Biomechanical comparison of two surgical techniques for press-fit reconstruction of the posterolateral complex of the knee.

BACKGROUND: To date, various surgical techniques to treat posterolateral knee instability have been described. Recent studies recommended an anatomical and isometric reconstruction of the posterolateral corner addressing the key structures, such as lateral collateral ligament (LCL), popliteus tendon (POP) and popliteofibular ligament (PFL). Two clinical established autologous respective local reconstruction methods of the posterolateral complex were tested for knot-bone cylinder press-fit fixation to assess efficacy of each reconstruction technique in comparison to the intact knee.

NULL HYPOTHESIS: The knot-bone cylinder press-fit fixation for both anatomic and isometric reconstruction techniques of the posterolateral complex shows equal biomechanical stability as the intact posterolateral knee structures.

STUDY DESIGN: This was a controlled laboratory study.

METHODS: Two surgical techniques (Larson: fibula-based semitendinosus autograft for LCL and PFL reconstruction/Kawano: biceps femoris and iliotibial tract autograft for LCL, PFL and POP reconstruction) with press-fit fixation were used for restoration of posterolateral knee stability. Seven cadaveric knees (66 ± 3.4 years) were tested under three conditions: intact knee, sectioned state and reconstructed knee for each surgical technique. Biomechanical stress tests were performed for every state at 30° and 90° knee flexion for anterior-posterior translation (60 N), internal-external and varus-valgus rotation (5 Nm) at 0°, 30° and 90° using a kinemator (Kuka robot).

RESULTS: At 30° and 90° knee flexion, no significant differences between the four knee states were registered for anterior-posterior translation loading. Internal-external and varus-valgus rotational loading showed significantly higher instability for the sectioned state than for the intact or reconstructed posterolateral structures (p < 0.05). There were no significant differences between the intact and reconstructed knee states for internal-external rotation, varus-valgus rotation and anterior-posterior translation at any flexion angles (p > 0.05). Comparing both reconstruction techniques, significant higher varus-/valgus stability was registered for the fibula-based Larson technique at 90° knee flexion (p < 0.05).

CONCLUSIONS: Both PLC reconstructions showed equal biomechanical stability as the intact posterolateral knee structures when using knot-bone cylinder press-fit fixation. We registered restoration of the rotational and varus-valgus stability with both surgical techniques. The anterior-posterior translational stability was not influenced significantly. The Larson technique showed significant higher varus/valgus stability in 90° flexion. The latter is easier to perform and takes half the preparation time, but needs grafting of the semitendinosus tendon. The Kawano reconstruction technique is an interesting alternative in cases of missing autografts.