Single-Bundle Posterior Cruciate Ligament Reconstruction and Mini-Open Popliteofibular Ligament Reconstruction in Knees With Severe Posterior and Posterolateral Rotation Instability: Clinical Results of Minimum 2-Year Follow-up

Abstract

The aim of this study was to assess the clinical outcome of arthroscopy-assisted posterior cruciate ligament (PCL) reconstruction and mini-open popliteofibular ligament (PFL) reconstruction for severe posterior and posterolateral rotation instability of the knee with lateral collateral ligament intact. Arthroscopic PCL reconstruction and mini-open PFL reconstruction were performed consecutively in 24 patients with chronic posterior and posterolateral rotation instability of the knee. The inclusion criteria for surgery were a side-to-side difference in posterior translation of more than 12 mm measured with stress radiography and tibial external rotation of 10 degrees more than that of the contralateral uninjured knee without varus laxity. The exclusion criterion was combined anterior cruciate ligament injury. The patients underwent single-bundle PCL reconstruction with Achilles tendon allograft. A mini-open PFL reconstruction was performed with anterior tibialis allograft. A 2-cm incision was made on the lateral epicondyle to build the femoral tunnel, and a 3-cm incision was made near the fibular head for the fibular tunnel. The minimum follow up was 2 years. At final follow up, 18 patients (75% [18 of 24]) were enrolled in the study group and 6 patients were lost. Postoperatively, mean posterior tibial translation (side-to-side difference) in our patients was reduced from 17.3 +/- 4.1 mm to 4.6 +/- 3.2 mm. Tibial external rotation was decreased from a mean of 14.7 degrees +/- 4.6 degrees to -2.8 degrees +/- 3.8 degrees, as compared with the contralateral uninjured knee. These differences were statistically significant. The International Knee Documentation Committee grade preoperatively was grade D in all 18 patients, whereas postoperatively, 5 were classified as grade A, 8 as grade B, and 5 as grade C. In this small clinical series, single-bundle PCL reconstruction combined with mini-open PFL reconstruction was proven to correct pathologic excessive posterior and posterolateral rotation instability. Level IV, therapeutic case series (no control or historical group).