Arthroscopic popliteus bypass graft for posterolateral instabilities of the knee : A new surgical technique

Autor: C. Pahl, A. Preiss, R. Akoto, M. Heitmann, Karl-Heinz Frosch, T. Drenck
Rok vydání: 2015
Předmět:
Adult
Joint Instability
Male
medicine.medical_specialty
Knee Joint
Posterolaterale Ecke
Posterior Cruciate Ligament Reconstruction
Arthroplasty
03 medical and health sciences
0302 clinical medicine
Hinteres Kreuzband
medicine
Humans
Posterior cruciate ligament
Orthopedics and Sports Medicine
Knee
Longitudinal Studies
Posterolaterale Instabilität
Range of Motion
Articular
Muscle
Skeletal
Knie
030222 orthopedics
business.industry
Operative Techniken
Soft tissue
Hand surgery
030229 sport sciences
Recovery of Function
Sulcus
Plastic Surgery Procedures
musculoskeletal system
Combined Modality Therapy
Popliteus tendon
Brace
Posterolateral corner
Popliteussehne
Surgery
Posterolateral instability
Plastic surgery
medicine.anatomical_structure
Treatment Outcome
Orthopedic surgery
Female
Range of motion
business
Zdroj: Operative Orthopadie Und Traumatologie
ISSN: 1439-0981
Popis: 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.
Databáze: OpenAIRE
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