1. Arciero vs. Laprade: A Biomechanical Comparison of Two Techniques for Knee Posterolateral Corner Reconstruction
Gabriel Ortiz1,2
, Heather Menzer1
, George K.Gill1
, Paul Johnson1
, Robert Schenck1
, Gehron Treme1
, Fares Qeadan3
, Christina Salas1,2
Dept. of Orthopaedics and Rehabilitation1
; Dept. of Mechanical Engineering2
; Clinical Translational Science Center (CTSC),3
University of New Mexico, Albuquerque, NM
Disclosures: The authors have nothing to disclose.
INTRODUCTION: The Posterolateral Corner (PLC) is an area of the knee that does not receive adequate research recognition despite its functionality and
contribution to the overall stability of the knee. Until recently, its anatomy and biomechanics have been poorly understood and the need for diagnosis and
treatment have been in a constant state of evolution. This has led to the creation of multiple reconstruction methods. The two most commonly used
techniques are the Arciero and LaPrade reconstructions. Both have shown promising outcomes, but the two techniques have never been compared against
each other from a biomechanical perspective. The objective of this study is to identify which reconstruction technique best restores stability to an isolated
PLC injury in addition to an injury at the tibiofibular joint.
METHODS: Ten matched paired fresh-frozen cadaveric specimens from mid femur to foot were used. A trained surgeon harvested the Semitendinosus,
Gracilis, and Achilles tendons from each specimen to use as allografts for the corresponding reconstructions. The skin and subcutaneous fat was removed
from all specimens. Mechanical Testing: To examine the significance of PLC instability a custom made testing fixture was created to isolate and test for 10
Nm Varus Angulation (VA) and 5 Nm External Rotation (ER) at 00
, 200
, 300
, 600
, and 900
of flexion about the knee joint. A torque/force rod was fixed in
the distal end of the tibial canal so that VA and ER may be applied through the testing fixture. VA was determined by measuring the length of the moment
arm (knee joint to force sensor) and calculating the appropriate tensile force in order to create a 10 Nm moment. A Nidec-SHIMPO FG-3008 digital force
gauge was used to apply a tensile force perpendicular to the direction of the Rod. A torque wrench set at a 5 Nm was used to apply ER about the Rod. Data
Acquisition: 8 Optitrax Motion Capture cameras were used to acquire VA and ER data through the use of 3 rigid body marker sets placed on the tibial
tuberosity, the anterior aspect of the femur (5 cm proximal from the knee joint), and on the outside arm of the testing fixture located adjacent to its point of
rotation. The motion capture software recorded the initial and final positions of the marker sets in the space defined around the testing fixture. An unaltered
initial test was taken of each specimen followed by post-sectioning of the PLC, post-reconstruction, and post Tib-Fib sectioning. For every pair, 1 leg was
reconstructed with the Arciero technique while the opposite leg underwent the LaPrade technique for comparison. Data Analysis: Multivariate Analysis of
Variance (MANOVA) was used, through the SAS system, to assess the mean differences over the five angles between the Arciero and LaPrade techniques.
The Wilks' Lambda statistic and significance level of 5% were used to establish statistically significant differences.
RESULTS: For initial testing, we found the VA profiles of the Arciero and LaPrade specimens to be statistically the same, while the ER profiles showed
dissimilarity at 60⁰ and 90⁰ of flexion. To account for this dissimilarity, the ER profiles for Post Reconstruction and Tib-Fib Sectioning were adjusted
accordingly by subtracting the differences of the Post Reconstruction/Post Tib-Fib Sectioning ER mean values from the Initial Testing ER mean values.
Data analysis concluded that there was no statistical significance between the LaPrade and Arciero techniques for Post Reconstruction and Tib-Fib
Sectioning (P >> 0.05) in either VA or ER based on the Wilks' Lambda statistic and a 5% significance level.
DISCUSSION: The outcome measures of this study show no statistical significance between the Arciero and LaPrade techniques for VA and ER at varying
degrees of knee flexion.
SIGNIFICANCE: This Arciero vs. LaPrade comparison allows for surgeons to select from the reconstruction technique they prefer based on their
experience and training without concern for varying surgical outcomes.
REFERENCES: [1] LaPrade, F. Robert et al. 2003. The Posterolateral Attachments of the Knee. Am J Sports Med. 854-860. [2] Arciero, A. Robert. 2005.
Technical Note: Anatomic Posterolateral Corner Reconstruction. The Journal of Arthroscopic and Related Surgery. (21) 1147.e1-1147.e5.
Figure 1. A. ER profiles for initial testing. B. ER adjusted profile post reconstruction. C. ER adjusted profile post tib-fib sectioning. D. VA profile for initial
testing. E. VA profile post reconstruction. F. VA profile post tib-fib sectioning.
A B C
D E F