title: Arthroscopic popliteus bypass graft for posterolateral instabilities of the knee : A new surgical technique.
abstract: OBJECTIVE
  An arthroscopic technique for the reconstruction of the posterolateral corner combined with posterior cruciate ligament (PCL) reconstruction was developed.
  
  
  METHODS
  Posterolateral rotational instabilities of the knee. Combined lesions of the PCL, the popliteus complex (PLT) and the posterolateral corner. Isolated PLT lesions lacking static stabilizing function.
  
  
  METHODS
  Neuromuscular disorders; knee deformities or fractures; severe posterolateral soft tissue damage.
  
  
  METHODS
  Six arthroscopic portals are necessary. Using the posteromedial portal, resect dorsal septum with a shaver. Visualize the PCL, the lateral femoral condyle and the posterolateral recessus with the PLT. Dissect the popliteomeniscal fibers; retract PLT until sulcus popliteus is visualized. Drill a 6-mm tunnel anteriorly into the distal third of the sulcus popliteus. Visualize femoral footprint of the PLT and place an anatomical drill tunnel. Pull the popliteus bypass graft into the knee and fix with bioscrews. Fix the reconstructed PCL. In cases of additional LCL injury, reconstruct LCL with autologous graft.
  
  
  METHODS
  Partial weight-bearing for 6 weeks, range of motion exercises, quadriceps-strengthening exercises on postoperative day 1. Full extension allowed immediately with flexion limited to 20° for 2 weeks, to 45° for up to week 4, and to 60° up to week 6. Use a PCL brace for 3 months, running and squatting exercises allowed after 3 months.
  
  
  RESULTS
  In the 35 patients treated, no technique-related complications. After 1 year, 12 patients had a mean Lysholm Score of 88.6 (± 8.7) points and a side-to-side difference in the posterior drawer test of 2.9 (± 2.2) mm (preoperative 13.3 [± 1.9] mm).
  
  
  CONCLUSIONS
  Low complication risk and good and excellent clinical results after arthroscopic posterolateral corner reconstruction.
authors.affiliation: Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany. k.frosch@asklepios.com.|Division of Knee and Shoulder Surgery, Sports Traumatology, Asklepios Clinic St. Georg, Hamburg, Germany. k.frosch@asklepios.com.
authors.forename: K-H
authors.initials: KH
authors.lastname: Frosch
authors.affiliation: Division of Knee and Shoulder Surgery, Sports Traumatology, Asklepios Clinic St. Georg, Hamburg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Akoto
authors.affiliation: Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Drenck
authors.affiliation: Division of Knee and Shoulder Surgery, Sports Traumatology, Asklepios Clinic St. Georg, Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Heitmann
authors.affiliation: Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Pahl
authors.affiliation: Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany.|Division of Knee and Shoulder Surgery, Sports Traumatology, Asklepios Clinic St. Georg, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Preiss
mesh_terms: D000328:Adult; D001178:Arthroplasty / Q000379:methods* / Q000534:rehabilitation; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000601:surgery; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D018482:Muscle, Skeletal / Q000601:surgery*; D000072229:Posterior Cruciate Ligament Reconstruction / Q000379:methods* / Q000534:rehabilitation; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000534:rehabilitation; D020127:Recovery of Function; D016896:Treatment Outcome
keywords: Knee; Popliteus tendon; Posterior cruciate ligament; Posterolateral corner; Posterolateral instability