Combined posterior cruciate ligament and chronic posterolateral corner deficiency in varus knee, two-stage reconstruction

Abstract

Background Conservative management of chronic posterolateral corner (PLC) knee injuries had a bad repetition and often followed by poor outcomes. In patients who had associated posterior cruciate ligament [PCL] and chronic PLC knee injuries with varus knee deformity, failure to correct the mechanical axis by correcting varus was usually followed by failure of the posterolateral knee repair or reconstruction. Aim of the study To assess prospectively the results of treatment of associated PCL and chronic PLC injury in the varus knee, with a two-stage procedure. Initial high tibial medial opening wedge osteotomy was followed by PCL reconstruction. Methods This study included 10 patients who had associated PCL and chronic PLC deficiency in varus knee who were treated by two-stage surgical technique, first stage was high tibial medial opening wedge osteotomy to align the mechanical axis and correct varus deformity, then PCL ligament reconstruction in the second stage. Results According to the International Knee Documentation Committee, the 10 patients included in the study [100%] were graded as grade C (abnormal) or D (sever abnormal) preoperatively, while 8 of the 10 patients [80%] were graded as grade A (normal) or B (nearly normal), and 2 patients [20%] were rated as abnormal grade C at final follow-up scoring. Statistically significant improvement was achieved. Radiologically, the average mechanical axis that preoperatively passed within the medial tibial plateau with varus deformity ranged between 10 and 15° in our cases, while the mechanical axis postoperatively passed through the mid of tibial plateau or slightly within the lateral tibial plateau with full correction of the deformity with valgus angle ranged from 5 to 10°. The preoperative posterior tibial sagittal slope angle was average 7.8°, which became 10.5° in the last follow-up visit. Conclusion Two-stage reconstruction of the knee in cases who had PLC injuries associated with varus knee, starting by proximal tibial medial opening wedge osteotomy followed by reconstruction of PCL, is a valuable technique and had good results.