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The Popliteus Bypass provides superior biomechanical properties compared to the Larson technique in the reconstruction of combined posterolateral corner and posterior cruciate ligament injury

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to compare the biomechanical properties of the popliteus bypass against the Larson technique for the reconstruction of a combined posterolateral corner and posterior cruciate ligament injury.

Methods

In 18 human cadaver knees, the kinematics for 134 N posterior loads, 10 Nm varus loads, and 5 Nm external rotational loads in 0°, 20°, 30°, 60,° and 90° of knee flexion were measured using a robotic and optical tracking system. The (1) posterior cruciate ligament, (2) meniscofibular/-tibial fibers, (3) popliteofibular ligament (PFL), (4) popliteotibial fascicle, (5) popliteus tendon, and (6) lateral collateral ligament were cut, and the measurements were repeated. The knees underwent posterior cruciate ligament reconstruction, and were randomized into two groups. Group PB (Popliteus Bypass; n = 9) underwent a lateral collateral ligament and popliteus bypass reconstruction and was compared to Group FS (Fibular Sling; n = 9) which underwent the Larson technique.

Results

Varus angulation, posterior translation, and external rotation increased after dissection (p < 0.01). The varus angulation was effectively reduced in both groups and did not significantly differ from the intact knee. No significant differences were found between the groups. Posterior translation was reduced by both techniques (p < 0.01), but none of the groups had restored stability to the intact state (p < 0.02), with the exception of group PB at 0°. No significant differences were found between the two groups. The two techniques revealed major differences in their abilities to reduce external rotational instability. Group PB had less external rotational instability compared to Group FS (p < 0.03). Only Group PB had restored rotational instability compared to the state of the intact knee (p < 0.04) at all degrees of flexion.

Conclusion

The popliteus bypass for posterolateral reconstruction has superior biomechanical properties related to external rotational stability compared to the Larson technique. Therefore, the popliteus bypass may have a positive influence on the clinical outcome. This needs to be proven through clinical trials.

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Acknowledgements

The study was supported by grants from Asklepios Proresearch, Hamburg, Germany. Cadaver specimens, surgical instruments and logistic support were provided by Arthrex, Naples, USA.

Funding

This study was supported by grants from Asklepios Proresearch, Hamburg, Germany. Cadaver specimens, surgical instruments and logistics were provided by Arthrex, Napels, USA.

Author information

Authors and Affiliations

  1. Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany

    Tobias C. Drenck, Achim Preiss & Ralph Akoto

  2. Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany

    Christoph Domnick & Mirco Herbort

  3. Department of Trauma, Hand and Reconstructive Surgery, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Jannik Frings, Matthias Krause & Karl-Heinz Frosch

Authors
  1. Tobias C. Drenck
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  2. Achim Preiss
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  3. Christoph Domnick
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  6. Ralph Akoto
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  8. Karl-Heinz Frosch
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Corresponding author

Correspondence to Karl-Heinz Frosch.

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Conflict of interest

TCD, CD, JF and MK declare no potential conflict of interest. MH receives consultancy fees from Medacta, Conmed Linvatec, Olympus, DJO, Karl Storz, Mathys and Arthrex. RA receives consultancy fees from Arthrex, Conmed, Otto Bock and Mathys. KHF receives consultancy fees from Arthrex. AP receives consultancy fees from Arthrex.

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Ethical approval was given by the ethics board of the medical association in Hamburg, Germany (ID WF-17/16).

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Drenck, T.C., Preiss, A., Domnick, C. et al. The Popliteus Bypass provides superior biomechanical properties compared to the Larson technique in the reconstruction of combined posterolateral corner and posterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 29, 732–741 (2021). https://doi.org/10.1007/s00167-020-05987-6

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