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Scientific Articles   |    
Anatomical Reconstruction for Chronic Posterolateral Instability Combined with Posterior Cruciate Ligament ReconstructionSurgical Technique
Sung-Jae Kim, MD, PhD1; Sung-Hwan Kim, MD1; Hee-Don Han, MD1; In-Sung Lee, MD1; Sung-Guk Kim, MD1; Yong-Min Chun, MD, PhD1
1 Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University Health System, CPO Box 8044, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea. E-mail address for S.-J. Kim: sungjaekim@yuhs.ac. E-mail address for S.-H. Kim: orthohwan@yuhs.ac. E-mail address for H.-D. Han: yaedrra@daum.net. E-mail address for I.-S. Lee: domlee1975@naver.com. E-mail address for S.-G. Kim: p10001@hanmail.net. E-mail address for Y.-M. Chun: min1201@hanmail.net
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Based on an original article: J Bone Joint Surg Am. 2011 May 4;93(9):809-18.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Jan 09;3(1):e1 1-9. doi: 10.2106/JBJS.ST.K.00038
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Extract

Overview
Introduction

We present surgical techniques for the anatomical reconstruction of the popliteus tendon and the lateral collateral ligament (LCL) with use of a tibialis posterior allograft for posterolateral corner insufficiency combined with anterolateral transtibial single-bundle posterior cruciate ligament (PCL) reconstruction with use of an Achilles tendon-bone allograft with a one-incision technique.

Step 1: Create the Portals

Use a parapatellar high anteromedial portal, a far anterolateral portal, and a high posteromedial portal.

Step 2: Prepare the Tibial Tunnel and Femoral Socket for the PCL Reconstruction

To reduce the graft/socket divergence, (1) flex the knee >100°, (2) push the proximal part of the tibia backward as much as possible, and (3) introduce the cannulated headed reamer through the far anterolateral portal with a smooth plastic sheath and push up posteriorly to make contact with the lateral femoral condyle.

Step 3: Prepare, Pass, and Fix the Graft for the PCL Reconstruction

Tie a 9-mm EndoPearl device securely to the tip of the tendon to improve the fixation strength.

Step 4: Make the Skin Incision and Develop the Surgical Plane for the Posterolateral Corner Reconstruction

Create a 7-mm fibular tunnel in a counterclockwise direction to avoid breaking the lateral cortex of the fibular tunnel or injuring the peroneal nerve.

Step 5: Prepare, Pass, and Fix the Graft for the Posterolateral Corner Reconstruction

Change the patient’s position to a lateral or semi-lateral decubitus position to prevent an inappropriate posterolateral corner reconstruction by the posterolateral corner of the knee sagging in the supine position due to gravity.

Step 6: Postoperative Rehabilitation

Immobilize the knee in extension, with the proximal part of the tibia supported with cotton pads to prevent posterior drooping, which may lead to graft stretch or failure.

Results

We performed a two-year follow-up study comparing the procedures described here (Group A) with the same PCL reconstruction technique combined with a modified biceps rerouting tenodesis to address the posterolateral corner deficiency (Group B).

What to Watch For

Indications

Contraindications

Pitfalls & Challenges

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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