A Modified LaPrade Technique in Posterolateral Corner Reconstruction of the Knee

Abstract

Posterolateral corner (PLC) injuries represent a complex injury pattern whose repair is essential for varus and rotational stability of the knee. Several surgical techniques have been described for PLC injuries, which can be divided into 2 main groups: anatomical and nonanatomical. Due to insufficiency of posterior stabilization of nonanatomic procedure, LaPrade represented an anatomical reconstruction. In this Technical Note, we describe and illustrate some modifications in the anatomic reconstruction of the PLC and lateral collateral ligament.

Fig 1

The patient is placed in the supine position on the operating table with the surgical limb hanging in front of the surgeon and other limbs resting on the table. The head of fibula and lateral condyle of femur and patella are marked on the skin.

Fig 2

After identification of the lateral epicondyle and exposure of the lateral collateral ligament femoral insertion, one pin is inserted in lateral epicondyle and second in popliteal groove.

Fig 3

The second incision is made extending from 1 cm proximal to the fibular head and extending distally 2 cm below it. At the distal end of the incision and posterior aspect of the fibular neck, the common peroneal nerve is palpated, explored, and protected.

Fig 4

The fibular attachment of the fibular collateral ligament (FCL) is identified and a horizontal window is made in the biceps.

Fig 5

The guide pin is inserted from Gerdy’s tubercle and aimed toward the posterior aspect of the tibia 1 cm distal to the joint line and 1 cm medial to the proximal tibiofibular joint and then its position is confirmed by the C-arm.

Fig 6

The tunnel is created with a 9-mm reamer.