Combined reconstruction of chronic posterior cruciate ligament and posterolateral corner deficiency

Abstract

We report a retrospective analysis of the results of combined arthroscopically-assisted posterior cruciate ligament reconstruction and open reconstruction of the posterolateral corner in 19 patients with chronic (three or more months) symptomatic instability and pain in the knee. All the operations were performed between 1996 and 2003 and all the patients were assessed pre- and post-operatively by physical examination and by applying three different ligament rating scores. All also had weight-bearing radiographs, MR scans and an examination under anaesthesia and arthroscopy pre-operatively. The posterior cruciate ligament reconstruction was performed using an arthroscopically-assisted single anterolateral bundle technique and the posterolateral corner structures were reconstructed using an open Larson type of tenodesis. The mean follow up was 66.8 months (24 to 110). Pre-operatively, all the patients had a grade III posterior sag according to Clancy and demonstrated more than 20 degrees of external rotation compared with the opposite normal knee on the Dial test. Post-operatively, seven patients (37%) had no residual posterior sag, 11 (58%) had a grade I posterior sag and one (5%) had a grade II posterior sag. In five patients (26%) there was persistent minimal posterolateral laxity. The Lysholm score improved from a mean of 41.2 (28 to 53) to 76.5 (57 to 100) (p = 0.0001) and the Tegner score from a mean of 2.6 (1 to 4) to 6.4 (4 to 9) (p = 0.0001). We conclude that while a combined reconstruction of chronic posterior cruciate ligament and posterolateral corner instability improves the function of the knee, it does not restore complete stability.

Management of combined anterior or posterior cruciate ligament and posterolateral corner injuries: A systematic review

“…Among them, four reported studies of combined ACL and posterolateral corner injuries [10][11][12][13] and nine studies of combined PCL and posterolateral corner injuries [14][15][16][17][18][19][20][21][22]. These 13 studies included a total of 390 patients with a mean age of 32 years.…”

“…The rehabilitation programme was detailed in only seven of the nine study reports [16][17][18][19]21,22]. In most cases, an extension splint was used for 8 days to 3 weeks then a hinged splint for 3 weeks.…”

“…In a single study, by Zorzi et al [22], the duration of immobilisation was only 2 weeks. Immediate weight bearing was allowed in one study [16], whereas time to weight bearing was 4 weeks in one study [21] and 6 weeks in another [17]. The return to sporting activities was allowed only after 6 months [19] to 9 months [16,21].…”

“…Immediate weight bearing was allowed in one study [16], whereas time to weight bearing was 4 weeks in one study [21] and 6 weeks in another [17]. The return to sporting activities was allowed only after 6 months [19] to 9 months [16,21]. The time to complete discontinuation of splint immobilisation was not specified in all the reports; it was 10-12 weeks in the study by Kim et al [21].…”

International Skeletal Trauma Symposia

“…Randomized clinical data is still lacking on the best surgical technique. [26][27][28][29][30][31][32][33][34][35][36][37][38][39] Graft options are still controversial and include autologous bone-patella tendonbone, quadriceps, and hamstring, and allograft Achilles tendon and patella tendon bone. PCL rehabilitation needs to proceed slower than ACL with a delay in hamstring resistance exercises and gravity extension.…”