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Posterolateral Corner Reconstruction with split quadriceps tendon autograft

Domenii publicaţii > Ştiinţe medicale + Tipuri publicaţii > Articol în revistã ştiinţificã

Autori: Nistor BM, Garofil DN, Ciolovan LM, Dinu G

Editorial: Przeglad Lekarski, apr 2006, V. 63, Suppl. II, 2006.

Rezumat:

Disruption of knee posterolateral corner (PLC) occurs after high-energy incidents and is always disabling. Varus, posterior translation and external rotational instability occur.
Despite improved understanding of PLC anatomy and function, consensus on treatment is still lacking.
The use of hamstrings or patellar tendon autografts, and Achilles tendon allografts has been reported recently for PLC reconstruction.
Our aim was testing the feasibility of quadriceps tendon autografting for PLC reconstruction.
Methods
We analyze the case of a young male patient, with very violent left knee trauma.
Associated injuries included tearing of posterior cruciate ligament, lateral collateral ligament (LCL), popliteus tendon (PT), popliteo-fibularis ligament (PFL).
Patient presented with severe knee instability. Early PLC reconstruction was considered.
Aiming to obtain a graft thicker than provided by hamstrings or patellar tendon, and yet benefit from the higher success of autologous tissue, we chose quadriceps tendon grafting.
A split quadriceps tendon autograft was used to reconstruct the LCL, PT and PFL.
Post-operatively, patient underwent a 4 month closely-monitored rehabilitation program.
Results
Following rehabilitation, patient achieved full Range of Motion, and a stable, trustworthy knee.
Graft was periodically monitored with ultrasound and MRI.
Clinical assessment tests performed throughout the 4 months follow-up showed good knee stability.
Conclusions
Split quadriceps autograft plasty successfully addresses the pitfalls of PLC reconstruction, including concurrent near-anatomic reconstruction of 3 important posterolateral structures, and secure fixation.
The sacrifice of some extensor strength for obtaining this sturdy graft may be justified in carefully selected young patients with severe PLC trauma.

Cuvinte cheie: knee, posterolateral corner, quadriceps tendon autograft