Anatomic Repair of a Lateral Collateral Ligament and Anterolateral Capsular Complex Injury With Internal Brace Augmentation
Background: Lateral collateral ligament (LCL) injuries are implicated in varus instability of the knee. Often, these accompany other ligamentous injuries including anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) tears, and injury to the anterolateral capsular complex (ALCC). Use...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2022-05-01
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| Series: | Video Journal of Sports Medicine |
| Online Access: | https://doi.org/10.1177/26350254221093082 |
| _version_ | 1828413419202543616 |
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| author | Kyle Schoell MD Aryan Haratian BA Amir Fathi BS Ioanna K. Bolia MD, MS, PhD Laith K. Hasan BBA Frank A. Petrigliano MD Alexander E. Weber MD George F. “Rick“ Hatch MD |
| author_facet | Kyle Schoell MD Aryan Haratian BA Amir Fathi BS Ioanna K. Bolia MD, MS, PhD Laith K. Hasan BBA Frank A. Petrigliano MD Alexander E. Weber MD George F. “Rick“ Hatch MD |
| author_sort | Kyle Schoell MD |
| collection | DOAJ |
| description | Background: Lateral collateral ligament (LCL) injuries are implicated in varus instability of the knee. Often, these accompany other ligamentous injuries including anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) tears, and injury to the anterolateral capsular complex (ALCC). Use of internal brace augmentation with anatomic repair is an alternative to reconstruction to improve patient outcomes and facilitate early range of motion and weight bearing. Indications: We present a case of an anatomic repair of a LCL and an ALCC injury with internal brace augmentation. Technique Description: A curvilinear incision centered over the lateral epicondyle is used. The avulsed LCL and biceps tendon was exposed and a placed #5 FiberWire was placed into the distal LCL, biceps tendon, and the popliteofibular ligament. A split was made in the iliotibial (IT) band and a second #5 FiberWire was placed proximally in the LCL/biceps tendon for additional fixation. A tunnel was made in the fibular head and tibia using a 2.4-mm beath pin and the two #5 FiberWires were passed to the anteromedial tibia. The FiberWires were fixed to the tibia using a 14-mm attachable button system (ABS) manhole cover for suspensory fixation. Repair and internal bracing of the anterolateral capsular complex was accomplished with 2 interlocked TightRopes and a #2 FiberTape. This fixation method achieved repair by compressing the anterolateral capsular complex onto its tibial origin. The suture devices also served to augment the repair and were fixed proximally to the femur using another 14-mm ABS manhole cover. The FiberTape was fixed to the anterolateral tibia distally with a 4.5 mm SwiveLock. The TightRopes were passed through a tunnel to the anterolateral tibia and secured using an ABS Dog Bone. The construct was tensioned in near full extension and gapping was matched fluoroscopically to the contralateral knee. Results: Patient was cleared for full return to sports 9 months postoperatively. At the final follow up visit, the patient had excellent strength, stability, and 135° range of motion on the operative knee. Patient had returned to exercise at home but was unable to return to sports due to COVID-19 restrictions. Conclusion: Anatomic repair of the LCL and the ALCC with internal brace augmentation can serve as an effective alternative to reconstruction and demonstrates excellent patient outcomes regarding restoring stability, ROM, and return to preoperative sports. |
| first_indexed | 2024-12-10T13:08:16Z |
| format | Article |
| id | doaj.art-9860417e2b2942bc9b8f0ae658e0bf4b |
| institution | Directory Open Access Journal |
| issn | 2635-0254 |
| language | English |
| last_indexed | 2024-12-10T13:08:16Z |
| publishDate | 2022-05-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Video Journal of Sports Medicine |
| spelling | doaj.art-9860417e2b2942bc9b8f0ae658e0bf4b2022-12-22T01:47:46ZengSAGE PublishingVideo Journal of Sports Medicine2635-02542022-05-01210.1177/26350254221093082Anatomic Repair of a Lateral Collateral Ligament and Anterolateral Capsular Complex Injury With Internal Brace AugmentationKyle Schoell MD0Aryan Haratian BA1Amir Fathi BS2Ioanna K. Bolia MD, MS, PhD3Laith K. Hasan BBA4Frank A. Petrigliano MD5Alexander E. Weber MD6George F. “Rick“ Hatch MD7USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USAUSC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USAUSC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USAUSC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USAUSC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USAUSC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USAUSC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USAUSC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USABackground: Lateral collateral ligament (LCL) injuries are implicated in varus instability of the knee. Often, these accompany other ligamentous injuries including anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) tears, and injury to the anterolateral capsular complex (ALCC). Use of internal brace augmentation with anatomic repair is an alternative to reconstruction to improve patient outcomes and facilitate early range of motion and weight bearing. Indications: We present a case of an anatomic repair of a LCL and an ALCC injury with internal brace augmentation. Technique Description: A curvilinear incision centered over the lateral epicondyle is used. The avulsed LCL and biceps tendon was exposed and a placed #5 FiberWire was placed into the distal LCL, biceps tendon, and the popliteofibular ligament. A split was made in the iliotibial (IT) band and a second #5 FiberWire was placed proximally in the LCL/biceps tendon for additional fixation. A tunnel was made in the fibular head and tibia using a 2.4-mm beath pin and the two #5 FiberWires were passed to the anteromedial tibia. The FiberWires were fixed to the tibia using a 14-mm attachable button system (ABS) manhole cover for suspensory fixation. Repair and internal bracing of the anterolateral capsular complex was accomplished with 2 interlocked TightRopes and a #2 FiberTape. This fixation method achieved repair by compressing the anterolateral capsular complex onto its tibial origin. The suture devices also served to augment the repair and were fixed proximally to the femur using another 14-mm ABS manhole cover. The FiberTape was fixed to the anterolateral tibia distally with a 4.5 mm SwiveLock. The TightRopes were passed through a tunnel to the anterolateral tibia and secured using an ABS Dog Bone. The construct was tensioned in near full extension and gapping was matched fluoroscopically to the contralateral knee. Results: Patient was cleared for full return to sports 9 months postoperatively. At the final follow up visit, the patient had excellent strength, stability, and 135° range of motion on the operative knee. Patient had returned to exercise at home but was unable to return to sports due to COVID-19 restrictions. Conclusion: Anatomic repair of the LCL and the ALCC with internal brace augmentation can serve as an effective alternative to reconstruction and demonstrates excellent patient outcomes regarding restoring stability, ROM, and return to preoperative sports.https://doi.org/10.1177/26350254221093082 |
| spellingShingle | Kyle Schoell MD Aryan Haratian BA Amir Fathi BS Ioanna K. Bolia MD, MS, PhD Laith K. Hasan BBA Frank A. Petrigliano MD Alexander E. Weber MD George F. “Rick“ Hatch MD Anatomic Repair of a Lateral Collateral Ligament and Anterolateral Capsular Complex Injury With Internal Brace Augmentation Video Journal of Sports Medicine |
| title | Anatomic Repair of a Lateral Collateral Ligament and Anterolateral Capsular Complex Injury With Internal Brace Augmentation |
| title_full | Anatomic Repair of a Lateral Collateral Ligament and Anterolateral Capsular Complex Injury With Internal Brace Augmentation |
| title_fullStr | Anatomic Repair of a Lateral Collateral Ligament and Anterolateral Capsular Complex Injury With Internal Brace Augmentation |
| title_full_unstemmed | Anatomic Repair of a Lateral Collateral Ligament and Anterolateral Capsular Complex Injury With Internal Brace Augmentation |
| title_short | Anatomic Repair of a Lateral Collateral Ligament and Anterolateral Capsular Complex Injury With Internal Brace Augmentation |
| title_sort | anatomic repair of a lateral collateral ligament and anterolateral capsular complex injury with internal brace augmentation |
| url | https://doi.org/10.1177/26350254221093082 |
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