A modified Laprade technique in treatment of lateral multi-ligament injuries of knee_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QUAN Songtao , CAI Litao ,  YANG Minglu

No.2 Department of Knee Injury, Luoyang Orthopedic-Traumatological Hospital, Henan Orthopedic Hospital, Luoyang Henan, 471000, P.R.China;

Corresponding author：

YANG Minglu, Email: yml0708@sina.com

Keywords：

Knee joint; modified Laprade technique; ligament injury; anatomical reconstruction

DOI：

10.7507/1002-1892.201702026

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ObjectiveTo evaluate the short-term effectiveness of a modified Laprade technique in the treatment of lateral multi-ligament injuries of knee by anatomical reconstruction of posterolateral complex (PLC) and anterior lateral ligament (ALL).MethodsBetween June 2013 and July 2015, 13 cases of lateral multi-ligament injuries of knee were treated. There were 9 males and 4 females with an average age of 38 years (range, 23-49 years). The injury was caused by traffic accident in 7 cases, falling from height in 4 cases, and sport injury in 2 cases. The time between injury and operation was 18-92 days (mean, 43 days). The results of anterior and posterior drawer tests and Lachmann test were positive, and all cases complicated by varus and external rotation instability. The Lysholm score of the knee was 38.4±7.7. According to International Knee Documentation Committee (IKDC) scoring, all were rated as grade D. According to Fanelli classification criteria, all were classified as type C. Anterior cruciate ligament, posterior cruciate ligament, PLC, and ALL were reconstructed simultaneously with autogenous tendon.ResultsAll incisions healed at stage I and no complication occurred. All patients were followed up 12-36 months (mean, 19 months). At last follow-up, the results of anterior and posterior drawer tests and Lachmann test were negative; 2 cases had varus instability, and 1 cases had external rotation instability. There was no anterior external rotation instability. The Lysholm score of the knee was 88.6 ±12.7, showing significant difference when compared with preoperative score (t=13.852, P=0.000). According to IKDC scoring, 8 cases were rated as grade A, 4 as grade B, and 1 as grade C; significant difference was found when compared with preoperative value (Z=3.182, P=0.000).ConclusionIn the treatment of lateral multi-ligament injuries knee, anatomical reconstruction of PLC and ALL with a modified Laprade technique can obtain good short-term effectiveness.

Citation： QUAN Songtao, CAI Litao, YANG Minglu. A modified Laprade technique in treatment of lateral multi-ligament injuries of knee. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(8): 922-925. doi: 10.7507/1002-1892.201702026 Copy

1.	刘心, 冯华, 张辉. 膝关节后外侧结构损伤的临床研究进展. 中国运动医学杂志, 2009, 28(3): 331-336.
2.	郭其勇, 李华德, 李明, 等. 膝关节多韧带损伤的治疗. 中国矫形外科杂志, 2015, 23(10): 892-896.
3.	Fanelli GC, Feldmann DD. Managemmet of combined anteriocruciate ligament/posterior cruciate ligament/posterolateral complex injuries of the knee. Oper Tech Sports Med, 1999, 7(3): 143-149.
4.	李丁峰, 皇甫小桥, 赵金忠. 腓骨长肌腱前半部作为自体移植材料的临床研究. 中华骨科杂志, 2014, 34(3): 285-292.
5.	LaPrade RF, Johansen S, Wentorf F, et al. An analysis of an anatomical poeterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med, 2004, 32: 1405.
6.	LaPrade RF, Spiridonov SI, Coobs BR, et al. Fibular collateral ligament anatomical reconstructions: a prospective outcomes study. Am J Sports Med, 2010, 38(10): 2005-2011.
7.	Strand T, Mølster A, Hordvik M, et al. Long-term follow-up after primary repair of the anterior cruciate ligament: clinical and radiological evaluation 15-23 years postoperatively. Arch Orthop Trauma Surg, 2005, 125(4): 217-221.
8.	Engebretsen L, Lew WD, Lewis JL, et al. Knee mechanics after repair of the anterior cruciate ligament. A cadaver study of ligament augmentation. Acta Orthop Scand, 1989, 60(6): 703-709.
9.	Ferretti A, Monaco E, Fabbri M, et al. Prevalence and Classification of Injuries of Anterolateral Complex in Acute Anterior Cruciate Ligament Tears. Arthroscopy, 2017, 33(1): 147-154.
10.	Levy BA, Boyd JL, Stuart MJ. Surgical treatment of acute and chronic anterior and posterior cruciate ligament and lateral side injuries of the knee. Sports Med Arthrosc Rev, 2011, 19(2): 110-119.
11.	Thein R, Boorman-Padgett J, Stone K, et al. Biomechanical Assessment of the Anterolateral Ligament of the Knee. J Bone Joint Surg (Am), 2016, 98: 937-943.
12.	Sonnery-Cottet B, Lutz C, Daggett M, et al. The Involvement of the Anterolateral Ligament in Rotational Control of the Knee. Am J Sports Med, 2016, 44(5): 1209-1214.
13.	Kernkamp WA, van de Velde SK, Bakker EW, et al. Anterolateral Extra-articular Soft Tissue Reconstruction in Anterolateral Rotatory Instability of the Knee. Arthros Tech, 2015, 4(6): e863-e867.

1. 刘心, 冯华, 张辉. 膝关节后外侧结构损伤的临床研究进展. 中国运动医学杂志, 2009, 28(3): 331-336.
2. 郭其勇, 李华德, 李明, 等. 膝关节多韧带损伤的治疗. 中国矫形外科杂志, 2015, 23(10): 892-896.
3. Fanelli GC, Feldmann DD. Managemmet of combined anteriocruciate ligament/posterior cruciate ligament/posterolateral complex injuries of the knee. Oper Tech Sports Med, 1999, 7(3): 143-149.
4. 李丁峰, 皇甫小桥, 赵金忠. 腓骨长肌腱前半部作为自体移植材料的临床研究. 中华骨科杂志, 2014, 34(3): 285-292.
5. LaPrade RF, Johansen S, Wentorf F, et al. An analysis of an anatomical poeterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med, 2004, 32: 1405.
6. LaPrade RF, Spiridonov SI, Coobs BR, et al. Fibular collateral ligament anatomical reconstructions: a prospective outcomes study. Am J Sports Med, 2010, 38(10): 2005-2011.
7. Strand T, Mølster A, Hordvik M, et al. Long-term follow-up after primary repair of the anterior cruciate ligament: clinical and radiological evaluation 15-23 years postoperatively. Arch Orthop Trauma Surg, 2005, 125(4): 217-221.
8. Engebretsen L, Lew WD, Lewis JL, et al. Knee mechanics after repair of the anterior cruciate ligament. A cadaver study of ligament augmentation. Acta Orthop Scand, 1989, 60(6): 703-709.
9. Ferretti A, Monaco E, Fabbri M, et al. Prevalence and Classification of Injuries of Anterolateral Complex in Acute Anterior Cruciate Ligament Tears. Arthroscopy, 2017, 33(1): 147-154.
10. Levy BA, Boyd JL, Stuart MJ. Surgical treatment of acute and chronic anterior and posterior cruciate ligament and lateral side injuries of the knee. Sports Med Arthrosc Rev, 2011, 19(2): 110-119.
11. Thein R, Boorman-Padgett J, Stone K, et al. Biomechanical Assessment of the Anterolateral Ligament of the Knee. J Bone Joint Surg (Am), 2016, 98: 937-943.
12. Sonnery-Cottet B, Lutz C, Daggett M, et al. The Involvement of the Anterolateral Ligament in Rotational Control of the Knee. Am J Sports Med, 2016, 44(5): 1209-1214.
13. Kernkamp WA, van de Velde SK, Bakker EW, et al. Anterolateral Extra-articular Soft Tissue Reconstruction in Anterolateral Rotatory Instability of the Knee. Arthros Tech, 2015, 4(6): e863-e867.

Chinese Journal of Reparative and Reconstructive Surgery

A modified Laprade technique in treatment of lateral multi-ligament injuries of knee

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