Name:
Anatomic Posterolateral Corner - PLC Reconstruction - La Prade Technique PLT, LCL & PFL Reconstruction
Description:
Anatomic Posterolateral Corner - PLC Reconstruction - La Prade Technique PLT, LCL & PFL Reconstruction
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/f5454de8-5188-4bb9-94c9-2eccb61c872e/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H08M56S
Embed URL:
https://stream.cadmore.media/player/f5454de8-5188-4bb9-94c9-2eccb61c872e
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/f5454de8-5188-4bb9-94c9-2eccb61c872e/Anatomic Posterolateral corner_ PLCReconstruction - La Prade.mp4?sv=2019-02-02&sr=c&sig=c8kLuB0ebP%2FxVAweFvNUyw%2BoKZjj%2B2atJCdGg5dXz1Q%3D&st=2024-11-23T11%3A05%3A17Z&se=2024-11-23T13%3A10%3A17Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
SHARATH RAMANATH: Hello, friends. You can see that there is gross subluxation of the tibia, there is severe hyperextension. This person has ACL, PCL and PLC injury. This video is taken before I did ACL and PCL reconstruction. Now I am going to demonstrate PLC anatomic reconstruction of this patient after ACL, PCL reconstruction.
SHARATH RAMANATH: So now I have made a lateral incision. This is the less common peroneal. Now we are watching now we are seeing and this is what is the torn ends of the biceps femoris. This is the avulsed end of the lateral collateral ligament from the tip of the fibular head. You can see I am pulling from one of the arteries and another hemostatis demonstrating the avulsed lateral epicondyle.
SHARATH RAMANATH: The first tunnel is over the fibular head antrolateral to posterior medial, feel with the finger and keep the knee in flexion and all the time you feel the finger where it is coming down. And this is a guidewire and 4.5 mm. drill bit. In the broadest aspect of the fibular head so that you should not damage the fibular head. I'll passed the shuttles threads and kept it.
SHARATH RAMANATH: Now, now again, you can see that LCL, which is and then we'll now come to the anterior posterior tunnel of the tibia, which is for the popliteal and posterior talofibular ligament. With the jig check the length of the tibial bone and keep the guidewire exactly at that length and protect the posterior aspect of the posterior structures with the finger, also with the jig, and make sure that the wire doesn't come too much over the exit, very much below the end of the bone.
SHARATH RAMANATH: If you keep only how much the length of the bone so it won't come out. Now hold to 8mm. This I had measured 8mm but the tendons and again with the bead pin, past the shuttle thread, keep the Hohmann as I'm keeping and protecting the posterior structures and a little longer incision and protecting the posterior structures with a flexed knee will help all the vascular structures to drop below so that you will not damage. After that,
SHARATH RAMANATH: now concentrate on the lateral epicondyle here. There was our lateral epicondylar fragment. So I am now drilling the lateral epicondyle for the lateral collateral ligament exactly at the area of where the bone was avulsed. This is now again, I am now demonstrating the popliteal attachment. I have made, put a saddle thread. Now you can see the popliteus, our popliteus, the distance between the LCL and the popliteus is at 1.8 centimeters,
SHARATH RAMANATH: that is 18 mm, which is described by Dr La Prade. So I'm keeping and just to make sure that it is about 18 mm. And both are slightly little different direction, not parallel, divergent but not too much divergent of the popliteus tendon also proximally directed, LCL is proximally and superiorly directed. Now popliteal tunnel, proximal directed and superior directed LCL is more proximal directed and superior directed.
SHARATH RAMANATH: Popliteal tendon is drilled about 4.5 mm. Just above the articular surface and distal to LCL tunnel. Hold drill, hold drill just with the forearm ma'am. Again, keep the shuttle thread like how we did for LCL tunnel. You can see two holes for lateral collateral ligament and popliteus.
SHARATH RAMANATH: The position of the knee is in flexion and the distance between this is 18 mm, to two centimeters as described by La Prade. Now I passed one graft both for popliteus and LCL line. I am using allograft because I have done already ACL and PCL for this patient from the same side peroneus and semitendinosus. I have taken allograft, now this is 5mm, a 6mm screw and filomen graft. This is for LCL
SHARATH RAMANATH: and the second thing is for popliteus. Both the graft I have kept, I have a reinforced with the fiber tape. You can see that the popliteal is thinner, about 4mm and I am trying to pass 6mm screw for the popliteus also. You can see the both first step is to fix both popliteal tendon and lateral collateral ligament.
SHARATH RAMANATH: I am fixing the popliteal tendon. It has to be buried below the lateral epicondyle bone. And now from the intra articular part, I took the hemostats and take the shuttle thread to pass popliteus through the articular surface to go below posterior to that inside the articular surface. This is the popliteus tendon. Now popliteus has come from intraarticular and now that has to be passed from the tibial tunnel.
SHARATH RAMANATH: This is lateral collateral ligament. This is also below the, beneath the AT band with the shuttle. Now, tibial lateral collateral ligament. Fibula collateral ligament is now passed from the fibular head and from the fibular head to the shuttle. Now lateral collateral ligament is now in position and popliteus tendon is on both in position. Both has to be passed below the now tibial tunnel.
SHARATH RAMANATH: OK. Now, both now are passed from that tibial tunnel. Now popliteus tendon, popliteus fibular and lateral collateral ligament. Now fixation of the fibular collateral ligament. We can fix the fibular collateral ligament before we pass from the tibial also.
SHARATH RAMANATH: Ah, we can fix it about 10 to 20 degrees of flexion or the antroneutral rotation. Pull, keep, keep the LCL part of the tendon pulled and keep the knee in 30 degrees of flexion fix with the 6mm screws. Now keep the knee in 60 degrees of flexion. Keep both the ligaments pulled and fix it with the 7mm screws 25mm, 25 to 27mm screw, tibial side.
SHARATH RAMANATH: Now here in this case, there was avulsion of the lateral epicondyle. I am now fixing the lateral epicondyle over the anatomic footprint or the screw just to make sure that I am fixing and without, I am going to, uh, reattach the avulsed lateral epicondylar fragment. Uh, so that reinforcement of the native LCL is also will be there and also reconstructed LCL also will be there.
SHARATH RAMANATH: This is the anchor suture anchor. You can put the suture anchor and reattach if there is no tear of the LCL. In this case, there was no tear. It was avulsion of the LCL and I am now checking the balance. Stability it is strong, good, stable. I'm demonstrating the native LCL, which is holding nicely with the anchors.
SHARATH RAMANATH: And this is the LCL which anteriorly is ACL which is, I have reconstructed, which is going through the fibula tunnel. One is the native LCL. Second thing is that.... [VIDEO ENDS]
