Posterolateral Corner Reconstruction Using the Anatomical Two-Tailed Graft Technique: Clinical Outcomes in the Multiligament Injured Knee

Abstract

Injury to the posterolateral corner (PLC) of the knee can lead to both varus and rotational instability. Multiple PLC reconstruction techniques have been described, including one-tailed graft (fibula-based constructs) or two-tailed graft (combined fibula- and tibia-based constructs). The purpose of our study was to evaluate the clinical outcomes of anatomical two-tailed graft reconstruction of the PLC in the setting of multiligament knee injuries (MKLIs) with grade III varus instability. Patients were identified through a prospective MLKI database between 2004 and 2013. Patients who received fibular collateral ligament and PLC reconstructions using a two-tailed graft and had a minimum follow-up of 2 years were included. Patients were assessed for clinical laxity grade, range of motion, and functional outcomes using Lysholm and International Knee Documentation Committee (IKDC) scores. Twenty patients (16 male, 4 female) with a mean age of 30.7 (range: 16–52) and a mean follow-up of 52.2 months (range: 24–93 months) were included. Knee dislocation (KD) grades included: 4 KD-1, 10 KD 3-L, 5 KD-4, and 1 KD-5. No patients had isolated PLC injuries. Mean IKDC and Lysholm score were 73.1 ± 25.8 and 78 ± 26, respectively. Mean range of motion was –1.1 to 122.8. In full extension, two patients (10%) had grade 1 laxity to varus stress. In 30 degrees of knee flexion, five (25%) patients had grade 1 laxity, and two (10%) had grade 2 laxity. Anatomical two-tailed PLC reconstruction can reliably restore varus stability when performed on patients with MLKIs and type C posterolateral instability with hyperextension external rotation recurvatum deformity. Satisfactory functional outcome scores were achieved in the majority of patients. This study supports the use of an anatomical two-tailed PLC reconstruction in the multiligament injured knee. The level of evidence is IV, case series.

Keywords

knee - posterolateral corner - knee dislocation

• References

• 1 LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A. An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med 2004; 32 (06) 1405-1414
• 2 LaPrade RF, Muench C, Wentorf F, Lewis JL. The effect of injury to the posterolateral structures of the knee on force in a posterior cruciate ligament graft: a biomechanical study. Am J Sports Med 2002; 30 (02) 233-238
• 3 Levy BA, Boyd JL, Stuart MJ. Surgical treatment of acute and chronic anterior and posterior cruciate ligament and lateral side injuries of the knee. Sports Med Arthrosc Rev 2011; 19 (02) 110-119
• 4 Levy BA, Fanelli GC, Whelan DB. , et al; Knee Dislocation Study Group. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg 2009; 17 (04) 197-206
• 5 Levy BA, Stuart MJ. Treatment of PCL, ACL, and lateral-side knee injuries: acute and chronic. J Knee Surg 2012; 25 (04) 295-305
• 6 LaPrade RF, Resig S, Wentorf F, Lewis JL. The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. A biomechanical analysis. Am J Sports Med 1999; 27 (04) 469-475
• 7 Stannard JP, Brown SL, Farris RC, McGwin Jr G, Volgas DA. The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med 2005; 33 (06) 881-888
• 8 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. Am J Sports Med 2010; 38 (04) 804-809
• 9 Schechinger SJ, Levy BA, Dajani KA, Shah JP, Herrera DA, Marx RG. Achilles tendon allograft reconstruction of the fibular collateral ligament and posterolateral corner. Arthroscopy 2009; 25 (03) 232-242
• 10 Fanelli GC, Fanelli DG, Edson CJ, Fanelli MG. Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries. J Knee Surg 2014; 27 (05) 353-358
• 11 Kim SJ, Kim SH, Chun YM, Hwang BY, Choi DH, Yoon JY. Clinical comparison of conventional and remnant-preserving transtibial single-bundle posterior cruciate ligament reconstruction combined with posterolateral corner reconstruction. Am J Sports Med 2012; 40 (03) 640-649
• 12 McGuire DA, Wolchok JC. Posterolateral corner reconstruction. Arthroscopy 2003; 19 (07) 790-793
• 13 Arciero RA. Anatomic posterolateral corner knee reconstruction. Arthroscopy 2005; 21 (09) 1147
• 14 Stannard JP, Brown SL, Robinson JT, McGwin Jr G, Volgas DA. Reconstruction of the posterolateral corner of the knee. Arthroscopy 2005; 21 (09) 1051-1059
• 15 Blackman AJ, Engasser WM, Krych AJ, Stuart MJ, Levy BA. Fibular head and tibial-based (2-tailed) posterolateral corner reconstruction. Sports Med Arthrosc Rev 2015; 23 (01) 44-50
• 16 Prince MR, Stuart MJ, King AH, Sousa PL, Levy BA. Posterolateral reconstruction of the knee: two-tailed surgical techniques. J Knee Surg 2015; 28 (06) 464-470
• 17 LaPrade RF, Johansen S, Agel J, Risberg MA, Moksnes H, Engebretsen L. Outcomes of an anatomic posterolateral knee reconstruction. J Bone Joint Surg Am 2010; 92 (01) 16-22
• 18 Görmeli G, Görmeli CA, Elmalı N, Karakaplan M, Ertem K, Ersoy Y. Outcome of the treatment of chronic isolated and combined posterolateral corner knee injuries with 2- to 6-year follow-up. Arch Orthop Trauma Surg 2015; 135 (10) 1363-1368
• 19 van der Wal WA, Heesterbeek PJ, van Tienen TG, Busch VJ, van Ochten JH, Wymenga AB. Anatomical reconstruction of posterolateral corner and combined injuries of the knee. Knee Surg Sports Traumatol Arthrosc 2016; 24 (01) 221-228
• 20 Collins MS, Bond JR, Crush AB, Stuart MJ, King AH, Levy BA. MRI injury patterns in surgically confirmed and reconstructed posterolateral corner knee injuries. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 2943-2949
• 21 Fanelli GC, Edson CJ, Reinheimer KN, Garofalo R. Posterior cruciate ligament and posterolateral corner reconstruction. Sports Med Arthrosc Rev 2007; 15 (04) 168-175
• 22 Edson CJ, Fanelli GC, Beck JD. Rehabilitation after multiple-ligament reconstruction of the knee. Sports Med Arthrosc Rev 2011; 19 (02) 162-166
• 23 Fanelli GC, Orcutt DR, Edson CJ. The multiple-ligament injured knee: evaluation, treatment, and results. Arthroscopy 2005; 21 (04) 471-486
• 24 Pestka JM, Bode G, Salzmann G. , et al. Clinical outcomes after cell-seeded autologous chondrocyte implantation of the knee: when can success or failure be predicted?. Am J Sports Med 2014; 42 (01) 208-215
• 25 Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR. The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 2009; 37 (05) 890-897
• 26 Hefti F, Muller W, Jakob RP, Staubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1993; 1: 226-234
• 27 Wascher DC, Dvirnak PC, DeCoster TA. Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma 1997; 11 (07) 525-529
• 28 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. Am J Sports Med 2013; 41 (07) 1605-1612
• 29 King AH, Krych AJ, Prince MR, Pareek A, Stuart MJ, Levy BA. Surgical outcomes of medial versus lateral multiligament-injured, dislocated knees. Arthroscopy 2016; 32 (09) 1814-1819
• 30 Levy NM, Krych AJ, Hevesi M. , et al. Does age predict outcome after multiligament knee reconstruction for the dislocated knee? 2- to 22-year follow-up. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 3003-3007
• 31 Kuzma SA, Chow RM, Engasser WM, Stuart MJ, Levy BA. Reconstruction of the posterolateral corner of the knee with Achilles tendon allograft. Arthrosc Tech 2014; 3 (03) e393-e398
• 32 Rios CG, Leger RR, Cote MP, Yang C, Arciero RA. Posterolateral corner reconstruction of the knee: evaluation of a technique with clinical outcomes and stress radiography. Am J Sports Med 2010; 38 (08) 1564-1574
• 33 Nau T, Chevalier Y, Hagemeister N, Deguise JA, Duval N. Comparison of 2 surgical techniques of posterolateral corner reconstruction of the knee. Am J Sports Med 2005; 33 (12) 1838-1845
• 34 Nau T, Chevalier Y, Hagemeister N, Duval N, deGuise JA. 3D kinematic in-vitro comparison of posterolateral corner reconstruction techniques in a combined injury model. Knee Surg Sports Traumatol Arthrosc 2005; 13 (07) 572-580
• 35 Moulton SGFC, Cram T, LaPrade RF. Posterolateral reconstruction of the knee: surgical technique with 2 grafts. Oper Tech Sports Med 2015; 23 (04) 331-337