Arthroscopic popliteus bypass graft for posterolateral instabilities of the knee
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Arthroscopic popliteus bypass graft for posterolateral instabilities of the knee : A new surgical technique. / Frosch, K-H; Akoto, R; Drenck, T; Heitmann, M; Pahl, C; Preiss, A.
In: OPER ORTHOP TRAUMATO, Vol. 28, No. 3, 06.2016, p. 193-203.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Arthroscopic popliteus bypass graft for posterolateral instabilities of the knee
T2 - A new surgical technique
AU - Frosch, K-H
AU - Akoto, R
AU - Drenck, T
AU - Heitmann, M
AU - Pahl, C
AU - Preiss, A
PY - 2016/6
Y1 - 2016/6
N2 - OBJECTIVE: An arthroscopic technique for the reconstruction of the posterolateral corner combined with posterior cruciate ligament (PCL) reconstruction was developed.INDICATIONS: Posterolateral rotational instabilities of the knee. Combined lesions of the PCL, the popliteus complex (PLT) and the posterolateral corner. Isolated PLT lesions lacking static stabilizing function.CONTRAINDICATIONS: Neuromuscular disorders; knee deformities or fractures; severe posterolateral soft tissue damage.SURGICAL TECHNIQUE: Six arthroscopic portals are necessary. Using the posteromedial portal, resect dorsal septum with a shaver. Visualize the PCL, the lateral femoral condyle and the posterolateral recessus with the PLT. Dissect the popliteomeniscal fibers; retract PLT until sulcus popliteus is visualized. Drill a 6-mm tunnel anteriorly into the distal third of the sulcus popliteus. Visualize femoral footprint of the PLT and place an anatomical drill tunnel. Pull the popliteus bypass graft into the knee and fix with bioscrews. Fix the reconstructed PCL. In cases of additional LCL injury, reconstruct LCL with autologous graft.POSTOPERATIVE MANAGEMENT: Partial weight-bearing for 6 weeks, range of motion exercises, quadriceps-strengthening exercises on postoperative day 1. Full extension allowed immediately with flexion limited to 20° for 2 weeks, to 45° for up to week 4, and to 60° up to week 6. Use a PCL brace for 3 months, running and squatting exercises allowed after 3 months.RESULTS: In the 35 patients treated, no technique-related complications. After 1 year, 12 patients had a mean Lysholm Score of 88.6 (± 8.7) points and a side-to-side difference in the posterior drawer test of 2.9 (± 2.2) mm (preoperative 13.3 [± 1.9] mm).CONCLUSION: Low complication risk and good and excellent clinical results after arthroscopic posterolateral corner reconstruction.
AB - OBJECTIVE: An arthroscopic technique for the reconstruction of the posterolateral corner combined with posterior cruciate ligament (PCL) reconstruction was developed.INDICATIONS: Posterolateral rotational instabilities of the knee. Combined lesions of the PCL, the popliteus complex (PLT) and the posterolateral corner. Isolated PLT lesions lacking static stabilizing function.CONTRAINDICATIONS: Neuromuscular disorders; knee deformities or fractures; severe posterolateral soft tissue damage.SURGICAL TECHNIQUE: Six arthroscopic portals are necessary. Using the posteromedial portal, resect dorsal septum with a shaver. Visualize the PCL, the lateral femoral condyle and the posterolateral recessus with the PLT. Dissect the popliteomeniscal fibers; retract PLT until sulcus popliteus is visualized. Drill a 6-mm tunnel anteriorly into the distal third of the sulcus popliteus. Visualize femoral footprint of the PLT and place an anatomical drill tunnel. Pull the popliteus bypass graft into the knee and fix with bioscrews. Fix the reconstructed PCL. In cases of additional LCL injury, reconstruct LCL with autologous graft.POSTOPERATIVE MANAGEMENT: Partial weight-bearing for 6 weeks, range of motion exercises, quadriceps-strengthening exercises on postoperative day 1. Full extension allowed immediately with flexion limited to 20° for 2 weeks, to 45° for up to week 4, and to 60° up to week 6. Use a PCL brace for 3 months, running and squatting exercises allowed after 3 months.RESULTS: In the 35 patients treated, no technique-related complications. After 1 year, 12 patients had a mean Lysholm Score of 88.6 (± 8.7) points and a side-to-side difference in the posterior drawer test of 2.9 (± 2.2) mm (preoperative 13.3 [± 1.9] mm).CONCLUSION: Low complication risk and good and excellent clinical results after arthroscopic posterolateral corner reconstruction.
KW - Adult
KW - Arthroplasty
KW - Combined Modality Therapy
KW - Female
KW - Humans
KW - Joint Instability
KW - Knee Joint
KW - Longitudinal Studies
KW - Male
KW - Muscle, Skeletal
KW - Posterior Cruciate Ligament Reconstruction
KW - Range of Motion, Articular
KW - Reconstructive Surgical Procedures
KW - Recovery of Function
KW - Treatment Outcome
KW - Clinical Trial
KW - Journal Article
U2 - 10.1007/s00064-015-0432-6
DO - 10.1007/s00064-015-0432-6
M3 - SCORING: Journal article
C2 - 26637298
VL - 28
SP - 193
EP - 203
JO - OPER ORTHOP TRAUMATO
JF - OPER ORTHOP TRAUMATO
SN - 0934-6694
IS - 3
ER -