gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)

23.10. - 26.10.2018, Berlin

Compared to palpation methods the use of fluoroscopy improves the identification of the femoral lateral collateral ligament insertion site

Meeting Abstract

  • presenting/speaker Thomas Pfeiffer - University Witten/Herdecke, Orthopädie, Unfallchirurgie und Sporttraumatologie, Köln, Germany
  • Elmar Herbst - Klinikum rechts der Isar der TU München, Abteilung für Sportorthopädie, München, Germany
  • Jan-Hendrik Naendrup - Universität Witten-Herdecke, Orthopädie, Unfallchirurgie und Sporttraumatologie, Köln, Germany
  • Ajay Kanakamedala - Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, United States
  • Volker Musahl - Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, United States

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018). Berlin, 23.-26.10.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocST28-298

doi: 10.3205/18dkou152, urn:nbn:de:0183-18dkou1522

Veröffentlicht: 6. November 2018

© 2018 Pfeiffer et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: The identification of the anatomic LCL insertion point is crucial to achieve isometric results during successful lateral collateral ligament (LCL) reconstruction. Although fluoroscopic methods to determine the LCL insertion point have been previously described, most LCL reconstruction techniques identify the LCL insertion point by palpation using the lateral epicondyle as a landmark. Therefore, the purpose of the study was to compare the accuracy and reliability of fluoroscopic imaging versus palpation methods for identification of the LCL insertion points.

It is hypothesized, that compared to palpation, the use of fluoroscopic imaging will lead to more accurate identification of the LCL insertion point as evaluated by distance from the identified point to the center of the anatomic origin of the LCL.

Methods: A 1 cm incision was made over the lateral epicondyle in 13 fresh-frozen cadaveric knee specimens, and the LCL insertion point was determined by palpation. Subsequently, a by Kamath et al. previously described fluoroscopic method was used. First, to simulate a surgical setting, fluoroscopy was used to determine the LCL insertion point without any measurement tools. Fluoroscopy was then used in a laboratory setting using measurement tools to determine the LCL insertion point. Each LCL insertion point position assessed by each method was marked using 2mm K-wires. Following this, the LCL insertion area was dissected and the anatomic center of the LCL was determined using Image J Software (NIH, Bethesda, MD, USA). The distances between the center of the anatomic LCL insertion point and the LCL insertion points determined by palpation and fluoroscopic imaging were calculated. An independent t-test was used to compare the distances between the anatomic LCL insertion point and the determined LCL insertion points. McNemar's test was used for the nominal dichotomous results.

Results and conclusion: The LCL insertion points determined by fluoroscopic imaging were significantly closer to the anatomic center of the LCL insertion point than the ones determined by palpation (3.2 mm ± 1.6 mm versus 5.0 ± 1.6 mm, respectively). 12 of 13 fluoroscopically determined LCL insertion points were within a 5mm radius surrounding the anatomic LCL insertion point, and 11 of 13 were within 3mm. In contrast, only 7 of 13 LCL insertion points determined by palpation were within a 5 mm radius surrounding the anatomic LCL insertion point, and only 3 of 13 were within 3 mm.

The sole use of palpation to identify the LCL insertion point may be inadequate for identifying the area of the anatomic LCL insertion point. A previously described fluoroscopic technique to determine the LCL insertion point is a reliable and accurate method. A more accurate determination of the LCL insertion points reduces the risk of eccentric tunnel positioning during LCL reconstruction and thus minimizes the associated complications including increased anisometry and risk of excess varus laxity.