Outcomes of an Anatomic Posterolateral Knee Reconstruction

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Presentation transcript:

Outcomes of an Anatomic Posterolateral Knee Reconstruction by Robert F. LaPrade, Steinar Johansen, and Lars Engebretsen JBJS Essent Surg Tech Volume os-93(Supplement 1):10-20 March 16, 2011 ©2011 by The Journal of Bone and Joint Surgery, Inc.

A left knee positioned prior to surgery. Robert F. LaPrade et al. J Bone Joint Surg Am 2011;os-93:10-20 ©2011 by The Journal of Bone and Joint Surgery, Inc.

The surgical approach with retraction of the superficial layer of the iliotibial band (right knee). Robert F. LaPrade et al. J Bone Joint Surg Am 2011;os-93:10-20 ©2011 by The Journal of Bone and Joint Surgery, Inc.

A common peroneal nerve neurolysis (right knee). Robert F. LaPrade et al. J Bone Joint Surg Am 2011;os-93:10-20 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Blunt dissection between the lateral gastrocnemius and soleus muscles is used to allow identification of the popliteofibular ligament by palpation (left knee). Blunt dissection between the lateral gastrocnemius and soleus muscles is used to allow identification of the popliteofibular ligament by palpation (left knee). Robert F. LaPrade et al. J Bone Joint Surg Am 2011;os-93:10-20 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Through the horizontal incision in the biceps bursa, a traction stitch is placed into the lax fibular collateral ligament (left knee). Through the horizontal incision in the biceps bursa, a traction stitch is placed into the lax fibular collateral ligament (left knee). Robert F. LaPrade et al. J Bone Joint Surg Am 2011;os-93:10-20 ©2011 by The Journal of Bone and Joint Surgery, Inc.

The location of the fibular head reconstruction tunnel (adjacent to the forceps) along the lateral aspect of the fibular head (left knee). The location of the fibular head reconstruction tunnel (adjacent to the forceps) along the lateral aspect of the fibular head (left knee). Robert F. LaPrade et al. J Bone Joint Surg Am 2011;os-93:10-20 ©2011 by The Journal of Bone and Joint Surgery, Inc.

The cruciate aiming device is used to guide placement of the tibial tunnel guide pin. The cruciate aiming device is used to guide placement of the tibial tunnel guide pin. Note that an obturator has been placed into the fibular head tunnel to assist with guide-pin placement (left knee). Robert F. LaPrade et al. J Bone Joint Surg Am 2011;os-93:10-20 ©2011 by The Journal of Bone and Joint Surgery, Inc.

The islet passing pins enter the femur at the anatomic attachment sites of the popliteus tendon and fibular collateral ligament (left knee). The islet passing pins enter the femur at the anatomic attachment sites of the popliteus tendon and fibular collateral ligament (left knee). Robert F. LaPrade et al. J Bone Joint Surg Am 2011;os-93:10-20 ©2011 by The Journal of Bone and Joint Surgery, Inc.

The location of the femoral reconstruction tunnels for the popliteus tendon (to the left) and the fibular collateral ligament (to the right) (left knee). The location of the femoral reconstruction tunnels for the popliteus tendon (to the left) and the fibular collateral ligament (to the right) (left knee). Robert F. LaPrade et al. J Bone Joint Surg Am 2011;os-93:10-20 ©2011 by The Journal of Bone and Joint Surgery, Inc.

The grafts are prepared for the posterolateral reconstruction. Robert F. LaPrade et al. J Bone Joint Surg Am 2011;os-93:10-20 ©2011 by The Journal of Bone and Joint Surgery, Inc.

The placement of the popliteus tendon and fibular collateral ligament grafts into the femoral tunnels (right knee). The placement of the popliteus tendon and fibular collateral ligament grafts into the femoral tunnels (right knee). Robert F. LaPrade et al. J Bone Joint Surg Am 2011;os-93:10-20 ©2011 by The Journal of Bone and Joint Surgery, Inc.

The popliteus tendon graft is passed down the popliteal hiatus, and the fibular collateral ligament graft is passed under the superficial layer of the iliotibial band (right knee). The popliteus tendon graft is passed down the popliteal hiatus, and the fibular collateral ligament graft is passed under the superficial layer of the iliotibial band (right knee). Robert F. LaPrade et al. J Bone Joint Surg Am 2011;os-93:10-20 ©2011 by The Journal of Bone and Joint Surgery, Inc.

The interference screw is placed into the fibular head tunnel to secure the fibular collateral ligament graft (right knee). The interference screw is placed into the fibular head tunnel to secure the fibular collateral ligament graft (right knee). Robert F. LaPrade et al. J Bone Joint Surg Am 2011;os-93:10-20 ©2011 by The Journal of Bone and Joint Surgery, Inc.

Interference screws secure the popliteus tendon and popliteofibular ligament grafts to the tibia (right knee). Interference screws secure the popliteus tendon and popliteofibular ligament grafts to the tibia (right knee). Robert F. LaPrade et al. J Bone Joint Surg Am 2011;os-93:10-20 ©2011 by The Journal of Bone and Joint Surgery, Inc.