Comminuted Fibular Head Fractures With Posterolateral Knee Instability: A Novel Repair Technique Using a Tension-Slide Device

A Novel Spiked Washer and Screw Technique Provides a Biomechanically Superior Posterolateral Corner and Arcuate Fracture Repair

Posterolateral corner and arcuate fractures can cause significant disruption to the stability and kinematics of the knee. This study aimed to determine the biomechanical performance of a novel spiked washer (SW) and intramedullary screw technique compared with a tension slide technique (TST) for the repair of arcuate fractures. Sixteen matched fresh-frozen cadaver knees underwent repair. Each specimen underwent transection of the posterolateral corner and lateral capsule along with a proximal fibula osteotomy to simulate an arcuate fracture. Eight specimens underwent repair with a SW technique and 8 underwent repair with a TST. Each specimen underwent cyclic loading followed by load to failure. Gap formation, ultimate load to failure, energy to failure, and stiffness were assessed. The SW technique had significantly less gap formation and higher load to failure. Furthermore, the SW technique had significantly higher stiffness and energy to failure. A SW and screw technique provided a significantly stronger construct with less gap formation when compared with a TST. [Orthopedics. 2024;47(5):e277-e281.].

Rare Fracture Knee Dislocation Treated with Ligament Repair and Novel Arcuate Fracture Repair Technique: A Case Report

CASE

A 57-year-old man presented with a left knee dislocation after a motor vehicle collision. Clinical and imaging evaluation demonstrated disruption of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), anterolateral ligament (ALL), and posterolateral corner (PLC). The patient underwent acute, single-stage arthroscopic primary ACL and PCL repair, with arcuate fracture fixation using a novel technique. At 4 years postoperatively, he continues to do well subjectively with minimal clinical laxity.

CONCLUSION

Acute, single-stage arthroscopic primary ligamentous repair is a viable option for high-grade multiligamentous knee dislocations and may be combined with our novel technique for arcuate fracture fixation.

LEVEL OF EVIDENCE

Level IV, Case Report.

The clinical outcome of minimally invasive popliteal tendon recess procedure is comparable to arthroscopic popliteal tendon reconstruction in patients with type A posterolateral rotational instability

PURPOSE

To compare the objective and subjective clinical outcome of minimally invasive popliteal tendon (PT) recess procedure versus arthroscopic PT reconstruction, combined with posterior cruciate ligament reconstruction in patients with Type A posterolateral rotational instability (PLRI). The hypothesis was that the two techniques had comparable clinical outcomes.

METHODS

Between 2012 and 2017, patients who were eligible for inclusion in this study if they (1) had Type A PLRI according to Fanelli's classification with posterior tibial translation > 12 mm on stress radiography and side-to-side difference of dial test external rotation > 10°, (2) PT peel-off lesion or laxity with structural integrity (3) were followed for a minimum of 2 years with examination under anesthesia (EUA) and stress radiograph results. Evaluation included subjective scoring, knee stability examinations and second-look arthroscopic lateral gutter drive-through (LGDT) test. Patients who underwent PT recess procedure were designated as Group A, while patients who underwent arthroscopic PT reconstruction were labelled as Group B. The differences between the two groups were analyzed.

RESULTS

A total of 61 eligible patients with a minimum follow-up time of 2 years were evaluated in the present study. At the final follow-up, there were no significant inter-group differences in Lysholm scores (Group A: 69.0 ± 16.5, Group B: 75.8 ± 14.6, ns), Tegner scores [Group A: 2 (1-4), Group B: 3 (1-5), ns], or IKDC subjective scores (Group A: 70.5 ± 13.5, Group B: 71.1 ± 9.1, ns). No significant difference in side-to-side difference on posterior stress radiography (Group A: 4.3 ± 3.8 mm, Group B: 4.7 ± 4.6 mm, P = 0.701), dial test result (Group A: 0.9 ± 4.4°, Group B: 1.6 ± 4.9°, ns) or LGDT test positive rate (Group A: 2/34, 5.9%, Group B: 2/27, 7.7%, ns) was observed.

CONCLUSION

Both minimally invasive PT recess procedure and arthroscopic PT reconstruction significantly improved the knee stability and subjective outcome comparing with preoperative value. In a comparison with arthroscopic PT reconstruction, the recess procedure demonstrated comparable subjective and objective clinical outcome. When both PT reconstruction and PT recess procedure are indicated, the minimally invasive and graft-free recess procedure can be a viable option.

LEVEL OF EVIDENCE

III.

Classification and Treatment Strategies of Concomitant Fibular Column Injuries in Tibial Plateau Fractures

Background

About 1/3 of tibial plateau fractures are associated with proximal fibula fractures, but most proximal fibula fractures are often ignored. The aim of this study was to precisely explain the classification and treatment strategies of six injury types of the fibular column associated with tibial plateau fractures.

Methods

Patients with ipsilateral proximal fibula and tibial plateau fractures treated in our hospital were retrospectively reviewed from Aug 2007 to Mar 2020. Two experienced surgeons and two radiologists divided fibular column injury into 6 injury types according to the AO classification and four-column nine-segment classification. The treatment scheme (surgically treated or conservatively treated) was also recorded.

Results

In total, 355 proximal fibula fractures were included. Type 2 fibular head fracture was the most common type of injury in 122, and the segregate of superior tibiofibular syndesmosis was the rarest type in 3. In avulsion injury proximal of fibular pattern, the proportion of patients who need surgical intervention is the highest.

Conclusions

Six injury types in the four-column nine-segment classification covered all types of bony and soft tissue injuries of the fibular column and concisely explained the injury mechanism. The classification is helpful for the precise judgement and decision-making of the concomitant fibular column injuries in tibial plateau fractures.