Systematic Review for Management of Posterolateral Corner Injuries of the Knee

Abstract

Background:There is a paucity of outcome data to guide the surgical treatment of posterolateral corner knee injuries. Purpose: To systematically review the literature to compare clinical outcomes of the treatment PLC injuries. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature including PubMed was performed. The following search terms were used: "posterolateral corner", "chronic PLC injuries" "acute PLC injuries" and "repair of PLC injuries", "reconstruction of PLC". Inclusion criteria were: Human examinations and treatment, measures of functional and clinical outcome included, exclusion criteria were: Non English papers, Non-human trials, Articles with no clinical data. Results: Eighteen studies with a total of 559 patients were included. When time to surgery was performed within 6 weeks it is considered acute injury while on the other hand more than that was considered chronic injury. Surgical treatment varied between repair and reconstruction there was an overall success rate of repair 75% and failure rate of 25% and overall success rate of reconstruction was 91% and 9% failure rate. Surgical techniques: 83 patients underwent repair for the PLC while 476 patients underwent reconstruction for the PLC, surgical techniques varied among studies, between repair and reconstruction techniques which was different between studies, including fibular sling using one femoral tunnel or two femoral tunnels, posterolateral capsular shift trying to increase rotational stability, anatomic PLC reconstruction, biceps tenodesis and isometric reconstruction of the FCL and the popliteus with a single graft. Conclusion:The repair of acute PLC injuries and staged treatment of combined cruciate injuries were associated with a substantially higher postoperative PLC failure rate than reconstruction. Further research is required to identify the reconstruction technique that provides optimal subjective and objective outcomes.