Study Shows Best Approach for Knee Surgery

The study was presented at the annual meeting of the American Orthopedic Society for Sports Medicine in Orlando (FL, USA).

Knee damage occurs when there is a tear or break in at least one of the four ligaments of the knee, particularly the anterior cruciate ligament (ACL). Orthopedic surgeons can reconstruct the joint using tissue from the patient or a cadaver. However, the posterolateral corner of the knee, the outside region of the knee just posterior to the kneecap, is a leading cause of knee reconstruction failure. Because it is poorly understood and treatment has often failed, this posterolateral corner has been called the "dark side of the knee.”

The study was led by Claude T. Moorman III, M.D., an orthopedic surgeon and director of the sports medicine program at Duke University (Durham, NC, USA). His team compared the benefits of two commonly used procedures to address this instability of the knee, using 12 pairs of cadaver knees. One procedure, called combined tibial and fibular-based reconstruction, used cadaveric tendon to make attachments from the femur to both the fibula and tibia. The other procedure, called fibular-base reconstruction, used a portion of the patient's tendon to make a figure-eight connection from the femur to the fibula.

After the surgical team performed each of the two surgeries on one knee of the pair, the knees were attached to a laboratory device that simulates the pressure and torques experienced by the knee. The team found that although both procedures can restore stability, the fibular-based method was the easier approach, requiring less time in the operating room and causing fewer surgical complications.

"While many techniques have been considered and used in clinical practice, few have been critically evaluated by biomechanical studies to determine their ability to restore normal knee function,” said Dr. Moorman. "Our study provides guidance for orthopedic surgeons who treat this difficult injury pattern.”






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Duke Univ. Medical Center