Meeting NewsPerspective

Presenter provides pearls for anatomic reconstruction of posterolateral corner injuries

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

Reference:

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.

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

Reference:

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.

    Perspective

    LaPrade has reiterated the surgical principals that repair of traumatic soft issue injuries of the knee joint requires precise anatomic repair of disrupted structures to obtain best functional outcomes. Preoperative planning is essential when treating such injuries.

    Thus, prior to embarking on operative repair of ligamentous structures of the PLC, the surgeon should identify the specific anatomic structures that have been compromised. This information should be obtained from a physical exam, stress radiographs and high-resolution MRI, which will identify ligamentous and osseous structures damaged and the locations of soft tissue detachments.

    The surgeon with knowledge of ligamentous anatomy of the knee can, prior to embarking on surgical repair of the injured knee, plan his or her strategy for surgical intervention and discuss with the patient projected postoperative rehabilitation and realistic outcome expectations.

    • Peter Jokl, MD
    • Professor
      Department of orthopaedics and rehabilitation
      Yale University
      New Haven, Connecticut

    Disclosures: Jokl reports no relevant financial disclosures.

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