Does combined posterior cruciate ligament and posterolateral corner reconstruction for chronic posterior and posterolateral instability restore normal knee function? - 07/06/10

Doi : 10.1016/j.otsr.2010.02.007

A. Wajsfisz ^a,^⁎ , P. Christel ^b, P. Djian ^a
^a Goethe Medical office, 23, avenue Niels, 75017 Paris, France
^b Riyadh, Saudi Arabia

Corresponding author. 25, avenue Robert-André-Vivien, 94160 Saint-Mandé, France. Tel.: +33 6 63 12 93 42.

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Summary

Introduction

Posterior cruciate ligament (PCL) injuries are frequently associated with posterolateral corner (PLC) damages. These complex lesions are most often poorly tolerated clinically. Adherence to sound biomechanical principles treating these complex lesions entails obtaining a functional PCL and reconstructing sufficient posterolateral stability.

Hypothesis

Surgical treatment of postero-posterolateral laxity (PPLL) re-establishes sufficient anatomical integrity to provide stability and satisfactory knee function.

Material and methods

In this retrospective, continuous, single-operator study, 21 patients were operated for chronic PPLL with combined reconstruction of the PCL and PLC and were reviewed with a minimum 1 year follow-up. The clinical and subjective outcomes were evaluated using the IKDC score. Surgical correction of posterior laxity was quantified clinically and radiologically on dynamic posterior drawer images (posterior Telos™ stress test and hamstrings contraction lateral view).

Results

The mean subjective IKDC score was 62.8 at the last follow-up versus a preoperative score of 54.5 (NS). Preoperatively, all were classified in groups C and D. Postoperatively, 13 patients out of 21 were classified in groups A and B according to the overall clinical IKDC score. The radiological gain in laxity was 51% on the hamstring contraction films and 67% on the posterior Telos™ images (p<0.05).

Discussion

The objective of surgical treatment is to re-establish anatomical integrity to the greatest possible extent. The clinical and radiological laxity results are disappointing in terms of the objectives but are in agreement with the literature. The subjective evaluation demonstrated that this operation can provide sufficient function for standard daily activities but not sports activities.