Posterolateral Corner Repair versus Reconstruction: 6-year Outcomes from a Prospective Multicenter Cohort

Abstract

Objectives:Injuries to the posterolateral corner (PLC) may occur concurrently with anterior cruciate ligament (ACL) injury. Restoration of stability to the lateral knee is important for both preventing posterolateral rotatory instability and protecting concurrently addressed cruciate reconstructions. There has been a growing trend towards PLC reconstruction in recent literature, however little is known about how these techniques relate to long-term patient outcomes. The purpose of the present study was to evaluate the outcomes of patients who underwent operative management of PLC injuries concurrently with ACL reconstruction in a prospective multicenter cohort. We hypothesized that there would be no differences in patient outcomes between patients who were treated with repair and reconstruction.Methods:Patients undergoing ACL reconstructions were enrolled into a prospective longitudinal multi-center cohort between 2002-2008. Patients with six-year follow-up data (repeat operations and patient reported outcomes) who underwent concurrent PLC reconstruction or repair at the time of ACL reconstruction were identified. Patients who underwent PLC repair were compared to those who underwent PLC reconstruction in regard to operative delay, need for revision surgery and long-term outcomes at 6-years.Results:Initially, 3028 patients were identified to have undergone primary ACL reconstruction during the identified time frame, with 34/3028 (1.1%) also undergoing PLC surgery: 15 repairs and 19 reconstructions (18 allografts, 1 autograft). There were no differences in the rate of meniscal or chondral injuries between groups. The median time to PLC reconstruction was 121 days compared to 19 days for concurrent ACL reconstruction and PLC repair (p=0.01). Mean preoperative scores were significantly lower in the repair group with respect to KOOS Pain (57.4 versus 74.3), KOOS ADL (62.3 versus 76.2), KOOS KRQOL (17.5 versus 30.9), and IKDC (29.1 versus 48.4, p=0.004). There were no differences between groups in Marx activity scores prior to surgery (p=0.4). At 6-year follow-up, there were no differences between groups with regard to KOOS (p=0.36-0.83) or IKDC scores (p=0.84), however patients treated with lateral reconstructions had lower Marx activity scores at 6-years (4.0 versus 9.4, p=0.02). There was one ACL revision in the PLC reconstruction group and one of the PLC repairs was revised to a reconstruction during the follow-up period.Conclusion:Good outcomes were achieved with both repair and reconstruction of PLC injuries treated concurrently with ACL reconstruction at 6-year follow-up. Patients treated with reconstruction had lower activity levels 6-years after surgery. Lower KOOS and IKDC scores at the time of surgery may be explained by the increased time interval between injury and surgery in the reconstruction group. One of the 15 lateral repairs required a later reconstruction. Contrary to recent reports, our data suggests that appropriately selected patients may be successfully treated with acute PLC repair with good long-term outcomes.