Reconstruction of the ligamentous-tendinous complex of the knee joint, ensuring its varus stability

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Abstract

А new technique for anatomical reconstruction of the ligament–tendon complex of the knee joint, which restores its varus stability, in patients with multiligament injury is substantiated. The technical feasibility, safety, and effectiveness of the proposed technique were evaluated in an anatomical experiment. The study was performed on eight lower extremities of four unfixed corpses. After simulating the varus instability of the knee joint, the plasty of the ligament–tendon complex providing the varus stability of the knee joint was performed according to the proposed technique. The essence of the proposed technique is the simultaneous restoration of the peroneal collateral ligament, popliteal tendon, and popliteal–peroneal ligament using a single autograft of a semitendinosus muscle. After simulating the surgical procedure on anatomical specimens, the varus stability of the knee joint was evaluated based on the results of functional radiography. The safety of the experimental procedure was evaluated based on the results of the applied morphometric study of the distance from the reconstructed elements of the posterolateral corner of the knee joint to the popliteal artery and the common peroneal nerve in the 90-degree flexion position in the knee joint. Accordingly, the formed bone tunnels for a single autograft were located at a safe distance from the elements of the neurovascular bundle of the popliteal fossa. The technical possibility of reconstruction of the collateral peroneal ligament, popliteal tendon, and popliteal–peroneal ligament according to the proposed technique. After simulating the reconstruction of elements of the posterolateral corner of the knee joint, varus stability was objectified by a series of functional X-ray studies of the anatomical specimens. The results indicate the technical feasibility, effectiveness, and relative safety of the proposed method of reconstruction of the ligament–tendon complex of the posterolateral corner of the knee joint providing the varus stability of the knee joint in patients with multiligament injury.

About the authors

Vladimir V. Khominets

Military medical academy of S.M. Kirov

Email: khominets_62@mail.ru
ORCID iD: 0000-0001-9391-3316
SPIN-code: 5174-4433
Scopus Author ID: 6504618617

doctor of medical sciences, professor

Russian Federation, Saint Peterburg

Aleksey L. Kudyashev

Military medical academy of S.M. Kirov

Email: a.kudyashev@gmail.com
ORCID iD: 0000-0002-8561-2289
SPIN-code: 6138-0950

doctor of medical sciences, associate professor

Russian Federation, Saint Peterburg

Ivan V. Gaivoronskiy

Military medical academy of S.M. Kirov

Email: i.v.gaivoronsky@mail.ru
ORCID iD: 0000-0002-6836-5650
SPIN-code: 1898-3355

doctor of medical sciences, professor

Russian Federation, Saint Peterburg

Ivan S. Bazarov

Military medical academy of S.M. Kirov

Email: dok055@yandex.ru
ORCID iD: 0000-0002-4708-493X
SPIN-code: 4745-2901

head of department

Russian Federation, Saint Peterburg

Aleksey S. Grankin

Military medical academy of S.M. Kirov

Email: aleksey-grankin@yandex.ru
ORCID iD: 0000-0002-4565-9066
SPIN-code: 1122-8388

candidate of medical sciences

Russian Federation, Saint Peterburg

Aleksey A. Semenov

Military medical academy of S.M. Kirov

Author for correspondence.
Email: semfeodosia82@mail.ru
SPIN-code: 1147-3072

candidate of medical sciences

Russian Federation, Saint Peterburg

Dmitri A. Konokotin

Military medical academy of S.M. Kirov

Email: konokotin.dmirty@yandex.ru
ORCID iD: 0000-0003-3100-0321
SPIN-code: 1625-0543

Adjunct

Russian Federation, Saint Peterburg

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Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Reconstruction scheme of popliteal tendon, popliteal–peroneal ligament, peroneal collateral ligament: 1 — peroneal collateral ligament graft; 2 — popliteal tendon graft; 3 — popliteal–peroneal ligament graft; 4 — system of adjustable cortical suspensory fixation of the graft

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3. Fig. 2. Creation of bone tunnels in the fibular head

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4. Fig. 3. Fig. 3. Creating blind bone tunnel in the proximal metaepiphysis of the tibia using variable-size drill: а — guided installation; b —Creating a bone tunnel with two diameters

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5. Fig. 4. Creation of bone tunnels in the lateral condyle of the femur: a — tunnel guide; b — guidewires are drilled through proximal attachments of the peroneal collateral ligament and popliteal tendon

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6. Fig. 5. Tensioning of the posterolateral corner graft using adjustable cortical suspensory fixation system: a — the graft is passed through the loop end of the cortical suspensory fixation system; b — final fixation of the graft is performed by interference screws and cortical suspensory fixation system

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7. Fig. 6. Specimen of the knee with reconstruction of the popliteal tendon, popliteal–peroneal ligament, and peroneal collateral ligament: 1 — distance between the peroneal collateral ligament graft and common peroneal nerve; 2 — distance between the peroneal collateral ligament graft and popliteal artery; 3 — distance between the popliteal–peroneal ligament graft and common peroneal nerve; 4 — distance between the popliteal–peroneal ligament graft and popliteal artery; 5 — distance between the popliteal tendon graft and common peroneal nerve; 6 — distance between the popliteal tendon graft and popliteal artery

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Copyright (c) 2022 Khominets V.V., Kudyashev A.L., Gaivoronskiy I.V., Bazarov I.S., Grankin A.S., Semenov A.A., Konokotin D.A.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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