Modified Laprade posterolateral complex reconstruction combined with arthroscopic reconstruction of posterior cruciate ligament_West China Medical Journal

Authors：

ZHOU Peng , LIU Juncai , DENG Xiangtian , YANG Shuncheng , SU Zhiyuan , AO Yunong , DENG Fuyuan ,  LI Zhong

Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

LI Zhong, Email: 545890312@qq.com

Keywords：

Posterior cruciate ligament; Posterolateral complex; Popliteal tendon; Simultaneous reconstruction

DOI：

10.7507/1002-0179.201908036

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Objective To study the anatomic reconstruction method of posterolateral complex (PLC) in combination injury of posterior cruciate ligament (PCL) and PLC of knee, and explore its early clinical effect. Methods A total of 16 patients (10 males and 6 females) with PCL and PLC injuries admitted to the Affiliated Hospital of Southwest Medical University between January 2017 and January 2019 were retrospectively analyzed. The PCL was reconstructed with artificial ligament under arthroscopy, and autologous semitendinosus and gracilis muscles were used to reconstruct the PLC using the modified Laprade procedure. We measured the tibia posterior displacement on stress radiographs, lateral compartment gapping on varus stress radiographs, external rotation angle of tibia, and range of motion (ROM) of knee before and after operation, observed and recorded the postoperative complications, and evaluated the joint function according to the score of International Knee Documentation Committee (IKDC) and Lysholm Knee score before and after operation. Results All the 16 patients were followed up for 12 to 25 months, with an average of 17 months. The stress radiographs at the last follow-up showed that the tibia posterior displacement [(18.42±4.93) vs. (3.63±2.37) mm], lateral compartment gapping [(13.70±3.19) vs. (3.28±1.89) mm], external tibial rotation at 30° and 90° of flexion [30°: (14.75±2.84) vs. (2.44±2.06)°; 90°: (15.94±2.52) vs. (2.72±2.14)°] were significantly reduced compared with those before surgery. Lysholm score (45.42±10.94 vs. 85.19±7.11) and IKDC grade were obviously improved compared with those before surgery. All the above indicators showed statistically significant differences (P<0.05). The postoperative ROMs of knees of 13 patients returned to normal, and 0-10° flexural function was limited in 3 patients. None of the patients suffered from infection, loose internal fixation, nerve injury, or other complications. Conclusion Modified Laprade PLC reconstruction combined with arthroscopic reconstruction of PCL can effectively restore the posterior and posterolateral rotatory stability of the knee, and is worthy of clinical promotion.

Citation： ZHOU Peng, LIU Juncai, DENG Xiangtian, YANG Shuncheng, SU Zhiyuan, AO Yunong, DENG Fuyuan, LI Zhong. Modified Laprade posterolateral complex reconstruction combined with arthroscopic reconstruction of posterior cruciate ligament. West China Medical Journal, 2019, 34(9): 974-979. doi: 10.7507/1002-0179.201908036 Copy

1.	Larsen MW, Alison T. Examination of posterolateral corner injuries. J Knee Surg, 2005, 18(2): 146-150.
2.	Arthur A, LaPrade RF, Agel J. Proximal tibial opening wedge osteotomy as the initial treatment for chronic posterolateral corner deficiency in the varus knee: a prospective clinical study. Am J Sports Med, 2007, 35(11): 1844-1850.
3.	Harner CD, Vogrin TM, Höher J, et al. Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med, 2000, 28(1): 32-39.
4.	Noyes FR, Barber-Westin SD. Posterior cruciate ligament revision reconstruction, part 1: causes of surgical failure in 52 consecutive operations. Am J Sports Med, 2005, 33(5): 646.
5.	Sekiya JK, Haemmerle MJ, Stabile KJ, et al. Biomechanical analysis of a combined double-bundle posterior cruciate ligament and posterolateral corner Reconstruction. Am J Sports Med, 2005, 33(3): 360-369.
6.	Lee DY, Park YJ, Kim DH, et al. The role of isolated posterior cruciate ligament reconstruction in knees with combined posterior cruciate ligament and posterolateral complex injury. Knee Surg Sports Traumatol Arthrosc, 2018, 26(9): 2669-2678.
7.	Hefti E, Müller W, Jakob RP, et al. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc, 1993, 1(3/4): 226-234.
8.	Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
9.	Gollehon DL, Torzilli PA, Warren RF. The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study. J Bone Joint Surg Am, 1987, 69(2): 233-242.
10.	Grood ES, Stowers SF, Noyes FR. Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am, 1988, 70(1): 88-97.
11.	Rosas HG. Unraveling the posterolateral corner of the knee. Radiographics, 2016, 36(6): 1776-1791.
12.	Watanabe Y, Moriya H, Takahashi K, et al. Functional anatomy of the posterolateral structures of the knee. Arthroscopy, 1993, 9(1): 57-62.
13.	LaPrade RF, Ly TV, Wentorf FA, et al. The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med, 2003, 31(6): 854-860.
14.	Sanchez ARI, Sugalski MT, LaPrade RF. Anatomy and biomechanics of the lateral side of the knee. Sports Med Arthrosc Rev, 2006, 14(1): 2-11.
15.	俞芳, 周益昭, 李康华, 等. 膝关节后交叉韧带损伤对侧副韧带生物力学的影响. 中国组织工程研究与临床康复, 2011, 15(37): 6887-6890.
16.	高石军. 人膝关节后外侧角生物力学和重建的临床应用研究. 石家庄: 河北医科大学, 2010.
17.	Harner CD, Höher J, Vogrin TM, et al. The effects of a popliteus muscle load on in situ forces in the posterior cruciate ligament and on knee kinematics. A human cadaveric study. Am J Sports Med, 1998, 26(5): 669-673.
18.	Fanelli GC, Larson RV. Practical management of posterolateral instability of the knee. Arthroscopy, 2002, 18(2, 1): 1-8.
19.	Cartwright-Terry M, Yates J, Tan CK, et al. Medium-term (5-year) comparison of the functional outcomes of combined anterior cruciate ligament and posterolateral corner reconstruction compared with isolated anterior cruciate ligament reconstruction. Arthroscopy, 2014, 30(7): 811-817.
20.	Petrillo S, Volpi P, Papalia R, et al. Management of combined injuries of the posterior cruciate ligament and posterolateral corner of the knee: a systematic review. Br Med Bull, 2017, 123(1): 47-57.
21.	Stannard JP, Brown SL, Farris RC, et al. The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med, 2005, 33(6): 881-888.
22.	Geeslin AG, Moulton SG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, Part 1: surgical treatment of acute injuries. Am J Sports Med, 2016, 44(5): 1336-1342.
23.	Moulton SG, Geeslin AG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, Part 2: surgical treatment of chronic injuries. Am J Sports Med, 2016, 44(6): 1616-1623.
24.	Baker CL Jr, Norwood LA, Hughston JC. Acute combined posterior cruciate and posterolateral instability of the knee. Am J Sports Med, 1984, 12(3): 204-208.
25.	Westermann RW, Spindler KP, Huston LJ, et al. Posterolateral corner repair versus reconstruction: 6-year outcomes from a prospective multicenter cohort. Orthopaedic J Sports Med, 2017, 5(7 Suppl 6).
26.	Stannard JP, Stannard JT, Cook JL. Repair or reconstruction in acute posterolateral instability of the knee: decision making and surgical technique introduction. J Knee Surg, 2015, 28(6): 450-454.
27.	Noyes FR, Barber-Westin SD. Posterolateral knee reconstruction with an anatomical bone-patellar tendon-bone reconstruction of the fibular collateral ligament. Am J Sports Med, 2007, 35(2): 259.
28.	Fanelli GC, Fanelli DG, Edson CJ, et al. Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries. J Knee Surg, 2014, 27(5): 353-358.
29.	Niki Y, Matsumoto H, Otani T, et al. A modified Larson’s method of posterolateral corner reconstruction of the knee reproducing the physiological tensioning pattern of the lateral collateral and popliteofibular ligaments. Sports Med Arthrosc Rehabil Ther Technol, 2012, 4(1): 21.
30.	LaPrade RF, Johansen S, Agel J, et al. Outcomes of an anatomic posterolateral knee reconstruction. J Bone Joint Surg Am, 2010, 92(1): 16-22.
31.	叶俊武. 膝关节后外侧复合体重建术的应用解剖学及腘肌腱、外侧副韧带的生物力学研究. 成都: 四川大学, 2006.
32.	赵金忠. 关节镜下自体肌腱和同种异体肌腱一期重建治疗膝关节多发韧带损伤. 中医正骨, 2014, 26(4): 61-62.
33.	李欢, 高桂英, 严伟洪, 等. 改良Laprade法重建膝关节后外侧角的初步临床应用. 中国骨与关节损伤杂志, 2014, 29(8): 826-827.

1. Larsen MW, Alison T. Examination of posterolateral corner injuries. J Knee Surg, 2005, 18(2): 146-150.
2. Arthur A, LaPrade RF, Agel J. Proximal tibial opening wedge osteotomy as the initial treatment for chronic posterolateral corner deficiency in the varus knee: a prospective clinical study. Am J Sports Med, 2007, 35(11): 1844-1850.
3. Harner CD, Vogrin TM, Höher J, et al. Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med, 2000, 28(1): 32-39.
4. Noyes FR, Barber-Westin SD. Posterior cruciate ligament revision reconstruction, part 1: causes of surgical failure in 52 consecutive operations. Am J Sports Med, 2005, 33(5): 646.
5. Sekiya JK, Haemmerle MJ, Stabile KJ, et al. Biomechanical analysis of a combined double-bundle posterior cruciate ligament and posterolateral corner Reconstruction. Am J Sports Med, 2005, 33(3): 360-369.
6. Lee DY, Park YJ, Kim DH, et al. The role of isolated posterior cruciate ligament reconstruction in knees with combined posterior cruciate ligament and posterolateral complex injury. Knee Surg Sports Traumatol Arthrosc, 2018, 26(9): 2669-2678.
7. Hefti E, Müller W, Jakob RP, et al. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc, 1993, 1(3/4): 226-234.
8. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
9. Gollehon DL, Torzilli PA, Warren RF. The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study. J Bone Joint Surg Am, 1987, 69(2): 233-242.
10. Grood ES, Stowers SF, Noyes FR. Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am, 1988, 70(1): 88-97.
11. Rosas HG. Unraveling the posterolateral corner of the knee. Radiographics, 2016, 36(6): 1776-1791.
12. Watanabe Y, Moriya H, Takahashi K, et al. Functional anatomy of the posterolateral structures of the knee. Arthroscopy, 1993, 9(1): 57-62.
13. LaPrade RF, Ly TV, Wentorf FA, et al. The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med, 2003, 31(6): 854-860.
14. Sanchez ARI, Sugalski MT, LaPrade RF. Anatomy and biomechanics of the lateral side of the knee. Sports Med Arthrosc Rev, 2006, 14(1): 2-11.
15. 俞芳, 周益昭, 李康华, 等. 膝关节后交叉韧带损伤对侧副韧带生物力学的影响. 中国组织工程研究与临床康复, 2011, 15(37): 6887-6890.
16. 高石军. 人膝关节后外侧角生物力学和重建的临床应用研究. 石家庄: 河北医科大学, 2010.
17. Harner CD, Höher J, Vogrin TM, et al. The effects of a popliteus muscle load on in situ forces in the posterior cruciate ligament and on knee kinematics. A human cadaveric study. Am J Sports Med, 1998, 26(5): 669-673.
18. Fanelli GC, Larson RV. Practical management of posterolateral instability of the knee. Arthroscopy, 2002, 18(2, 1): 1-8.
19. Cartwright-Terry M, Yates J, Tan CK, et al. Medium-term (5-year) comparison of the functional outcomes of combined anterior cruciate ligament and posterolateral corner reconstruction compared with isolated anterior cruciate ligament reconstruction. Arthroscopy, 2014, 30(7): 811-817.
20. Petrillo S, Volpi P, Papalia R, et al. Management of combined injuries of the posterior cruciate ligament and posterolateral corner of the knee: a systematic review. Br Med Bull, 2017, 123(1): 47-57.
21. Stannard JP, Brown SL, Farris RC, et al. The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med, 2005, 33(6): 881-888.
22. Geeslin AG, Moulton SG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, Part 1: surgical treatment of acute injuries. Am J Sports Med, 2016, 44(5): 1336-1342.
23. Moulton SG, Geeslin AG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, Part 2: surgical treatment of chronic injuries. Am J Sports Med, 2016, 44(6): 1616-1623.
24. Baker CL Jr, Norwood LA, Hughston JC. Acute combined posterior cruciate and posterolateral instability of the knee. Am J Sports Med, 1984, 12(3): 204-208.
25. Westermann RW, Spindler KP, Huston LJ, et al. Posterolateral corner repair versus reconstruction: 6-year outcomes from a prospective multicenter cohort. Orthopaedic J Sports Med, 2017, 5(7 Suppl 6).
26. Stannard JP, Stannard JT, Cook JL. Repair or reconstruction in acute posterolateral instability of the knee: decision making and surgical technique introduction. J Knee Surg, 2015, 28(6): 450-454.
27. Noyes FR, Barber-Westin SD. Posterolateral knee reconstruction with an anatomical bone-patellar tendon-bone reconstruction of the fibular collateral ligament. Am J Sports Med, 2007, 35(2): 259.
28. Fanelli GC, Fanelli DG, Edson CJ, et al. Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries. J Knee Surg, 2014, 27(5): 353-358.
29. Niki Y, Matsumoto H, Otani T, et al. A modified Larson’s method of posterolateral corner reconstruction of the knee reproducing the physiological tensioning pattern of the lateral collateral and popliteofibular ligaments. Sports Med Arthrosc Rehabil Ther Technol, 2012, 4(1): 21.
30. LaPrade RF, Johansen S, Agel J, et al. Outcomes of an anatomic posterolateral knee reconstruction. J Bone Joint Surg Am, 2010, 92(1): 16-22.
31. 叶俊武. 膝关节后外侧复合体重建术的应用解剖学及腘肌腱、外侧副韧带的生物力学研究. 成都: 四川大学, 2006.
32. 赵金忠. 关节镜下自体肌腱和同种异体肌腱一期重建治疗膝关节多发韧带损伤. 中医正骨, 2014, 26(4): 61-62.
33. 李欢, 高桂英, 严伟洪, 等. 改良Laprade法重建膝关节后外侧角的初步临床应用. 中国骨与关节损伤杂志, 2014, 29(8): 826-827.

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Modified Laprade posterolateral complex reconstruction combined with arthroscopic reconstruction of posterior cruciate ligament

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