Biomechanical Comparisons Between 4-Strand and Modified Larson 2-Strand Procedures for Reconstruction of the Posterolateral Corner of the Knee

Abstract

Background: The posterolateral corner (PLC) resists tibial varus angulation, external rotation, and, to a lesser extent, posterior translation. It is important that reconstructions of posterolateral knee injuries restore joint laxity and patient function, but residual laxities are often observed.

Hypothesis: The knee laxity after a new 4-strand PLC reconstruction would be closer to normal than after a 2-strand “modified Larson” reconstruction.

Study Design: Controlled laboratory study.

Methods: Fourteen intact cadaveric knees were mounted in a 6 degrees of freedom rig and subjected to the following external loading conditions: a 90-N posterior tibial force, a 5-N·m external rotation torque, and 5-N·m varus moment. Knee kinematics were recorded with an active optical tracking system for the intact, PLC-deficient, modified Larson PLC reconstruction and 4-strand PLC reconstruction.

Results: With external tibial torque, the rotational laxity in 4-strand reconstruction was significantly less than in the PLC-deficient (P < .0001) and modified Larson reconstruction (P = .0112) and did not differ significantly from intact laxity at any angle of flexion. In response to posterior load, posterior translation did not change in any of the tested conditions, while the coupled external rotation laxity in 4-strand PLC reconstruction was significantly less than in the PLC-deficient (P < .0001) and modified Larson reconstruction (P < .0486) and was not significantly different from the intact movements for both reconstructions. The varus angulation-versus-flexion curves were significantly different between the PLC-deficient and both PLC reconstructions (P < .0001). The varus laxity was not significantly different between the modified Larson reconstruction, the 4-strand reconstruction, and the intact knee.

Conclusion: This study showed that the rotational knee laxity in response to both external rotation and posterior translation load were significantly better after the 4-strand PLC reconstruction than after the modified Larson reconstruction, although significant differences were not found between the 2 procedures for varus laxity.

Clinical Relevance: The 4-strand PLC reconstruction may produce a better biomechanical outcome, especially during external rotation and posterior translation tibial load. The authors suggest that this relates to load sharing among 4 graft strands crossing the joint.