The Clinical Outcome of Arthroscopic Versus Open Popliteal Tendon Reconstruction Combined With Posterior Cruciate Ligament Reconstruction in Patients With Type A Posterolateral Rotational Instability

Abstract

To compare the objective and subjective clinical outcomes of arthroscopic versus open popliteal tendon (PT) reconstruction combined with posterior cruciate ligament reconstruction in patients with type A posterolateral corner injury. From January 2012 to March 2016, patients were eligible for inclusion in this study if they (1) had type A posterolateral rotational instability according to Fanelli's classification, (2) underwent arthroscopic (group A) or open PT (group B) reconstruction, and (3) were followed for a minimum of 2years with second-look arthroscopic findings. For evaluation, this study used subjective scoring systems (Lysholm, Tegner, and International Knee Documentation Committee subjective scores), knee stability examinations (side-to-side differences of tibial external rotation angle by dial test and posterior and varus stress radiographs), and second-look arthroscopic lateral gutter drive-through tests during hardware removal operations. A total of 38 patients were included in the study. The mean follow-up period was 31.0 ± 5.8months in group A (n= 21) and 34.8 ± 12.7months in group B (n= 17). At the final follow-up, all subjective and objective evaluation results were significantly improved compared with the preoperative condition. There were no significant intergroup differences in Lysholm score (group A, 72.7 ± 17.2; group B, 67.2 ± 14.2; P= .818), Tegner score (group A, 2; group B, 2; P= .710), or International Knee Documentation Committee subjective score (group A, 73.0 ± 13.8; group B, 69.7 ± 20.7; P= .561) at the final follow-up. In terms of objective evaluations, there was no difference in side-to-side difference of posterior stress radiography (group A, 4.0 ± 3.2mm; group B, 5.0 ± 2.9mm; P= .336) or lateral gutter drive-through test positive rate (group A, 1/21, 4.8%; group B, 2/17, 11.8%; P= .426). Both arthroscopic and open PT reconstruction significantly improved the knee stability and subjective outcome of patients with type A posterolateral rotational instability. In comparison with the open procedure, the arthroscopic PT reconstruction showed similar subjective and objective clinical outcomes. Level III, retrospective cohort study.