2025 ISAKOS Biennial Congress ePoster
Posterolateral Corner Reconstruction: Modification Of The Laprade Technique Using Autologous Hamstring Tendon Grafts: “The Popliteofibular Loop”
Marcos Mestriner, MD, São Paulo, SP BRAZIL
Ricardo P.L. Cury, MD, São Paulo, SP BRAZIL
Luiz Gabriel B. Guglielmetti, MD, PhD, São Paulo, SP BRAZIL
Leandro J. Aihara, MD, São Paulo, SP BRAZIL
Viktor Nelson Mazzola Corrêa, MD, Sao Paulo, Sao Paulo BRAZIL
Victor M. Oliveira, MD, PhD, São Paulo, SP BRAZIL
Santa Casa Medical School and Hospitals, Sao Paulo, Sao Paulo, BRAZIL
FDA Status Cleared
Summary
This is a technincal note that describe a a modification of the LaPrade technique for PLC reconstruction using autologous hamstring tendon grafts.
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Abstract
Purpose
This is a technincal note that describe a a modification of the LaPrade technique for PLC reconstruction using autologous hamstring tendon grafts. The surgical technique is described to ensure reproducibility, with particular emphasis on the proposed modifications: the use of autologous grafts (gracilis and semitendinosus tendons); the configuration in which they are used to increase the thickness of the reconstructed structures; and the exclusive fixation with widely available interference screws.
Methods
The patient is positioned supine. The hamstring grafts are harverst from the ipsilateral leg. With the knee flexed at 90_, an arched incision is made, with the parameters being the lateral femoral epicondyle, Gerdy tubercle, and the head of the fíbula. Following this, the 3 fascial windows are created: the most posterior one, adjacent to the fibular neck, the intermediate one, located anterior to the biceps femoris tendo, and the most anterior one, made through a longitudinal incision of approximately 6 cm on the iliotibial band at the level of the lateral epicondyle and the PT groove. The tunnels are created, just as describle by LaPrade. The gracilis tendon is used for reconstruction of the popliteus tendon: the graft is passed without any folds (“single”) through the tibial tunnel, from anterior to posterior. Then, the semitendinosus tendon is passed around the previously passed gracilis tendon (in a “loop” around it) so that this winding of one graft over the other is adjacent to the posterior exit of the tibial tunnel and the proximal tibiofibular joint. The gracilis tendon is then directed to the femoral tunnel, ensuring that it lies deep to the lateral structures. After that, with the semitendinosus graft now folded (“doubled”), it is passed through the fibular tunnel, from posterior to anterior. After passage through the femoral tunnel corresponding to the PT, fixation of the gracilis graft with interference screws can be performed. Subsequently, again under manual tension and with the knee in the same position, the double bundle of the semitendinosus graft is fixed with an interference screw in the fibular tunnel, reproducing the PFL. Finally, after passing the doubled semitendinosus graft under the iliotibial band, ensuring that it is adjacente to the remaining native LCL, it is passed and fixed with an interference screw.
Conclusion
We believe that the modification of the LaPrade technique presented here is reproducible, inexpensive, and easily implemented, since it does not depend on allograft availability and requires simple materials for adequate fixation.