Posterolateral Rotational Knee Instability: Evolution and Current Trends in Surgical Treatment

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Abstract

Background. Diagnostics and treatment of patients with chronic posterior and posterolateral instability of the knee is one of the most understudied problems of modern orthopedics. This is due to rather low frequency of this pathology, as well as to complex anatomy of tendoligamentous structures of the posterolateral part of the knee joint. Steadily increasing number of foreign publications dedicated to this topic say that there is no common approach to the tactics of surgical treatment of patients of this category at the moment.

Aim of review — to evaluate the main trends of surgical treatment of this pathology according to the stage of involvement of various anatomical structures responsible for posterolateral rotational instability in the pathologic process.

Results. Despite a large number of methods of surgical treatment of posterolateral corner injuries, when analyzing modern publications, several main trends concerning posterolateral instability of the knee joint can be identified. In case of type 1 posterolateral instability, an isolated arthroscopic posterior cruciate ligament plasty is the most optimal. As for types 3 and 4, today such anatomical techniques as Larson and LaPrade have completely replaced the methods of non-anatomical reconstruction of the posterolateral corner. In addition, a large number of publications have recently appeared concerning arthroscopic techniques of these surgeries. The most important problem concerns the extent and the methods of surgical intervention in case of type 2 instability. Authors of the article consider that an arthroscopic posterior cruciate ligament plasty combined with popliteal tendon plasty is the most optimal for such category of patients.

Conclusion. The actual problem is the question of the method of surgical treatment in case of type 2 instability. The optimal technique for such patients is arthroscopic posterior cruciate ligament plasty combined with popliteal tendon plasty.

About the authors

Dmitrii A. Shulepov

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: dr.shulepov@gmail.com
ORCID iD: 0000-0002-6297-0710

Cand. Sci. (Med.)

Russian Federation, St. Petersburg

Evgenii P. Sorokin

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: sorokinortoped@gmail.com
ORCID iD: 0000-0002-9948-9015

Cand. Sci. (Med.)

Russian Federation, St. Petersburg

Nikita S. Konovalchuk

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: konovalchuk91@gmail.com
ORCID iD: 0000-0002-2762-816X

Cand. Sci. (Med.)

Russian Federation, St. Petersburg

Ekaterina A. Pashkova

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: caterinapashkova@yandex.ru
ORCID iD: 0000-0003-3198-9985
Russian Federation, St. Petersburg

Ksenia A. Demyanova

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: ksunyablack@yandex.ru
ORCID iD: 0000-0002-2239-2792
Russian Federation, St. Petersburg

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Supplementary files

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2. Fig. 1. Main structures of posterolateral corner

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3. Fig. 2. Scheme of PLC reconstruction according to G. Bousquet et al.: a — small-size reconstruction; b — large-size reconstruction

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4. Fig. 3. Scheme of PLC reconstruction according to J.H. Jaeger et al.

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5. Fig. 4. Technique of PLC plasty according to W.G. Clancy

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6. Fig. 5. Larson’s method:a — isolated popliteofibular ligament plasty;b — plasty of popliteofibular and lateral collateral ligaments

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7. Fig. 6. Scheme of popliteal tendon plasty

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