Outcomes of Repair and Reconstruction of the Acute Posterolateral Corner Injuries of the Knee Combined with Cruciate Ligaments Injuries

Document Type : RESEARCH PAPER

Authors

1 Clinical Research Development Unit of Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 2 Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 3 Joint, Bone, Connective Tissue Rheumatology Research Center (JBCRC), Golestan University of Medical Sciences, Gorgan, Iran

4 2 Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 4 Department of Surgery and Orthopedics, Ardabil University of Medical Sciences, Ardabil, Iran

Abstract

Background: This study aimed to report objective and subjective knee stability scores for patients who underwent 
acute repair of avulsed posterolateral corner (PLC) structures or acute reconstruction of midsubstance tears combined 
with delayed reconstruction of cruciate ligaments. 
Methods: A total of 48 sport and vehicle accident traumatic patients were enrolled in a three-year follow-up study. The 
patients were investigated by clinical exams, subjective and objective International Knee Documentation Committee 
(IKDC) score, Tegner score, Lysholm score, and stress imaging. All scores were compared between the reconstruction 
and repair groups.
Results: Subjective IKDC scores were obtained at 83.3±9.6 and 88.3±4.39 for the reconstruction and repair groups, 
respectively. Only two patients in the reconstruction group had abnormal objective IKDC scores. Based on the Tegner 
score, 15 out of 18 patients in the repair group and 20 out of 24 patients in the reconstruction group regained their 
pre-injury functional level. Mean Lysholm scores for the reconstruction and repair groups were estimated at 83.4±8.2 
and 88.2±4.1, respectively. Mean lateral joint opening differences between two knees in the reconstruction and repair 
groups were -0.2±0.1mm and 0.5±0.1mm, respectively. There were no statistically significant differences between 
groups outcomes. We had no failure of treatment at the final follow-up.
Conclusion: Acute intervention within 3 weeks after PLC injuries combined with delayed cruciate ligaments 
reconstructions showed favorable outcomes. Both repair and reconstruction are effective when deciding based on the 
type of injury (i.e., avulsion and midsubstance tear).
Level of evidence: IV

Keywords

References

  1. Wascher DC, Grauer JD, Markoff KL. Biceps tendon tenodesis for posterolateral instability of the knee: an in vitro study. The American Journal of Sports Medicine. 1993;21(3):400-6.
  2. Yang BS, Bae WH, Ha JK, Lee DW, Jang HW, Kim JG. Posterolateral corner reconstruction using the single fibular sling method for posterolateral rotatory instability of the knee. The American journal of sports medicine. 2013;41(7):1605-12.
  3. Seebacher J, Inglis A, Marshall J, Warren R. The structure of the posterolateral aspect of the knee. JBJS. 1982;64(4):536-41.
  4. Baker JR CL, Norwood LA, Hughston JC. Acute combined posterior cruciate and posterolateral instability of the knee. The American Journal of Sports Medicine. 1984;12(3):204-8.
  5. LaPrade RF, Hamilton CD, Engebretsen L. Treatment or acute and chronic combined anterior cruciate ligament and posterolateral knee ligament injuries. Sports Medicine and Arthroscopy Review. 1997;5(2):91-9.
  6. Harner CD, Vogrin TM, Höher J, Ma CB, Woo SL. Biomechanical analysis of a posterior cruciate ligament reconstruction: deficiency of the posterolateral structures as a cause of graft failure. The American journal of sports medicine. 2000;28(1):32-9.
  7. LaPrade RF, Resig S, Wentorf F, Lewis JL. The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. The American Journal of Sports Medicine. 1999;27(4):469-75.
  8. Cooper JM, McAndrews PT, LaPrade RF. Posterolateral corner injuries of the knee: anatomy, diagnosis, and treatment. Sports medicine and arthroscopy review. 2006;14(4):213-20.
  9. Veltri D, Warren R. Anatomy, biomechanics, and physical findings in posterolateral knee instability. Clinics in sports medicine. 1994;13(3):599-614.
  10. Chahla J, Moatshe G, Dean CS, LaPrade RF. Posterolateral corner of the knee: current concepts. Archives of Bone and Joint Surgery. 2016;4(2):97.
  11. Levy BA, Dajani KA, Morgan JA, Shah JP, Dahm DL, Stuart MJ. Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. The American journal of sports medicine. 2010;38(4):804-9.
  12. McCarthy M, Ridley T, Bollier M, Cook S, Wolf B, Amendola A. Posterolateral knee reconstruction versus repair. The Iowa Orthopaedic Journal. 2015;35:20.
  13. Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ, et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2009;25(4):430-8.
  14. Stannard JP, Brown SL, Farris RC, McGwin G, Volgas DA. The posterolateral corner of the knee: repair versus reconstruction. The American journal of sports medicine. 2005;33(6):881-8.
  15. Owens BD, Neault M, Benson E, Busconi BD. Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years. Journal of orthopaedic trauma. 2007;21(2):92-6.
  16. Geeslin AG, Moulton SG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, part 1: surgical treatment of acute injuries. The American journal of sports medicine. 2016;44(5):1336-42.
  17. Geeslin AG, LaPrade RF. Location of bone bruises and other osseous injuries associated with acute grade III isolated and combined posterolateral knee injuries. The American journal of sports medicine. 2010;38(12):2502-8.
  18. Geeslin AG, LaPrade RF. Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries: a prospective case series and surgical technique. JBJS. 2011;93(18):1672-83.
The Archives of Bone and Joint Surgery
Volume 10, Issue 4
April 2022
Pages 339-346

Files

History

  • Receive Date: 02 November 2020
  • Accept Date: 29 May 2021

Share

How to cite

Statistics