Single stage anatomic posterolateral corner reconstruction with modified LaPrade technique, combined with arthroscopic posterior cruciate ligament reconstruction with tibia nail in situ-A current technique.

Abstract

The posterolateral corner (PLC) of the knee is a key anatomical structure which provides varus and rotational stability to the knee joint. Injuries to the PLC pose a great challenge for orthopedic surgeons due to their complex nature. PLC injuries rarely occur in isolation, with up to 95% being associated with ligament tears. Surgical reconstruction is indicated in Grade III injuries, defined clinically as >10 ​mm lateral opening on varus stress and >10° external rotation on the dial test, supported by MRI magnetic resonance imaging findings. Several techniques have been described for PLC reconstruction; however, the classic anatomic reconstruction described by LaPrade remains the gold standard, traditionally performed using an Achilles tendon allograft. In this video technique, we describe a modified LaPrade technique using peroneus longus and hamstring tendon autografts for PLC and posterior cruciate ligament (PCL) reconstruction, respectively, in a patient having tibia nail in situ for Type IIIb open fracture shaft of tibia. The peroneus longus tendon is fashioned into a Y-shaped construct and must be at least 250 ​mm long to perform this technique. The graft passage and fixation sequence are the reverse of the LaPrade technique. This method ensures anatomic fixation, independent tensioning, and secure fixation of each segment, thereby restoring the normal biomechanics of the knee.