Purpose
To determine whether a fluoroscopic technique can be used to improve the accuracy
of the determination of the femoral origin of the lateral collateral ligament (LCL).
Methods
A 1-cm incision was made over the lateral epicondyle in 13 fresh-frozen cadaveric
knee specimens, and the LCL origin was determined first by palpation and then with
a previously described fluoroscopic method. Both points for the LCL origin were marked
with 2-mm Kirschner wires. The distances between the center of the anatomic LCL origin
and the LCL origin points determined by palpation and fluoroscopic imaging were calculated.
An independent t-test was used to compare the distances between the anatomic LCL origin center and
the determined LCL origin points.
Results
The LCL origin points determined by fluoroscopic imaging were significantly (P = .005) closer to the anatomic center of the LCL origin point than the ones determined
by palpation (3.2 mm ± 1.6 mm vs 5.0 mm ± 1.6 mm, respectively). A total of 92.7%
fluoroscopically determined LCL origin points were within a 5 mm radius surrounding
the anatomic LCL origin point. In contrast, only 53.8% LCL origin points determined
by palpation were within a 5 mm radius surrounding the anatomic LCL origin point.
Conclusions
The use of palpation to identify the LCL origin may not be an accurate method for
performing an isometric and anatomic LCL reconstruction. The use of fluoroscopic imaging
appears to be a feasible method for identifying the LCL origin in clinical practice
and may increase the accuracy of LCL origin identification. Fluoroscopic guidance
improves accuracy in determining the anatomic LCL origin, which may help avoiding
tunnel malplacement during LCL reconstruction.
Clinical Relevance
The use of a previously described radiographic method for identifying the LCL origin
may be used to achieve a more anatomic LCL reconstruction.
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Article info
Publication history
Published online: May 30, 2018
Accepted:
March 26,
2018
Received:
November 9,
2017
Footnotes
See commentary on page 2494
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2018 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Small Incisions Can Make Big Mistakes: Knee Lateral Collateral Ligament Reconstruction Is All About the Anatomy!ArthroscopyVol. 34Issue 8
- PreviewIt is becoming increasingly recognized that isolated lateral collateral ligament (LCL) tears are more common than have been previously recognized and that anatomic-based LCL reconstructions have the best outcomes. Although it was believed that posterolateral corner injuries were often missed or mistreated and were given the pneumonic of "the dark side of the knee," we are getting to the point where most of these more severe injuries are being recognized, and it is the isolated LCL injuries that are still less well recognized.
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