The two-tailed posterolateral corner (PLC) reconstruction in multi-ligament knee injuries (MLKI) is mostly described with interference screws. Data on the use of suture anchors is limited. Our purpose was to report clinical and radiological outcomes of the modified technique, and to describe a technique for concomitant biceps femoris tendon repair.

Demographic data, clinical and radiological outcomes were collected from 60 patients who underwent two-tailed PLC reconstruction in the setting of MLKI between 2017 and 2021. Patients were assessed for range of motion (ROM) and functional outcomes including Tegner, Lysholm and International Knee Documentation Committee (IKDC) scores. Complications and reoperations were also reported. Radiographic parameters focused on measurements of the lateral femorotibial space in varus stress views to evaluate stability and determine failure rate. Analysis based on time from injury to reconstruction was additionally performed.

With two (3.3%) loss to follow-up, 58 patients with a mean age of 33.8 and a mean follow-up of 15.1 months (range: 4.2–44.8) were included. Sixty-five percent were men. Knee dislocation grades included KD 3-L, 4 and 5. No isolated PLC reconstructions were performed. Twenty-five patients (43.1%) underwent acute reconstruction and 5 (8.6%) presented with a neurovascular injury. Seventy-five percent had concomitant meniscal tears requiring repair. The mean postoperative ROM was 1.7–133.2 degrees. Mean Tegner, Lysholm, and IKDC scores were 5.1±2.3, 84.6±12.1, and 73.4±18.2, respectively. The mean lateral femorotibial space on varus stress views was 0.3±1.2mm. Fourteen (24.1%) patients required revision surgery for hardware removal, stiffness, or clinical failure, and 6 (10.3%) had complications including infection and anchor pull-out. In addition, patients with acute reconstructions had better functional outcomes compared to those who presented with a chronic injury.

The use of suture anchors as fixation method of choice for fibular head docking in two-tailed PLC reconstruction can reliably restore varus stability and provide fair functional outcomes in patients with either acute or chronic MLKI with posterolateral instability, associated with a low rate of implant-specific complications.