Double-bundle PCL and Posterolateral Corner Reconstruction Components are Codominant |
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Authors: | Craig S Mauro MD Jon K Sekiya MD Kathryne J Stabile MD Marcus J Haemmerle MD Christopher D Harner MD |
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Institution: | (1) Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA 15203, USA;(2) Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA;(3) Department of Orthopaedic Surgery, Wake Forest University, Winston-Salem, NC, USA;(4) Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI, USA |
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Abstract: | A more complete biomechanical understanding of a combined posterior cruciate ligament and posterolateral corner knee reconstruction
may help surgeons develop uniformly accepted clinical surgical techniques that restore normal anatomy and protect the knee
from premature arthritic changes. We identified the in situ force patterns of the individual components of a combined double-bundle
posterior cruciate ligament and posterolateral corner knee reconstruction. We tested 10 human cadaveric knees using a robotic
testing system by sequentially cutting and reconstructing the posterior cruciate ligament and posterolateral corner. The knees
were subjected to a 134-N posterior tibial load and 5-Nm external tibial torque. The posterior cruciate ligament was reconstructed
with a double-bundle technique. The posterolateral corner reconstruction included reattaching the popliteus tendon to its
femoral origin and reconstructing the popliteofibular ligament. The in situ forces in the anterolateral bundle were greater
in the posterolateral corner-deficient state than in the posterolateral corner-reconstructed state at 30° under the posterior
tibial load and at 90° under the external tibial torque. We observed no differences in the in situ forces between the anterolateral
and posteromedial bundles under any loading condition. The popliteus tendon and popliteofibular ligament had similar in situ
forces at all flexion angles. The data suggest the two bundles protect each other by functioning in a load-sharing, codominant
fashion, with no component dominating at any flexion angle. We believe the findings support reconstructing both posterior
cruciate ligament bundles and both posterolateral corner components.
One or more of the authors (CDH) have received funding from the Aircast Foundation, Pittsburgh, PA.
Each author certifies that his or her institution either has waived or does not require approval for the human protocol for
this investigation and that all investigations were conducted in conformity with ethical principles of research. |
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