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Arthroscopic anatomy of the posterolateral corner of the knee: anatomic relations and arthroscopic approaches
INTRODUCTION: Although open-surgical techniques for the reconstruction of the posterolateral corner (PLC) are well established, the use of arthroscopic procedures has recently increased. When compared with open surgical preparation, arthroscopic orientation in the PLC is challenging and anatomic rel...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8843911/ https://www.ncbi.nlm.nih.gov/pubmed/33751186 http://dx.doi.org/10.1007/s00402-021-03864-6 |
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author | Frings, Jannik Weiß, Sebastian Kolb, Jan Behrendt, Peter Frosch, Karl-Heinz Krause, Matthias |
author_facet | Frings, Jannik Weiß, Sebastian Kolb, Jan Behrendt, Peter Frosch, Karl-Heinz Krause, Matthias |
author_sort | Frings, Jannik |
collection | PubMed |
description | INTRODUCTION: Although open-surgical techniques for the reconstruction of the posterolateral corner (PLC) are well established, the use of arthroscopic procedures has recently increased. When compared with open surgical preparation, arthroscopic orientation in the PLC is challenging and anatomic relations may not be familiar. Nevertheless, a profound knowledge of anatomic key structures and possible structures at risk as well as technical variations of arthroscopic approaches are mandatory to allow a precise and safe surgical intervention. MATERIALS AND METHODS: In a cadaveric video demonstration, an anterolateral (AL), anteromedial (AM), posteromedial (PM) and posterolateral (PL) portal, as well as a transseptal approach (TSA) were developed. Key structures of the PLC were defined and sequentially exposed during posterolateral arthroscopy. Finally, anatomic relations of all key structures were demonstrated. RESULTS: All key structures of the PLC can be visualized during arthroscopy. Thereby, careful portal placement is crucial in order to allow an effective exposure. Two alternatives of the TSA were described, depending on the region of interest. The peroneal nerve can be visualized dorsal to the biceps femoris tendon (BT), lateral to the soleus muscle (SM) and about 3 cm distal to the fibular styloid (FS). The distal attachment of the fibular collateral ligament (FCL) can be exposed on the lateral side of the fibular head (FH). The fibular attachment of the popliteofibular ligament (PFL) is exposed at the tip of the FS. CONCLUSION: Arthroscopy of the posterolateral recessus allows full visualization of all key structures of the posterolateral corner, which provides the basis for anatomic and safe drill channel placement in PLC reconstruction. A sufficient exposure of relevant anatomic landmarks and precise portal preparation reduce the risk of iatrogenic vascular and peroneal nerve injury. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00402-021-03864-6. |
format | Online Article Text |
id | pubmed-8843911 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-88439112022-02-23 Arthroscopic anatomy of the posterolateral corner of the knee: anatomic relations and arthroscopic approaches Frings, Jannik Weiß, Sebastian Kolb, Jan Behrendt, Peter Frosch, Karl-Heinz Krause, Matthias Arch Orthop Trauma Surg Arthroscopy and Sports Medicine INTRODUCTION: Although open-surgical techniques for the reconstruction of the posterolateral corner (PLC) are well established, the use of arthroscopic procedures has recently increased. When compared with open surgical preparation, arthroscopic orientation in the PLC is challenging and anatomic relations may not be familiar. Nevertheless, a profound knowledge of anatomic key structures and possible structures at risk as well as technical variations of arthroscopic approaches are mandatory to allow a precise and safe surgical intervention. MATERIALS AND METHODS: In a cadaveric video demonstration, an anterolateral (AL), anteromedial (AM), posteromedial (PM) and posterolateral (PL) portal, as well as a transseptal approach (TSA) were developed. Key structures of the PLC were defined and sequentially exposed during posterolateral arthroscopy. Finally, anatomic relations of all key structures were demonstrated. RESULTS: All key structures of the PLC can be visualized during arthroscopy. Thereby, careful portal placement is crucial in order to allow an effective exposure. Two alternatives of the TSA were described, depending on the region of interest. The peroneal nerve can be visualized dorsal to the biceps femoris tendon (BT), lateral to the soleus muscle (SM) and about 3 cm distal to the fibular styloid (FS). The distal attachment of the fibular collateral ligament (FCL) can be exposed on the lateral side of the fibular head (FH). The fibular attachment of the popliteofibular ligament (PFL) is exposed at the tip of the FS. CONCLUSION: Arthroscopy of the posterolateral recessus allows full visualization of all key structures of the posterolateral corner, which provides the basis for anatomic and safe drill channel placement in PLC reconstruction. A sufficient exposure of relevant anatomic landmarks and precise portal preparation reduce the risk of iatrogenic vascular and peroneal nerve injury. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00402-021-03864-6. Springer Berlin Heidelberg 2021-03-22 2022 /pmc/articles/PMC8843911/ /pubmed/33751186 http://dx.doi.org/10.1007/s00402-021-03864-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/ Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .. |
spellingShingle | Arthroscopy and Sports Medicine Frings, Jannik Weiß, Sebastian Kolb, Jan Behrendt, Peter Frosch, Karl-Heinz Krause, Matthias Arthroscopic anatomy of the posterolateral corner of the knee: anatomic relations and arthroscopic approaches |
title | Arthroscopic anatomy of the posterolateral corner of the knee: anatomic relations and arthroscopic approaches |
title_full | Arthroscopic anatomy of the posterolateral corner of the knee: anatomic relations and arthroscopic approaches |
title_fullStr | Arthroscopic anatomy of the posterolateral corner of the knee: anatomic relations and arthroscopic approaches |
title_full_unstemmed | Arthroscopic anatomy of the posterolateral corner of the knee: anatomic relations and arthroscopic approaches |
title_short | Arthroscopic anatomy of the posterolateral corner of the knee: anatomic relations and arthroscopic approaches |
title_sort | arthroscopic anatomy of the posterolateral corner of the knee: anatomic relations and arthroscopic approaches |
topic | Arthroscopy and Sports Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8843911/ https://www.ncbi.nlm.nih.gov/pubmed/33751186 http://dx.doi.org/10.1007/s00402-021-03864-6 |
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