Anatomic reconstructive surgery for posterolateral instability of the knee (SS-85)

Abstract

Our purpose is to describe a new anatomic reconstructive surgery which simultaneously reconstructs the fibular collateral ligament, popliteal tendon and popliteofibular ligament using split Achilles allograft and to compare the clinical results after this new technique and the posterolateral corner sling procedure of the posterolateral instability of the knee. Materials and Methods: Forty-six patients were treated for posterolateral instability of the knee between 1998 and 2002. The posterolateral corner sling procedure (group A) was performed in 25 patients and anatomic reconstructive surgery (group B) in 21 patients. The minimum follow-up was 12 months. In all cases arthroscopic evaluation was undertaken. Clinical review included the Lysholm knee scores and varus laxity and tibial external rotation assessment. Results: The mean Lysholm knee scores were 54.8 points in group A and 54.4 points in group B before operation, and 86.9 and 93.6 points at the time of the latest follow-up respectively. Tibial external rotation of 5° more than the contralateral uninjured knee was noted in 12% of group A and in 7% of group B. Varus laxity of 5 mm greater than the contralateral knee was observed in 28% of group A and in 13% of group B. Conclusions: The remaining varus laxity and tibial external rotation after anatomic reconstructive surgery was less than that after the posterolateral corner sling procedure. We believe that this new anatomic reconstructive surgery could be an acceptable choice for posterolateral instability of the knee. Our purpose is to describe a new anatomic reconstructive surgery which simultaneously reconstructs the fibular collateral ligament, popliteal tendon and popliteofibular ligament using split Achilles allograft and to compare the clinical results after this new technique and the posterolateral corner sling procedure of the posterolateral instability of the knee. Materials and Methods: Forty-six patients were treated for posterolateral instability of the knee between 1998 and 2002. The posterolateral corner sling procedure (group A) was performed in 25 patients and anatomic reconstructive surgery (group B) in 21 patients. The minimum follow-up was 12 months. In all cases arthroscopic evaluation was undertaken. Clinical review included the Lysholm knee scores and varus laxity and tibial external rotation assessment. Results: The mean Lysholm knee scores were 54.8 points in group A and 54.4 points in group B before operation, and 86.9 and 93.6 points at the time of the latest follow-up respectively. Tibial external rotation of 5° more than the contralateral uninjured knee was noted in 12% of group A and in 7% of group B. Varus laxity of 5 mm greater than the contralateral knee was observed in 28% of group A and in 13% of group B. Conclusions: The remaining varus laxity and tibial external rotation after anatomic reconstructive surgery was less than that after the posterolateral corner sling procedure. We believe that this new anatomic reconstructive surgery could be an acceptable choice for posterolateral instability of the knee.