Double-bundle PCL and Posterolateral Corner Reconstruction Components are Codominant

• Published in: Clinical orthopaedics and related research Vol. 466; no. 9; pp. 2247 - 2254
• Main Authors: Mauro, Craig S., Sekiya, Jon K., Stabile, Kathryne J., Haemmerle, Marcus J., Harner, Christopher D.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.09.2008; Springer; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adult; Aged; Biological and medical sciences; Biomechanical Phenomena; Conservative Orthopedics; Diseases of the osteoarticular system; Humans; Knee Injuries - physiopathology; Knee Injuries - surgery; Knee Joint - physiopathology; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Original; Original Article; Orthopedics; Posterior Cruciate Ligament - injuries; Posterior Cruciate Ligament - physiopathology; Posterior Cruciate Ligament - surgery; Range of Motion, Articular - physiology; Reconstructive Surgical Procedures; Robotics; Sports Medicine; Surgery; Surgical Orthopedics; Flexion Angle; Femoral Tunnel; Popliteus Tendon; Posterior Cruciate Ligament; Posterior Cruciate Ligament Reconstruction; Anatomical reconstruction; Treatment; Surgery; Orthopedics
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-008-0319-z

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.