Anatomical reconstruction of posterolateral corner and combined injuries of the knee

Abstract

PURPOSE: The goal of this study was to present a 2- to 5-year prospective follow-up of an anatomical posterolateral corner reconstruction in a series of 16 patients with symptomatic instability and pain complaints of the knee. METHODS: All 16 patients underwent a posterolateral corner reconstruction as described by LaPrade et al. If cruciate ligament ruptures were present and had not been addressed earlier, these were reconstructed as well. Preoperatively and 2-5 years after surgery, multiple subjective knee outcome scores (VAS satisfaction score, Tegner, Lysholm, Noyes score and IKDC subjective knee form) were obtained, and the laxity of the joint was evaluated objectively by using bilateral varus stress radiographs to compare the injured with the uninjured knee. RESULTS: Eleven patients had concomitant ACL or PCL surgery or already had undergone surgery on this cruciate ligament. Mean varus laxity of the injured knee on varus stress radiographs improved significantly from 9.6 degrees (6.6-17.1) to 6.3 degrees (0.3-13.4), p = 0.0011. Post-operative varus laxity did not return to the level of the uninjured knee: 4.4 degrees (1.5-7.7), p = 0.036. VAS satisfaction score, the Tegner, Lysholm, Noyes scores and the IKDC subjective knee form all improved significantly. CONCLUSION: The anatomical reconstruction of the posterolateral corner does provide restoration of the external rotation stability in the majority of patients. However, the varus laxity could not be restored in all patients. Functional knee scores improved significantly, and most reconstructed knees had a laxity of <3 degrees compared with the uninjured knee, but the reconstructed knee did not become as stable as the uninjured knee. The results of this study can assist surgeons and patients to have realistic expectations of this operation. LEVEL OF EVIDENCE: Case series with no comparative group, Level IV.