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Helal A, Marei AE, Shafik A, Elforse E. Clinical and radiological outcomes of a modified anatomic posterolateral corner reconstruction technique using a single semitendinosus autograft. Arch Orthop Trauma Surg 2023; 143:5767-5776. [PMID: 37140604 PMCID: PMC10449660 DOI: 10.1007/s00402-023-04862-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/26/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE We aimed to assess the clinical and radiological outcomes of a modified anatomical posterolateral corner (PLC) reconstruction technique using a single autograft. METHODS This prospective case series included 19 patients with a posterolateral corner injury. The posterolateral corner was reconstructed using a modified anatomical technique that utilized adjustable suspensory fixation on the tibial side. Patients were evaluated subjectively using the international knee documentation form (IKDC), Lysholm, and Tegner activity scales and objectively by measuring the tibial external rotation angle, knee hyperextension, and lateral joint line opening on stress varus radiographs before and after surgery. The patients were followed-up for a minimum of 2 years. RESULTS Both IKDC and Lysholm knee scores significantly improved from 49 and 53 preoperatively to 77 and 81 postoperatively, respectively. The tibial external rotation angle and knee hyperextension showed significant reduction to normal values at the final follow-up. However, the lateral joint line opening measured on the varus stress radiograph remained larger than the contralateral normal knee. CONCLUSION Posterolateral corner reconstruction with a hamstring autograft using a modified anatomical reconstruction technique significantly improved both the subjective patient scores and objective knee stability. However, the varus stability was not completely restored compared with the uninjured knee. LEVEL OF EVIDENCE Prospective case series (Level of evidence IV).
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Affiliation(s)
- Ahmed Helal
- Department of Orthopaedics, Tanta Faculty of Medicine, Tanta University, El-Gash St. Medical Campus, Tanta, El-Gharbia Governorate, Egypt.
| | - Abdelhakim E Marei
- Department of Orthopaedics, Tanta Faculty of Medicine, Tanta University, El-Gash St. Medical Campus, Tanta, El-Gharbia Governorate, Egypt
| | - Ahmed Shafik
- Department of Orthopaedics, Tanta Faculty of Medicine, Tanta University, El-Gash St. Medical Campus, Tanta, El-Gharbia Governorate, Egypt
| | - Elsayed Elforse
- Department of Orthopaedics, Tanta Faculty of Medicine, Tanta University, El-Gash St. Medical Campus, Tanta, El-Gharbia Governorate, Egypt
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Arora M, Shukla T. Peroneus Longus Graft Harvest: A Technique Note. Indian J Orthop 2023; 57:611-616. [PMID: 37006731 PMCID: PMC10050498 DOI: 10.1007/s43465-023-00847-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/12/2023] [Indexed: 03/30/2023]
Abstract
Multiple graft options are available for knee ligament surgeries, one of the latest being peroneus longus grafts. Despite, an increasing usage of PL for graft harvest there is a scarcity of technique guides for its harvest, finding mention in only a few case studies. The following is a technical note dedicated to peroneous longus graft harvest. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-023-00847-0.
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Affiliation(s)
- Manit Arora
- Department of Orthopaedics, Fortis Hospital, Sector 62, Jail Road, Mohali, 160062 Punjab India
| | - Tapish Shukla
- Department of Orthopaedics, Fortis Hospital, Sector 62, Jail Road, Mohali, 160062 Punjab India
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Vivacqua T, Vakili S, Willing R, Moatshe G, Degen R, Getgood AM. Biomechanical Assessment of Knee Laxity After a Novel Posterolateral Corner Reconstruction Technique. Am J Sports Med 2022; 50:962-967. [PMID: 35099324 DOI: 10.1177/03635465211070553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Different techniques to restore knee stability after posterolateral corner (PLC) injury have been described. The original anatomic PLC reconstruction uses 2 separate allografts to reconstruct the PLC. Access to allograft tissue continues to be a significant limitation of this technique, which led to the development of a modified anatomic approach utilizing a single autologous semitendinosus graft fixed on the tibia with an adjustable suspensory loop to enable differential tensioning of the PLC components. PURPOSE/HYPOTHESIS The purpose of this study was to compare the modified anatomic technique with the original anatomic reconstruction in terms of varus and external rotatory laxity in a cadaveric biomechanical model. The hypothesis was that both techniques would restore varus and external rotatory laxity after a simulated complete PLC injury. STUDY DESIGN Controlled laboratory study. METHODS Eight pairs of fresh-frozen cadaveric knee specimens were tested to compare the 2 techniques. Varus and external tibial rotation laxity of the knee were measured while applying 10-N·m varus and 5-N·m external rotatory torques at 0°, 30°, 60°, and 90° of flexion. These measurements were tested under 3 conditions: (1) intact fibular collateral ligament, popliteal tendon, and popliteofibular ligament; (2) complete transection of the fibular collateral ligament, popliteal tendon, and popliteofibular ligament; (3) after PLC reconstruction with either the modified (n = 8) or the original (n = 8) technique. RESULTS After PLC reconstruction, varus laxity was restored with no statistically significant differences from the intact condition after both reconstruction techniques. Similar outcomes were observed for external rotation in extension; however, in terms of the external rotation limit with respect to the intact joint, significant reductions of mean ± SD 4.1°± 6.3° (P = .036) and 5.1°± 6.6° (P = .016) were recorded with the modified technique at 60° and 90° of flexion, respectively. No significant effect was observed on the neutral flexion kinematics from 0° to 90° of flexion, and no significant differences were observed between reconstructions (P = .222). CONCLUSION Both PLC reconstruction techniques restored the normal native varus as compared with the intact knee. Although the modified technique constrained end-range external rotation at 60° and 90° of flexion, no differences were noted with neutral flexion kinematics. Care should be taken when tensioning in the modified technique so that the tibia is in a neutral position to avoid overconstraining the knee. CLINICAL RELEVANCE The modified technique may prove useful in situations where there are limited graft options, particularly where allografts are not available or are restricted.
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Affiliation(s)
- Thiago Vivacqua
- Fowler Kennedy Sports Medicine Clinic, London, Ontario, Canada
| | | | | | - Gilbert Moatshe
- Fowler Kennedy Sports Medicine Clinic, London, Ontario, Canada.,Orthopaedic Division, Oslo University Hospital, and University of Oslo, Oslo, Norway.,OSTRC, Norwegian School of Sports Sciences, Oslo, Norway
| | - Ryan Degen
- Fowler Kennedy Sports Medicine Clinic, London, Ontario, Canada.,Western University, London, Canada
| | - Alan M Getgood
- Fowler Kennedy Sports Medicine Clinic, London, Ontario, Canada.,Western University, London, Canada.,Robarts Research Institute, London, Canada
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He J, Byrne K, Ueki H, Kanto R, Linde MA, Smolinski P, Wu S, Fu F. Low to moderate risk of nerve damage during peroneus longus tendon autograft harvest. Knee Surg Sports Traumatol Arthrosc 2022; 30:109-115. [PMID: 34498132 DOI: 10.1007/s00167-021-06698-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aims to evaluate the proximity of the tendon stripper to both the peroneal and sural nerves during peroneus longus tendon (PLT) autograft harvesting. METHODS Ten fresh-frozen human cadaveric lower extremities were used to harvest a full-thickness PLT autograft using a standard closed blunt-ended tendon stripper. The distance to the sural nerve from the PLT (at 0, 1, 2 and 3 cm proximal to lateral malleolus (LM), and the distance to the peroneal nerve and its branches from the end of the tendon stripper were measured by two separate observers using ImageJ software. RESULTS The average distance from the PLT to the sural nerve increased significantly from 0 to 2 cm proximal to LM. The average distance to the sural nerve at the LM was 4.9 ± 1.5 mm and increased to 10.8 ± 2.4 mm (2 cm proximal to LM). The average distance from the tendon stripper to the deep peroneal nerve was 52.9 ± 11.4 mm. The average distance to the PLT branch of peroneal nerve was 29.3 ± 4.2 mm. The superficial peroneal nerve, which coursed parallel and deep to the tendon stripper, was on average 5.2 ± 0.7 mm from the end of the stripper. No transection injuries of the nerves were observed in any of the ten legs after harvesting. CONCLUSION This cadaver study found during a full-thickness PLT harvest, the distances between the tendon stripper and the nerves were greater than 5 mm with an initial incision at 2 cm proximal to LM which is recommended.
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Affiliation(s)
- Jinshen He
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.,Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Kevin Byrne
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Hiroko Ueki
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Ryo Kanto
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Monica A Linde
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Patrick Smolinski
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.,Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Song Wu
- Department of Orthopaedic Surgery, Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Freddie Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA. .,Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
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Peroneus longus tendon autograft has functional outcomes comparable to hamstring tendon autograft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2869-2879. [PMID: 32984919 DOI: 10.1007/s00167-020-06279-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE This review aimed to assess whether peroneus longus tendon (PLT) autograft would have comparable functional outcomes and graft survival rates when compared to hamstring tendon (HT) autograft for anterior cruciate ligament (ACL) reconstruction. METHODS PubMed, Web of Science, Cochrane Library, Ovid (MEDICINE), and EMBASE databases were queried for original articles from clinical studies including the keywords: ACL reconstruction and PLT autograft. Studies comparing PLT autograft versus HT autograft were included in this analysis and the following data were extracted from studies meeting the inclusion criteria: graft diameter, functional outcomes (Tegner activity scale, Lysholm score, and International Knee Documentation Committee (IKDC) subjective score), knee laxity (Lachman test), and complications (donor site pain or paresthesia, graft failure). Besides, the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the Foot and Ankle Disability Index (FADI) pre-operation and at last follow-up were also compared among patients using PLT autograft. Meta-analysis was applied using Review Manager 5.3 and p < 0.05 was considered statistically significant. RESULTS Twenty-three studies including 925 patients with ACL reconstruction met inclusion criteria. Of these, 5 studies included a direct comparison of PLT autograft (164 patients) versus HT autograft (174 patients). No significant difference was observed between PLT and HT autografts for Tegner activity scale, Lachman test, donor site pain, or graft failure. However, PLT groups demonstrated better Lysholm score (mean difference between PLT and HT groups, 1.55; 95% CI 0.20-2.89; p = 0.02) and IKDC subjective score (mean difference between PLT and HT groups, 3.24; 95% CI 0.29-6.19; p = 0.03). No difference of FADI was found (n.s.) but AOFAS was slightly decreased at last post-operative follow-up for patients with PLT autograft compared with pre-operative scores (mean difference of 0.31, 95% CI 0.07-0.54, p = 0.01). CONCLUSION PLT autograft demonstrated comparable functional outcomes and graft survival rates compared with HT autograft for ACL reconstruction. However, a slight decrease in AOFAS score should be considered during surgical planning. Hence, the PLT is a suitable autograft harvested outside the knee for ACL reconstruction to avoid the complication of quadriceps-hamstring imbalance which can occur when harvesting autografts from the knee. LEVEL OF EVIDENCE Level II.
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Richter DL, Held M, Campos T, Wascher DC, Schenck RC. The Management of Knee Dislocations in the Limited-Resource Setting. J Bone Joint Surg Am 2020; 102:e136. [PMID: 33060423 DOI: 10.2106/jbjs.20.00743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Michael Held
- University of Cape Town, Cape Town, South Africa
| | - Túlio Campos
- Federal University of Minas Gerais, Belo Horizonte, Brazil
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