Anterolateral Transtibial PCL Reconstruction Combined with Reconstruction of Posterolateral Corner Insufficiency: Comparison of Single-bundle vs Double-bundle PCL Reconstruction over a 2-6 Year Period (SS-45)

Abstract

There is a paucity of clinical studies comparing single- and double-bundle posterior cruciate ligament (PCL) reconstruction combined with posterolateral corner reconstruction. The purpose of this study is to compare the clinical outcomes of single- and double-bundle transtibial PCL reconstruction combined with reconstruction of the lateral collateral ligament (LCL) and popliteus tendon for posterolateral corner insufficiency. The study population consisted of 42 patients who had undergone PCL reconstruction between March 2002 and July 2006, and for whom a minimum of two years of follow-up data were available. We compared clinical outcomes of two surgical techniques: a single-bundle technique with remnant preservation (23 patients, single-bundle group) or a double-bundle technique (19 patients, double-bundle group), each combined with reconstruction of the lateral collateral ligament and popliteus tendon for posterolateral corner insufficiency. There were no difference between the single- and double-bundle groups in the mean side-to-side difference of posterior translation measured with Telos stress radiography (4.2 ± 1.7 vs. 3.9 ± 1.6 mm, p = 0.628), and rates greater than 5 mm were 22% in single-bundle group and 21% in double-bundle group. Regarding the posterolateral rotatory laxity, there were no differences between the two groups in the mean side-to-side difference in the dial test. (5.3° ± 2.7° vs. 5.1° ± 2.4° at 30°, p = 0.801; 6.7° ± 2.7° vs. 6.7° ± 2.4° at 90°, p = 0.917), or in varus stress radiography (1.2 ± 1.2 mm vs. 1.3 ± 1.4 mm, p = 0.722). The Lysholm knee scores were 85.7 ± 7.6 in the single-bundle group and 87.7 ± 7.3 in the double-bundle group (p =0.392). There was a trend of no difference between the groups in IKDC knee score (p =0.969). The rates of abnormal and severely abnormal categories in IKDC were 30% in single-bundle group and 26% in double-bundle group. Double-bundle PCL reconstruction combined with posterolateral corner reconstruction does not appear to have advantages over remnant preserving single-bundle PCL reconstruction combined with posterolateral corner reconstruction with respect to the clinical outcomes or posterior knee stability.