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Comparison of three surgical techniques of posterolateral knee reconstruction: A cadaver study
Orthopaedics & Traumatology: Surgery & Research ( IF 2.3 ) Pub Date : 2022-09-17 , DOI: 10.1016/j.otsr.2022.103414
Charles Pioger 1 , Pierre-Alban Bouché 2 , Thomas-Xavier Haen 1 , Nicolas Pujol 1
Affiliation  

Background

Injuries to the posterolateral corner (PLC) of the knee are often overlooked but, require reconstruction in order to restore stability in varus and external rotation. Among the many anatomic and non-anatomic PLC reconstruction techniques available, the modified Larson (mLR), LaPrade (LPR) and Versailles reconstruction (VR) procedures are widely used.

Hypothesis

The hypothesis was that anatomic PLC reconstruction (VR and LPR procedures) provides better restoration and control of external rotation.

Patients and methods

Fifteen fresh-frozen cadaveric knees were tested to compare the 3 procedures. Varus laxity on stress radiographs in full knee extension and external rotatory laxity on dial test at 30° flexion were quantified at 3 phases: intact knee, PLC sectioned and PLC reconstructed.

Results

Mean varus laxity did not differ significantly between techniques in intact knees (p = .14), after PLC sectioning (p = .14) or after PLC reconstruction (p = .17). After PLC reconstruction, varus laxity was restored, with no statistical difference between mLR, VR and LPR compared to intact test values (respectively, -1.0, -1.3 and -1.5; p = .98). In all 3 groups, mean external rotation laxity on dial test at 30° flexion did not significantly differ between intact knees (p = .32) and after PLC sectioning (p = .15). After PLC reconstruction, the mLR technique was significantly less effective in restoring rotational stability than the VR and LPR techniques (p = .025).

Discussion

The VR technique provided similar outcomes to LPR for restoring stability in varus and external rotation. The 2 “anatomic” reconstruction procedures (VR and LPR) were significantly more effective than the modified Larson technique for external rotation control, confirming the study hypothesis. Consequently, it remains preferable to use anatomic techniques in multiligament injuries involving the PLC.

Level of evidence

IV, cadaver study.



中文翻译:

膝关节后外侧重建三种手术技术的比较:一项尸体研究

背景

膝关节后外侧角 (PLC) 的损伤经常被忽视,但需要重建以恢复内翻和外旋的稳定性。在众多可用的解剖学和非解剖学 PLC 重建技术中,改良的 Larson (mLR)、LaPrade (LPR) 和 Versailles 重建 (VR) 程序被广泛使用。

假设

假设是解剖 PLC 重建(VR 和 LPR 程序)提供更好的外旋恢复和控制。

患者和方法

对 15 个新鲜冷冻的尸体膝盖进行了测试,以比较这 3 个程序。全膝伸展应力射线照片上的内翻松弛和 30° 屈曲时表盘测试的外旋松弛在 3 个阶段进行量化:完整膝关节、PLC 分段和 PLC 重建。

结果

完整膝关节 ( p  =  .14)、PLC 切片后 ( p  =  .14) 或 PLC 重建后 ( p  =  .17)的平均内翻松弛度在技术之间没有显着差异。PLC 重建后,内翻松弛得到恢复,与完整测试值相比,mLR、VR 和 LPR 之间没有统计学差异(分别为 -1.0、-1.3 和 -1.5;p  =  .98)。在所有 3 组中,在 30° 屈曲度的拨盘测试中的平均外旋松弛度在完整膝关节 ( p  =  .32) 和 PLC 切片后 ( p  = .15). PLC 重建后,mLR 技术在恢复旋转稳定性方面的效果明显低于 VR 和 LPR 技术 ( p  =  .025)。

讨论

VR 技术提供了与 LPR 相似的结果,用于恢复内翻和外旋的稳定性。2 种“解剖学”重建程序(VR 和 LPR)比外旋控制的改良 Larson 技术明显更有效,证实了研究假设。因此,在涉及 PLC 的多韧带损伤中使用解剖学技术仍然更可取。

证据等级

四、尸体研究。

更新日期:2022-09-17
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