Skip to main content
Top
Published in: Archives of Orthopaedic and Trauma Surgery 11/2012

01-11-2012 | Arthroscopy and Sports Medicine

Relative role changing of lateral collateral ligament on the posterolateral rotatory instability according to the knee flexion angles: a biomechanical comparative study of role of lateral collateral ligament and popliteofibular ligament

Authors: Hong Chul Lim, Ji Hoon Bae, Tae Soo Bae, Byung Chul Moon, Ashok K. Shyam, Joon Ho Wang

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 11/2012

Login to get access

Abstract

Purpose

This cadaveric study assessed the relative role of the lateral collateral ligament (LCL) and popliteofibular ligament (PFL) in limiting tibia external rotation.

Methods

Eight paired cadaveric knees were divided into two groups. The specimens were mounted on a rotational wheel and 5 Nm external rotation torque was applied before and after cutting the ligaments at 0°–30°–60°–90° knee flexion. Three cutting steps were applied: (1) PT (popliteus tendon)-, (2) LCL-, (3) PFL in group I, and (1) PT-, (2) PFL-, (3)LCL in group II. Increased external rotation at each step was taken as the ratio of final external rotation at the end of step 3. Repeated measure ANOVA and a Mann–Whitney U test were used for statistical analysis.

Results

At step 2, the ratio of increased external rotation after cutting the LCL (group I) was similar to the ratio after cutting the PFL (group II) at 0° and 30° flexion, but that of group I was lower than group II at 60° and 90° flexion (p = 0.029 and p = 0.029). At step-3, the ratio after cutting the LCL (group II) was less than the ratio after cutting the PFL (group I) at 90° flexion (p = 0.029).

Conclusion

The PFL and LCL play equally important roles in limiting external rotation at the knee extended position (0°, 30°) but the LCL contribution becomes smaller than PFL at the flexed position (60°, 90°).
Literature
1.
go back to reference Albright JP, Brown AW (1998) Management of chronic posterolateral rotatory instability of the knee: surgical technique for the posterolateral corner sling procedure. Instr Course Lect 47:369–378PubMed Albright JP, Brown AW (1998) Management of chronic posterolateral rotatory instability of the knee: surgical technique for the posterolateral corner sling procedure. Instr Course Lect 47:369–378PubMed
2.
go back to reference Bae JH, Choi IC, Suh SW, Lim HC, Bae TS, Nha KW, Wang JH (2008) Evaluation of the reliability of the dial test for posterolateral rotatory instability: a cadaveric study using an isotonic rotation machine. Arthroscopy 24:593–598PubMedCrossRef Bae JH, Choi IC, Suh SW, Lim HC, Bae TS, Nha KW, Wang JH (2008) Evaluation of the reliability of the dial test for posterolateral rotatory instability: a cadaveric study using an isotonic rotation machine. Arthroscopy 24:593–598PubMedCrossRef
3.
go back to reference Chun YM, Kim SJ, Kim HS (2008) Evaluation of the mechanical properties of posterolateral structures and supporting posterolateral instability of the knee. J Orthop Res 26:1371–1376PubMedCrossRef Chun YM, Kim SJ, Kim HS (2008) Evaluation of the mechanical properties of posterolateral structures and supporting posterolateral instability of the knee. J Orthop Res 26:1371–1376PubMedCrossRef
4.
go back to reference Clavert P, Kempf JF, Bonnomet F, Boutemy P, Marcelin L, Kahn JL (2001) Effects of freezing/thawing on the biomechanical properties of human tendons. Surg Radiol Anat 23:259–262PubMedCrossRef Clavert P, Kempf JF, Bonnomet F, Boutemy P, Marcelin L, Kahn JL (2001) Effects of freezing/thawing on the biomechanical properties of human tendons. Surg Radiol Anat 23:259–262PubMedCrossRef
5.
go back to reference Coobs BR, LaPrade RF, Griffith CJ, Nelson BJ (2007) Biomechanical analysis of an isolated fibular (lateral) collateral ligament reconstruction using an autogenous semitendinosus graft. Am J Sports Med 35:1521–1527PubMedCrossRef Coobs BR, LaPrade RF, Griffith CJ, Nelson BJ (2007) Biomechanical analysis of an isolated fibular (lateral) collateral ligament reconstruction using an autogenous semitendinosus graft. Am J Sports Med 35:1521–1527PubMedCrossRef
6.
go back to reference Covey DC (2001) Injuries of the posterolateral corner of the knee. J Bone Joint Surg Am 83-A:106–118PubMed Covey DC (2001) Injuries of the posterolateral corner of the knee. J Bone Joint Surg Am 83-A:106–118PubMed
7.
go back to reference Csintalan RP, Ehsan A, McGarry MH, Fithian DF, Lee TQ (2006) Biomechanical and anatomical effects of an external rotational torque applied to the knee: a cadaveric study. Am J Sports Med 34:1623–1629PubMedCrossRef Csintalan RP, Ehsan A, McGarry MH, Fithian DF, Lee TQ (2006) Biomechanical and anatomical effects of an external rotational torque applied to the knee: a cadaveric study. Am J Sports Med 34:1623–1629PubMedCrossRef
8.
go back to reference Fanelli GC, Edson CJ (1995) Posterior cruciate ligament injuries in trauma patients: part II. Arthroscopy 11:526–529PubMedCrossRef Fanelli GC, Edson CJ (1995) Posterior cruciate ligament injuries in trauma patients: part II. Arthroscopy 11:526–529PubMedCrossRef
9.
go back to reference Fanelli GC, Larson RV (2002) Practical management of posterolateral instability of the knee. Arthroscopy 18:1–8PubMed Fanelli GC, Larson RV (2002) Practical management of posterolateral instability of the knee. Arthroscopy 18:1–8PubMed
10.
go back to reference Ferrari DA, Wilson DR, Hayes WC (2003) The effect of release of the popliteus and quadriceps force on rotation of the knee. Clin Orthop Relat Res 412:225–233PubMedCrossRef Ferrari DA, Wilson DR, Hayes WC (2003) The effect of release of the popliteus and quadriceps force on rotation of the knee. Clin Orthop Relat Res 412:225–233PubMedCrossRef
11.
go back to reference Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee: a biomechanical study. J Bone Joint Surg Am 69:233–242PubMed Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee: a biomechanical study. J Bone Joint Surg Am 69:233–242PubMed
12.
go back to reference Grood ES, Stowers SF, Noyes FR (1988) Limits of movement in the human knee: effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am 70:88–97PubMed Grood ES, Stowers SF, Noyes FR (1988) Limits of movement in the human knee: effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am 70:88–97PubMed
13.
go back to reference Jakobsen BW, Lund B, Christiansen SE, Lind MC (2010) Anatomic reconstruction of the posterolateral corner of the knee: a case series with isolated reconstructions in 27 patients. Arthroscopy 26:918–925PubMedCrossRef Jakobsen BW, Lund B, Christiansen SE, Lind MC (2010) Anatomic reconstruction of the posterolateral corner of the knee: a case series with isolated reconstructions in 27 patients. Arthroscopy 26:918–925PubMedCrossRef
14.
go back to reference Kanamori A, Lee JM, Haemmerle MJ, Vogrin TM, Harner CD (2003) A biomechanical analysis of two reconstructive approaches to the posterolateral corner of the knee. Knee Surg Sports Traumatol Arthrosc 11:312–317PubMedCrossRef Kanamori A, Lee JM, Haemmerle MJ, Vogrin TM, Harner CD (2003) A biomechanical analysis of two reconstructive approaches to the posterolateral corner of the knee. Knee Surg Sports Traumatol Arthrosc 11:312–317PubMedCrossRef
15.
go back to reference Kim SJ, Kim HS, Moon HK, Chang WH, Kim SG, Chun YM (2010) A biomechanical comparison of 3 reconstruction techniques for posterolateral instability of the knee in a cadaveric model. Arthroscopy 26:335–341PubMedCrossRef Kim SJ, Kim HS, Moon HK, Chang WH, Kim SG, Chun YM (2010) A biomechanical comparison of 3 reconstruction techniques for posterolateral instability of the knee in a cadaveric model. Arthroscopy 26:335–341PubMedCrossRef
16.
go back to reference Kim SJ, Park IS, Cheon YM, Ryu SW (2004) New technique for chronic posterolateral instability of the knee: posterolateral reconstruction using the tibialis posterior tendon allograft. Arthroscopy 20(Suppl 2):195–200PubMed Kim SJ, Park IS, Cheon YM, Ryu SW (2004) New technique for chronic posterolateral instability of the knee: posterolateral reconstruction using the tibialis posterior tendon allograft. Arthroscopy 20(Suppl 2):195–200PubMed
17.
go back to reference LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A (2004) An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med 32:1405–1414PubMedCrossRef LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A (2004) An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med 32:1405–1414PubMedCrossRef
18.
go back to reference LaPrade RF, Ly TV, Wentorf FA, Engebretsen L (2003) The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med 31:854–860PubMed LaPrade RF, Ly TV, Wentorf FA, Engebretsen L (2003) The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med 31:854–860PubMed
19.
go back to reference LaPrade RF, Resig S, Wentorf F, Lewis JL (1999) The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force: a biomechanical analysis. Am J Sports Med 27:469–475PubMed LaPrade RF, Resig S, Wentorf F, Lewis JL (1999) The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force: a biomechanical analysis. Am J Sports Med 27:469–475PubMed
20.
go back to reference LaPrade RF, Tso A, Wentorf FA (2004) Force measurements on the fibular collateral ligament, popliteofibular ligament, and popliteus tendon to applied loads. Am J Sports Med 32:1695–1701PubMedCrossRef LaPrade RF, Tso A, Wentorf FA (2004) Force measurements on the fibular collateral ligament, popliteofibular ligament, and popliteus tendon to applied loads. Am J Sports Med 32:1695–1701PubMedCrossRef
21.
go back to reference LaPrade RF, Wozniczka JK, Stellmaker MP, Wijdicks CA (2010) Analysis of the static function of the popliteus tendon and evaluation of an anatomic reconstruction: the “fifth ligament” of the knee. Am J Sports Med 38:543–549PubMedCrossRef LaPrade RF, Wozniczka JK, Stellmaker MP, Wijdicks CA (2010) Analysis of the static function of the popliteus tendon and evaluation of an anatomic reconstruction: the “fifth ligament” of the knee. Am J Sports Med 38:543–549PubMedCrossRef
22.
23.
go back to reference Lee MC, Park YK, Lee SH, Jo H, Seong SC (2003) Posterolateral reconstruction using split Achilles tendon allograft. Arthroscopy 19:1043–1049PubMedCrossRef Lee MC, Park YK, Lee SH, Jo H, Seong SC (2003) Posterolateral reconstruction using split Achilles tendon allograft. Arthroscopy 19:1043–1049PubMedCrossRef
24.
go back to reference Markolf KL, Graves BR, Sigward SM, Jackson SR, McAllister DR (2007) How well do anatomical reconstructions of the posterolateral corner restore varus stability to the posterior cruciate ligament-reconstructed knee? Am J Sports Med 35:1117–1122PubMedCrossRef Markolf KL, Graves BR, Sigward SM, Jackson SR, McAllister DR (2007) How well do anatomical reconstructions of the posterolateral corner restore varus stability to the posterior cruciate ligament-reconstructed knee? Am J Sports Med 35:1117–1122PubMedCrossRef
25.
go back to reference Maynard MJ, Deng X, Wickiewicz TL, Warren RF (1996) The popliteofibular ligament: rediscovery of a key element in posterolateral stability. Am J Sports Med 24:311–316PubMedCrossRef Maynard MJ, Deng X, Wickiewicz TL, Warren RF (1996) The popliteofibular ligament: rediscovery of a key element in posterolateral stability. Am J Sports Med 24:311–316PubMedCrossRef
26.
go back to reference Nau T, Chevalier Y, Hagemeister N, Deguise JA, Duval N (2005) Comparison of 2 surgical techniques of posterolateral corner reconstruction of the knee. Am J Sports Med 33:1838–1845PubMedCrossRef Nau T, Chevalier Y, Hagemeister N, Deguise JA, Duval N (2005) Comparison of 2 surgical techniques of posterolateral corner reconstruction of the knee. Am J Sports Med 33:1838–1845PubMedCrossRef
27.
go back to reference Pasque C, Noyes FR, Gibbons M, Levy M, Grood E (2003) The role of the popliteofibular ligament and the tendon of popliteus in providing stability in the human knee. J Bone Joint Surg Br 85:292–298PubMedCrossRef Pasque C, Noyes FR, Gibbons M, Levy M, Grood E (2003) The role of the popliteofibular ligament and the tendon of popliteus in providing stability in the human knee. J Bone Joint Surg Br 85:292–298PubMedCrossRef
28.
go back to reference Ricchetti ET, Sennett BJ, Huffman GR (2008) Acute and chronic management of posterolateral corner injuries of the knee. Orthopedics 31:479–488 quiz 489–490CrossRef Ricchetti ET, Sennett BJ, Huffman GR (2008) Acute and chronic management of posterolateral corner injuries of the knee. Orthopedics 31:479–488 quiz 489–490CrossRef
29.
go back to reference Sekiya JK, Kurtz CA (2005) Posterolateral corner reconstruction of the knee: surgical technique utilizing a bifid Achilles tendon allograft and a double femoral tunnel. Arthroscopy 21:1400PubMed Sekiya JK, Kurtz CA (2005) Posterolateral corner reconstruction of the knee: surgical technique utilizing a bifid Achilles tendon allograft and a double femoral tunnel. Arthroscopy 21:1400PubMed
30.
go back to reference Shahane SA, Ibbotson C, Strachan R, Bickerstaff DR (1999) The popliteofibular ligament: an anatomical study of the posterolateral corner of the knee. J Bone Joint Surg Br 81:636–642PubMedCrossRef Shahane SA, Ibbotson C, Strachan R, Bickerstaff DR (1999) The popliteofibular ligament: an anatomical study of the posterolateral corner of the knee. J Bone Joint Surg Br 81:636–642PubMedCrossRef
31.
go back to reference Sidles JA, Larson RV, Garbini JL, Downey DJ, Matsen FA 3rd (1988) Ligament length relationships in the moving knee. J Orthop Res 6:593–610PubMedCrossRef Sidles JA, Larson RV, Garbini JL, Downey DJ, Matsen FA 3rd (1988) Ligament length relationships in the moving knee. J Orthop Res 6:593–610PubMedCrossRef
32.
go back to reference Sugita T, Amis AA (2001) Anatomic and biomechanical study of the lateral collateral and popliteofibular ligaments. Am J Sports Med 29:466–472PubMed Sugita T, Amis AA (2001) Anatomic and biomechanical study of the lateral collateral and popliteofibular ligaments. Am J Sports Med 29:466–472PubMed
33.
go back to reference Veltri DM, Deng XH, Torzilli PA, Warren RF, Maynard MJ (1995) The role of the cruciate and posterolateral ligaments in stability of the knee: a biomechanical study. Am J Sports Med 23:436–443PubMedCrossRef Veltri DM, Deng XH, Torzilli PA, Warren RF, Maynard MJ (1995) The role of the cruciate and posterolateral ligaments in stability of the knee: a biomechanical study. Am J Sports Med 23:436–443PubMedCrossRef
34.
go back to reference Veltri DM, Warren RF (1994) Operative treatment of posterolateral instability of the knee. Clin Sports Med 13:615–627PubMed Veltri DM, Warren RF (1994) Operative treatment of posterolateral instability of the knee. Clin Sports Med 13:615–627PubMed
35.
go back to reference Veltri DM, Warren RF (1995) Posterolateral instability of the knee. Instr Course Lect 44:441–453PubMed Veltri DM, Warren RF (1995) Posterolateral instability of the knee. Instr Course Lect 44:441–453PubMed
36.
go back to reference Yoon KH, Bae DK, Ha JH, Park SW (2006) Anatomic reconstructive surgery for posterolateral instability of the knee. Arthroscopy 22:159–165PubMedCrossRef Yoon KH, Bae DK, Ha JH, Park SW (2006) Anatomic reconstructive surgery for posterolateral instability of the knee. Arthroscopy 22:159–165PubMedCrossRef
Metadata
Title
Relative role changing of lateral collateral ligament on the posterolateral rotatory instability according to the knee flexion angles: a biomechanical comparative study of role of lateral collateral ligament and popliteofibular ligament
Authors
Hong Chul Lim
Ji Hoon Bae
Tae Soo Bae
Byung Chul Moon
Ashok K. Shyam
Joon Ho Wang
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 11/2012
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-012-1591-7

Other articles of this Issue 11/2012

Archives of Orthopaedic and Trauma Surgery 11/2012 Go to the issue