthrex.
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Cited by (39)
Comparison of extended lateral approaches to the tibial plateau: The articular exposure of lateral epicondyle osteotomy with and without popliteus tendon vs. fibula osteotomy
2020, InjuryCitation Excerpt :Instead, with the lateral femoral epicondyle osteotomy, ligamentous isometry of the posterolateral corner could easily be restored by simply reducing the alternatively osteotomized femoral LCL and/or PLT attachments [17]. While the LCL acts as the main stabilizer of the knee joint against varus stress, biomechanical studies have proven that the PLT stabilizes the knee not only against external rotation but also functions as an agonist to the LCL [28]. Therefore, to increase the visibility of lateral articular surface, the additional detachment of the femoral PLT along with the LCL has been proposed [1].
Applied anatomy and three-dimensional visualization of the tendon-bone junctions of the knee joint posterolateral complex
2020, Annals of AnatomyCitation Excerpt :Crespo et al., 2015) Many related studies have investigated anatomy, biomechanics and surgical procedures of the knee joint PLC (Devitt and Whelan, 2015b; Kang et al., 2019; Kim et al., 2011; Porrino et al., 2018; Rosas, 2016; Song et al., 2018; Thaunat et al., 2014). Great progress also has been made in the diagnosis, treatment and reconstruction of PLC injuries (Dilworth et al., 2018; Domnick et al., 2017; Ho et al., 2011; LaPrade et al., 2000; LaPrade and Terry, 1997; Serra Cruz et al., 2016; Vega-Espana et al., 2017; Yoon et al., 2011). Regarding PLC reconstruction surgery, the selection of the tunnel position is very important.
An All-Arthroscopic Technique for Complex Posterolateral Corner Reconstruction
2019, Arthroscopy TechniquesCitation Excerpt :In this article, we present an all-arthroscopic technique for anatomic PLC reconstruction for the first time. Numerous open fixation techniques have been described before.6,7,9,10 In open fixation techniques, detailed exposure of the anatomic landmarks is necessary and is therefore naturally accompanied by soft-tissue damage.
The Clinical Outcome of Arthroscopic Versus Open Popliteal Tendon Reconstruction Combined With Posterior Cruciate Ligament Reconstruction in Patients With Type A Posterolateral Rotational Instability
2019, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :Thus, reconstruction of the PT may also have a role in the prevention of graft failure after PCL reconstruction.17 Because of the imperative function of PT as the restraint of external rotation and PTT, the reconstruction of PT has proved beneficial.3,7,18,19 A consensus has been reached that isolated PT reconstruction is indicated in cases of posterolateral knee injuries with a primary external rotation instability pattern where varus rotation is minimally affected.3,7,19,20
See commentary on page 1831
C.D. and K-H.F. contributed equally to this work.
The authors report the following potential conflicts of interest or sources of funding: K-H.F. receives support from Arthrex. M.J.R. receives support from Depuy-Synthes, MSD, Marquardt, Nexilis, and Implantcast. M.H. receives support from Karl Storz, Mathys, and Conmed-Linvatec.