Rotational Profile Alterations After Anatomic Posterolateral Corner Reconstructions in Multiligament Injured Knees

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2013 Sep 6

PMID 24005333

Citations 4

Authors

Nicolas Tardy

Caroline Mouton

Philippe Boisrenoult

Daniel Theisen

Philippe Beaufils

Romain Seil

Affiliations

Soon will be listed here.

Abstract

Purpose: Injuries of the posterolateral corner (PLC) are rare and severe knee injuries, resulting in posterolateral rotatory instability and an increase in external rotation. Surgical reconstruction techniques reproducing the normal anatomy showed promising results. In vivo evaluations of static rotational knee laxity at 30° of knee flexion have not been reported so far. The purpose of this study was to evaluate static rotational knee laxity after anatomic PLC reconstructions.

Methods: This is a retrospective clinical cohort study. Twenty patients with PLC reconstructions with an average follow-up time of 39 ± 22 months and no history of knee trauma or surgery of the contralateral knee were included in the study. They underwent a routine clinical examination and static rotational laxity measurements at 30° of knee flexion in the prone position. Side-to-side differences were recorded and compared to a group of matched controls.

Results: The postoperative IKDC score was graded A for 8 patients, B for 16, C for 6 and D for one patient. The primary goal of the surgical procedure which consists in reducing excessive external tibiofemoral rotation could be reached in 18 of the 20 patients (90%). Anatomic PLC reconstructions yielded a comparable rotational profile in operated and healthy knees in 7 patients (35%). Thirteen patients (65%) presented a significantly altered rotational profile in comparison with a healthy control group. Unexpected increases in internal rotation were found in 8 patients (40%).

Conclusion: Anatomic PLC reconstructions reduced excessive external tibiofemoral rotation in a vast majority of patients. Static rotational laxity measurements allowed for a determination of the patients' individual rotational profile after PLC reconstructions. This profile was normalised in only one-third of the patients. The understanding of this finding needs further investigation as well as the clinical impact of rotational profile alterations on knee function.

Level Of Evidence: Diagnostic studies, Level III.

Citing Articles

Technical variables of ACL surgical reconstruction: effect on post-operative static laxity and clinical implication.

Zaffagnini S, Signorelli C, Bonanzinga T, Roberti Di Sarsina T, Grassi A, Budeyri A Knee Surg Sports Traumatol Arthrosc. 2016; 24(11):3496-3506.

PMID: 27628740 DOI: 10.1007/s00167-016-4320-x.

Tibiofemoral forces for the native and post-arthroplasty knee: relationship to maximal laxity through a functional arc of motion.

Manning W, Ghosh K, Blain A, Longstaff L, Deehan D Knee Surg Sports Traumatol Arthrosc. 2016; 25(6):1669-1677.

PMID: 27034084 DOI: 10.1007/s00167-016-4093-2.

Objective measurements of static anterior and rotational knee laxity.

Mouton C, Theisen D, Seil R Curr Rev Musculoskelet Med. 2016; 9(2):139-47.

PMID: 26970758 PMC: 4896875. DOI: 10.1007/s12178-016-9332-0.

Combined anterior and rotational laxity measurements allow characterizing personal knee laxity profiles in healthy individuals.

Mouton C, Seil R, Meyer T, Agostinis H, Theisen D Knee Surg Sports Traumatol Arthrosc. 2014; 23(12):3571-7.

PMID: 25155050 PMC: 4661198. DOI: 10.1007/s00167-014-3244-6.

References

Feeley B, Muller M, Sherman S, Allen A, Pearle A . Comparison of posterolateral corner reconstructions using computer-assisted navigation. Arthroscopy. 2010; 26(8):1088-95. DOI: 10.1016/j.arthro.2009.12.014. View

Irrgang J, Ho H, Harner C, Fu F . Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 1998; 6(2):107-14. DOI: 10.1007/s001670050082. View

Fanelli G, Edson C . Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up. Arthroscopy. 2004; 20(4):339-45. DOI: 10.1016/j.arthro.2004.01.034. View

Almquist P, Arnbjornsson A, Zatterstrom R, Ryd L, Ekdahl C, Friden T . Evaluation of an external device measuring knee joint rotation: an in vivo study with simultaneous Roentgen stereometric analysis. J Orthop Res. 2002; 20(3):427-32. DOI: 10.1016/S0736-0266(01)00148-6. View

Alam M, Bull A, Thomas R, Amis A . A clinical device for measuring internal-external rotational laxity of the knee. Am J Sports Med. 2013; 41(1):87-94. DOI: 10.1177/0363546512469874. View

Markolf K, Graves B, Sigward S, Jackson S, McAllister D . Effects of posterolateral reconstructions on external tibial rotation and forces in a posterior cruciate ligament graft. J Bone Joint Surg Am. 2007; 89(11):2351-8. DOI: 10.2106/JBJS.F.01086. View

Gollehon D, Torzilli P, Warren R . 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):233-42. View

Branch T, Browne J, Campbell J, Siebold R, Freedberg H, Arendt E . Rotational laxity greater in patients with contralateral anterior cruciate ligament injury than healthy volunteers. Knee Surg Sports Traumatol Arthrosc. 2009; 18(10):1379-84. DOI: 10.1007/s00167-009-1010-y. View

Rios C, Leger R, Cote M, Yang C, Arciero R . Posterolateral corner reconstruction of the knee: evaluation of a technique with clinical outcomes and stress radiography. Am J Sports Med. 2010; 38(8):1564-74. DOI: 10.1177/0363546510363462. View

10.

Nau T, Chevalier Y, Hagemeister N, Duval N, Deguise J . 3D kinematic in-vitro comparison of posterolateral corner reconstruction techniques in a combined injury model. Knee Surg Sports Traumatol Arthrosc. 2005; 13(7):572-80. DOI: 10.1007/s00167-004-0586-5. View

11.

LaPrade R, Johansen S, Wentorf F, Engebretsen L, Esterberg J, Tso A . An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med. 2004; 32(6):1405-14. DOI: 10.1177/0363546503262687. View

12.

Geeslin A, LaPrade R . Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries: a prospective case series and surgical technique. J Bone Joint Surg Am. 2011; 93(18):1672-83. DOI: 10.2106/JBJS.J.01639. View

13.

Musahl V, Bell K, Tsai A, Costic R, Allaire R, Zantop T . Development of a simple device for measurement of rotational knee laxity. Knee Surg Sports Traumatol Arthrosc. 2007; 15(8):1009-12. DOI: 10.1007/s00167-007-0317-9. View

14.

Noyes F, Barber-Westin S . Surgical reconstruction of severe chronic posterolateral complex injuries of the knee using allograft tissues. Am J Sports Med. 1995; 23(1):2-12. DOI: 10.1177/036354659502300102. View

15.

LaPrade R, Spiridonov S, Coobs B, Ruckert P, Griffith C . Fibular collateral ligament anatomical reconstructions: a prospective outcomes study. Am J Sports Med. 2010; 38(10):2005-11. DOI: 10.1177/0363546510370200. View

16.

HUGHSTON J, Norwood Jr L . The posterolateral drawer test and external rotational recurvatum test for posterolateral rotatory instability of the knee. Clin Orthop Relat Res. 1980; (147):82-7. View

17.

Kanamori A, Lee J, Haemmerle M, Vogrin T, Harner C . A biomechanical analysis of two reconstructive approaches to the posterolateral corner of the knee. Knee Surg Sports Traumatol Arthrosc. 2003; 11(5):312-7. DOI: 10.1007/s00167-003-0379-2. View

18.

Nau T, Chevalier Y, Hagemeister N, Deguise J, Duval N . Comparison of 2 surgical techniques of posterolateral corner reconstruction of the knee. Am J Sports Med. 2005; 33(12):1838-45. DOI: 10.1177/0363546505278302. View

19.

Krudwig W, Witzel U, Ullrich K . Posterolateral aspect and stability of the knee joint. II. Posterolateral instability and effect of isolated and combined posterolateral reconstruction on knee stability: a biomechanical study. Knee Surg Sports Traumatol Arthrosc. 2002; 10(2):91-5. DOI: 10.1007/s00167-001-0269-4. View

20.

Lorbach O, Wilmes P, Maas S, Zerbe T, Busch L, Kohn D . A non-invasive device to objectively measure tibial rotation: verification of the device. Knee Surg Sports Traumatol Arthrosc. 2009; 17(7):756-62. DOI: 10.1007/s00167-009-0756-6. View