LAS VEGAS — A presenter at the Arthroscopy Association of North American and American Orthopaedic Society for Sports Medicine Specialty Day, here, offered pearls for anatomic reconstruction of posterolateral corner injuries.
“[U]nderstand the anatomy. If you understand the anatomy, you can make the surgery slick. The popliteal tendon and [posterolateral corner] PLC injuries are the main stabilizers,” Robert F. LaPrade, MD, said. “Use MRI, especially stress X-rays, [to] confirm diagnosis. Varus gapping is the key. You can’t subjectively guess on these. Look for alignment in chronic injuries and consider these anatomical reconstructions.”
LaPrade said surgeons who treat PLC injuries with anatomic reconstruction need to know the anatomy well because surgical time will decrease, the surgery will go better and motion can be initiated earlier. He said it is important for orthopedic surgeons to recognize injury patterns. Surgeons should get PLC varus stress X-rays to see how much the gapping has increased.
He said, “Now when looking at reconstruction to further uncover these issues, we look at the attachment points. We want to put things back where they attach. So, what we have done is looked at anatomic reconstruction and placed the hamstring graft in the femur and through the fibula head.”
When he performs anatomic reconstructions, LaPrade said he uses two grafts — a split Achilles tendon graft and a popliteus tendon. The medial collateral ligament and popliteal ligament can be combined with these to stabilize the knee.
“So, we try to wean them off crutches. Get them to full activity roughly anywhere from 6 to 9 months depending on when its isolated or combined with another ligament reconstruction,” LaPrade said. “We can get these patients back to fairly good activities.” – by Monica Jaramillo
LaPrade RF. Uncovering the dark side of the knee – Dealing with PLC injuries. Presented at: Arthroscopy Association of North American and American Orthopaedic Society for Sports Medicine Specialty Day; March 16, 2019; Las Vegas.
Disclosure: LaPrade reports no relevant financial disclosures.