Achilles Tendon Allograft Reconstruction of the Fibular Collateral Ligament and Posterolateral Corner

Abstract

The purpose of this study was to investigate the functional and clinical outcomes of a consecutive series of patients who underwent fibular collateral ligament (FCL) and posterolateral corner (PLC) reconstruction by use of a single Achilles tendon allograft construct. Patients were identified through prospective sports medicine databases at 2 academic institutions. Only patients who had undergone FCL and PLC reconstruction (as opposed to repair) were included. All patients followed a standard postoperative rehabilitation protocol. Various patterns of combined ligament injuries were included and divided into 2 groups (2 ligament v multiligament). Functional and clinical outcomes were assessed by clinical examination, Lysholm scores, and International Knee Documentation Committee subjective scores. Statistical analysis was performed by use of Wilcoxon paired rank-sum tests and multivariate regression. We identified 16 knees in 16 patients, with a minimum of 2 years' follow-up. There were 13 men and 3 women. The mean age was 30 years (range, 19 to 61 years). The mean length of clinical follow-up was 30 months (range, 24 to 75 months). The mean International Knee Documentation Committee subjective scores were 80 points and 80 points (P = .79) in the 2-ligament and multiligament groups, respectively, and the mean Lysholm scores were 90 points and 89 points (P = .96), respectively. Age (P = .41), gender (P = .84), and interval between injury and surgery (P = .72) did not affect the clinical and functional outcomes between the 2 groups. Arthrofibrosis requiring manipulation developed in 1 patient. Residual varus laxity (1+) was noted in 4 patients, none of whom displayed functional instability. No patient has required revision reconstruction to date. We describe a novel technique that takes into account the main static PLC stabilizers (FCL, popliteofibular ligament, and posterolateral capsule) that has not been previously reported. Our series showed no significant differences in clinical and functional outcomes between 2-ligament and multiligament PLC-based reconstructions. However, given the heterogeneity and small sample size of our study group, it is difficult to draw qualitative conclusions. Level IV, therapeutic case series.