Fibular- Versus Tibiofibular-Based Reconstruction of the Posterolateral Corner of the Knee: A Systematic Review and Meta-analysis

Abstract

Background: Fibular- and tibiofibular-based reconstructions are the gold standard treatment for posterolateral corner (PLC) injuries of the knee. Despite comparable outcomes in biomechanical studies, clinical results comparing these constructs remain elusive with no consensus reached regarding the best treatment option. Purpose: To perform a systematic review and meta-analysis to compare fibular- and tibiofibular-based techniques for posterolateral corner reconstruction. We aimed to identify whether any differences existed between the 2 techniques in terms of clinical outcomes and rotational and varus stability. Study Design: Meta-analysis; Level of evidence, 4. Methods: The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms (“posterolateral corner” OR “fibular collateral ligament” OR “lateral collateral ligament” OR “popliteus tendon” OR “popliteofibular ligament”) AND (“reconstruction” OR “LaPrade” OR “Larson” OR “Arciero”). Data pertaining to all patient-reported outcome measures (PROMs), postoperative complications, and valgus and rotational stability were extracted from each study. The pooled outcome data were analyzed by random- and fixed-effects models. Results: After abstract and full-text screening, 6 clinical studies were included. In total, there were 183 patients, of which 90 received fibular-based and 93 tibiofibular-based reconstruction. The majority of studies used similar surgical techniques regarding tunnel orientation, attachment sites, and graft fixation sequence. There were no differences between the groups in terms of PROMs and subjective knee scores at a mean of 20.3 months. The techniques were equally effective in restoring varus and rotational stability. Subgroup analysis revealed that the stability of a posterior cruciate ligament reconstruction postoperatively was not affected by either construct. Conclusion: Both constructs had comparable clinical outcomes and were equally effective in restoring varus and rotational stability for PLC knee injuries. The fibular-based technique may offer advantages in view of being less technically demanding and invasive and requiring fewer grafts with a quicker operative time. However, higher quality studies are required to reinforce or refute such conclusions, as the majority of studies in this review were poor to fair quality.

Posterolateral Corner of the Knee: An Update on Current Evaluation and Management Strategies

“…They concluded, however, that higher quality studies are required to reinforce or refute such conclusions because most of the studies in this review were of poor-to-fair quality. 38 Dekker et al 39 in their retrospective study found no difference in laxity or clinical outcomes in patients having LCL reconstructions when comparing autografts and allografts. The extra-articular nature of the PLC makes allograft a reasonable option, barring their availability.…”

“…They concluded, however, that higher quality studies are required to reinforce or refute such conclusions because most of the studies in this review were of poor-to-fair quality. 38…”

“…1 A medial opening wedge osteotomy allows better control of the slope and is preferred in combined PLC/PCL injuries. 38 Rarely, a distal femoral osteotomy may be required depending on where the bony deformity lies. Techniques described for reconstruction in the chronic setting include the use of a fibular sling with a capsular shift or a two-tunnel (fibular and tibial) technique.…”

The Triple Varus Knee: A Case Presentation

“…Particularly in the revision setting, the patient should be made aware of the possibility of arthrofibrosis, graft failure, and the occurrence or persistence of peroneal nerve symptoms. 2,5,7,9…”

Higher success rate observed in reconstruction techniques of acute posterolateral corner knee injuries as compared to repair: an updated systematic review

“…However, non‐operative management for grade III PLC injuries have been reported to result in inferior functional outcomes, persistent instability, and the development of early‐onset degenerative changes [12, 26]. As a result, a variety of repair and reconstruction techniques have evolved to restore knee stability [1, 3, 8, 13, 16, 35, 37, 43, 47, 49, 53, 55, 56]. Despite considerable attention in the recent orthopaedic literature, optimal timing of surgery and the ideal surgical treatment option remains controversial for these complex injuries [6].…”