The clinical outcome of minimally invasive popliteal tendon recess procedure is comparable to arthroscopic popliteal tendon reconstruction in patients with type A posterolateral rotational instability

Abstract

PurposeTo compare the objective and subjective clinical outcome of minimally invasive popliteal tendon (PT) recess procedure versus arthroscopic PT reconstruction, combined with posterior cruciate ligament reconstruction in patients with Type A posterolateral rotational instability (PLRI). The hypothesis was that the two techniques had comparable clinical outcomes. MethodsBetween 2012 and 2017, patients who were eligible for inclusion in this study if they (1) had Type A PLRI according to Fanelli’s classification with posterior tibial translation > 12 mm on stress radiography and side‐to‐side difference of dial test external rotation > 10°, (2) PT peel‐off lesion or laxity with structural integrity (3) were followed for a minimum of 2 years with examination under anesthesia (EUA) and stress radiograph results. Evaluation included subjective scoring, knee stability examinations and second‐look arthroscopic lateral gutter drive‐through (LGDT) test. Patients who underwent PT recess procedure were designated as Group A, while patients who underwent arthroscopic PT reconstruction were labelled as Group B. The differences between the two groups were analyzed. ResultsA total of 61 eligible patients with a minimum follow‐up time of 2 years were evaluated in the present study. At the final follow‐up, there were no significant inter‐group differences in Lysholm scores (Group A: 69.0 ± 16.5, Group B: 75.8 ± 14.6, ns), Tegner scores [Group A: 2 (1–4), Group B: 3 (1–5), ns], or IKDC subjective scores (Group A: 70.5 ± 13.5, Group B: 71.1 ± 9.1, ns). No significant difference in side‐to‐side difference on posterior stress radiography (Group A: 4.3 ± 3.8 mm, Group B: 4.7 ± 4.6 mm, P = 0.701), dial test result (Group A: 0.9 ± 4.4°, Group B: 1.6 ± 4.9°, ns) or LGDT test positive rate (Group A: 2/34, 5.9%, Group B: 2/27, 7.7%, ns) was observed. ConclusionBoth minimally invasive PT recess procedure and arthroscopic PT reconstruction significantly improved the knee stability and subjective outcome comparing with preoperative value. In a comparison with arthroscopic PT reconstruction, the recess procedure demonstrated comparable subjective and objective clinical outcome. When both PT reconstruction and PT recess procedure are indicated, the minimally invasive and graft‐free recess procedure can be a viable option. Level of evidenceIII.

Most Publications Regarding Arthroscopic Treatment of Posterolateral Corner Injuries of the Knee Have a Low Level of Evidence and Provide Limited Information to Determine the Most Effective Treatment

“…Only 3 studies reported a comparison between an arthroscopic or open technique for posterolateral corner reconstruction. 7 , 8 , 9 The results were comparable in these 2 studies. The mean CMS score of all studies with exception of the biomechanical and cadaveric studies was 43 ± 11.4, which is rated as poor.…”

“… 31 Another study reports equal restoration of varus stability with use of an arthroscopic popliteus bypass procedure and minimally invasive lateral collateral ligament (LCL) reconstruction compared to an open LaPrade technique. 32 Six technical descriptive articles were identified in which the technique was described and already performed on patients: 4 used a tibial-based reconstruction technique 7 , 8 , 37 , 38 and 2 used a fibular-based reconstruction technique. 31 , 38 Four authors used a transseptal approach.…”

“… 31 , 38 Four authors used a transseptal approach. 5 , 7 , 8 , 32 In 2 of these studies, there was no mention of the number of patients and in 4 studies no outcome was noted. Five case series or case–control series were identified for a total of 141 patients.…”

“…In 2022 Li et al. 8 compared the results of an arthroscopic popliteus bypass procedure with a popliteal tendon recess procedure in patients with Fanelli type A posterolateral corner injuries and found the results to be comparable. In 2022 Weiss et al 5 reported their results on performing an arthroscopic Arciero technique or an arthroscopic LaPrade technique for 19 patients with Fanelli type B posterolateral corner injuries with a concomitant PCL injury.…”

“…Some authors suggest that arthroscopically treating these injuries may provide a less-invasive surgical option with potentially less arthrofibrosis and equal accuracy as with open techniques. 3 , 4 , 5 , 6 , 7 , 8 , 9 Other authors underline the potential for neurovascular injury or malpositioning of the tunnels with these techniques. 10 , 11 , 12 A systematic review focused on the technical details of published studies concerning the specific structures that were reconstructed.…”