Download PDF
J Knee Surg 2021; 34(01): 067-073
DOI: 10.1055/s-0039-1693003
Original Article

Clinical Outcomes of Posterolateral Complex Reconstruction Performed with a Single Femoral Tunnel

Camilo Partezani Helito
1   Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
2   Hospital Sírio Libanês, São Paulo, Brazil
,
Marcel Faraco Sobrado 
1   Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
,
Pedro Nogueira Giglio
1   Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
,
Marcelo Batista Bonadio
1   Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
,
José Ricardo Pécora
1   Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
,
Riccardo Gomes Gobbi
1   Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
,
Gilberto Luis Camanho
1   Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
,
Fabio Janson Angelini
1   Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

The objective of this study is to report the functional outcomes, complications, and reconstruction failure rate of patients undergoing posterolateral complex reconstruction with a single femoral tunnel technique. Patients with posterolateral complex injuries associated with injury of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), or both undergoing surgical treatment with the single femoral tunnel technique were included in the study. The International Knee Documentation Committee (IKDC) and Lysholm's scales were evaluated, in addition to age, gender, time between trauma and surgery, trauma type, range of motion (ROM) restrictions, peroneal nerve injury, and reconstruction failure. Sixty-six patients were included. Eighteen underwent ACL and posterolateral complex (PLC) reconstruction (group 1), 24 underwent ACL, PCL, and PLC reconstruction (group 2), and 24 underwent PCL and PLC reconstruction (group 3). The mean follow-up was 63 months. The subjective IKDC was 83.7 ± 14.6 for group 1, 74.3 ± 12.6 for group 2, and 66.3 ± 16.0 for group 3 (p < 0.001). The Lysholm's score was 87.1 ± 12.8 for group 1, 79.5 ± 15.0 for group 2, and 77.7 ± 15.2 for group 3 (p = 0.042). There were six reconstruction failures among the patients (9.1%) with no differences among the groups (p = 0.368). Female gender and reconstruction failure were associated with worse outcomes. Patients undergoing reconstruction of PLC structures with the single femoral tunnel technique achieved good functional outcomes and a failure rate similar to literature. Patients undergoing only combined ACL reconstruction showed better outcomes than patients undergoing combined PCL reconstruction. Female gender was associated with a worse functional outcome irrespective of the injury type.

Keywords

posterolateral complex - posterolateral corner - fibular (lateral) collateral ligament - multiligament - chronic knee injury


Publication History

Received: 13 March 2019

Accepted: 19 May 2019

Article published online:
09 July 2019

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Nannaparaju M, Mortada S, Wiik A, Khan W, Alam M. Posterolateral corner injuries: epidemiology, anatomy, biomechanics and diagnosis. Injury 2018; 49 (06) 1024-1031
    CrossrefPubMedGoogle Scholar
  • 2 Krukhaug Y, Mølster A, Rodt A, Strand T. Lateral ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc 1998; 6 (01) 21-25
    CrossrefPubMedGoogle Scholar
  • 3 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
    Google Scholar
  • 4 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
    CrossrefPubMedGoogle Scholar
  • 5 Demange MK, Camanho GL, Pécora JR, Gobbi RG, Tirico LEP, da Mota e Albuquerque RF. Simultaneous anterior cruciate ligament reconstruction and computer-assisted open-wedge high tibial osteotomy: a report of eight cases. Knee 2011; 18 (06) 387-391
    CrossrefPubMedGoogle Scholar
  • 6 Chahla J, Moatshe G, Dean CS, LaPrade RF. Posterolateral corner of the knee: current concepts. Arch Bone Jt Surg 2016; 4 (02) 97-103
    Google Scholar
  • 7 Geeslin AG, Moulton SG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, part 1: surgical treatment of acute injuries. Am J Sports Med 2016; 44 (05) 1336-1342
    Google Scholar
  • 8 Moulton SG, Geeslin AG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, part 2: surgical treatment of chronic injuries. Am J Sports Med 2016; 44 (06) 1616-1623
    Google Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 Veltri DM, Deng XH, Torzilli PA, Maynard MJ, Warren RF. The role of the popliteofibular ligament in stability of the human knee. a biomechanical study. Am J Sports Med 1996; 24 (01) 19-27
    CrossrefPubMedGoogle Scholar
  • 11 Bonanzinga T, Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Neri MP, Marcacci M. Management of combined anterior cruciate ligament-posterolateral corner tears: a systematic review. Am J Sports Med 2014; 42 (06) 1496-1503
    Google Scholar
  • 12 Franciozi CE, Albertoni LJB, Gracitelli GC. et al. Anatomic posterolateral corner reconstruction with autografts. Arthrosc Tech 2018; 7 (02) e89-e95
    CrossrefPubMedGoogle Scholar
  • 13 Angelini FJ, Helito CP, Tozi MR. et al. Combined reconstruction of the anterior cruciate ligament and posterolateral corner with a single femoral tunnel. Arthrosc Tech 2013; 2 (03) e285-e288
    Google Scholar
  • 14 Sanders TL, Johnson NR, Pareek A. et al. Satisfactory knee function after single-stage posterolateral corner reconstruction in the multi-ligament injured/dislocated knee using the anatomic single-graft technique. Knee Surg Sports Traumatol Arthrosc 2018; 26 (04) 1258-1265
    PubMedGoogle Scholar
  • 15 Moatshe G, Chahla J, Brady AW. et al. The influence of graft tensioning sequence on tibiofemoral orientation during bicruciate and posterolateral corner knee ligament reconstruction: a biomechanical study. Am J Sports Med 2018; 46 (08) 1863-1869
    CrossrefPubMedGoogle Scholar
  • 16 Hefti F, Müller W, Jakob RP, Stäubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1993; 1 (3-4): 226-234
    Google Scholar
  • 17 Kim S-J, Kim S-G, Lee I-S. et al. Effect of physiological posterolateral rotatory laxity on early results of posterior cruciate ligament reconstruction with posterolateral corner reconstruction. J Bone Joint Surg Am 2013; 95 (13) 1222-1227
    CrossrefPubMedGoogle Scholar
  • 18 Zorzi C, Alam M, Iacono V, Madonna V, Rosa D, Maffulli N. Combined PCL and PLC reconstruction in chronic posterolateral instability. Knee Surg Sports Traumatol Arthrosc 2013; 21 (05) 1036-1042
    CrossrefPubMedGoogle Scholar
  • 19 Noyes FR, Barber-Westin SD. Long-term assessment of posterolateral ligament femoral-fibular reconstruction in chronic multiligament unstable knees. Am J Sports Med 2011; 39 (03) 497-505
    Google Scholar
  • 20 Kim S-J, Kim T-W, Kim S-G, Kim H-P, Chun Y-M. Clinical comparisons of the anatomical reconstruction and modified biceps rerouting technique for chronic posterolateral instability combined with posterior cruciate ligament reconstruction. J Bone Joint Surg Am 2011; 93 (09) 809-818
    CrossrefPubMedGoogle Scholar
  • 21 Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am 2004; 86 (02) 262-273
    Google Scholar
  • 22 Wang C-J, Chen H-S, Huang T-W, Yuan L-J. Outcome of surgical reconstruction for posterior cruciate and posterolateral instabilities of the knee. Injury 2002; 33 (09) 815-821
    CrossrefPubMedGoogle Scholar
  • 23 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Yoon KH, Lee JH, Bae DK, Song SJ, Chung KY, Park YW. Comparison of clinical results of anatomic posterolateral corner reconstruction for posterolateral rotatory instability of the knee with or without popliteal tendon reconstruction. Am J Sports Med 2011; 39 (11) 2421-2428
    CrossrefPubMedGoogle Scholar
  • 25 Kim S-J, Jung M, Moon H-K, Kim S-G, Chun Y-M. Anterolateral transtibial posterior cruciate ligament reconstruction combined with anatomical reconstruction of posterolateral corner insufficiency: comparison of single-bundle versus double-bundle posterior cruciate ligament reconstruction over a 2- to 6-year follow-up. Am J Sports Med 2011; 39 (03) 481-489
    CrossrefPubMedGoogle Scholar
  • 26 Jakobsen BW, Lund B, Christiansen SE, Lind MC. Anatomic reconstruction of the posterolateral corner of the knee: a case series with isolated reconstructions in 27 patients. Arthroscopy 2010; 26 (07) 918-925
    CrossrefPubMedGoogle Scholar
  • 27 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
    CrossrefPubMedGoogle Scholar
  • 28 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
    CrossrefPubMedGoogle Scholar
  • 29 Noyes FR, Barber-Westin SD. Posterolateral knee reconstruction with an anatomical bone-patellar tendon-bone reconstruction of the fibular collateral ligament. Am J Sports Med 2007; 35 (02) 259-273
    CrossrefPubMedGoogle Scholar
  • 30 Fanelli GC, Edson CJ. Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up. Arthroscopy 2004; 20 (04) 339-345
    CrossrefPubMedGoogle Scholar
  • 31 Tardy N, Boisrenoult P, Teissier P, Steltzlen C, Beaufils P, Pujol N. Clinical outcomes after multiligament injured knees: medial versus lateral reconstructions. Knee Surg Sports Traumatol Arthrosc 2017; 25 (02) 524-531
    CrossrefPubMedGoogle Scholar
  • 32 Helito CP, Bonadio MB, Demange MK. et al. Functional assessment of combined reconstruction of the anterior cruciate ligament and posterolateral corner with a single femoral tunnel: a two-year minimum follow-up. Int Orthop 2015; 39 (03) 543-548
    Google Scholar
  • 33 Lee SH, Jung YB, Jung HJ, Song KS, Ko YB. Combined reconstruction for posterolateral rotatory instability with anterior cruciate ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc 2010; 18 (09) 1219-1225
    CrossrefPubMedGoogle Scholar
  • 34 Ross G, DeConciliis GP, Choi K, Scheller AD. Evaluation and treatment of acute posterolateral corner/anterior cruciate ligament injuries of the knee. J Bone Joint Surg Am 2004; 86-A (Suppl. 02) 2-7
    CrossrefPubMedGoogle Scholar
  • 35 Angelini FJ, Helito CP, Bonadio MB. et al. External fixator for treatment of the sub-acute and chronic multi-ligament-injured knee. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 3012-3018
    Google Scholar
  • 36 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
    CrossrefPubMedGoogle Scholar