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The Use of Fluoroscopy Leads to Improved Identification of the Femoral Lateral Collateral Ligament Origin Site When Compared With Traditional Tactile Techniques

  • Thomas R. Pfeiffer
    Affiliations
    Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany

    Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
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  • Elmar Herbst
    Affiliations
    Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.

    Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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  • Ajay C. Kanakamedala
    Affiliations
    Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
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  • Jan-Hendrik Naendrup
    Affiliations
    Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany

    Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
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  • Richard E. Debski
    Affiliations
    Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
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  • Volker Musahl
    Correspondence
    Address correspondence to Volker Musahl, M.D., Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA 15203, U.S.A.
    Affiliations
    Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
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      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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