Summary

An anatomic PLC reconstruction technique using autografts was successful in improving subjective outcomes and objective stability in patients with a chronic multi- ligamentous knee injury involving the PLC; relying just on a semitendinosus and a gracilis autografts, augmented by a strip of the biceps, when necessary, avoiding the need of contra-lateral side knee autografts or allografts.

Abstract

Purpose

Currently, there is a lack of anatomical reconstruction procedures of the posterolateral corner (PLC) of the knee that rely on autografts. Nonetheless, autografts can be an acceptable graft choice for an anatomical PLC reconstruction if they can reproduce the three main structures of the posterolateral aspect of the knee. The purpose of this study is to report the subjective outcomes and objective stability in a series of chronically grade III posterolateral injured knees treated with an anatomic PLC reconstruction technique using autografts. The technique relies just on a semitendinosus and a gracilis autografts, augmented by a strip of the biceps, when necessary, avoiding the need of contra-lateral side knee autografts or allografts.
STUDY DESIGN: Case Series (Level IV).

Methods

An outcome study of 33 patients with a chronic complete tear of all ligamentous structures of the PLC (>5mm of varus gapping at 30°, >=10° of external tibial rotation during the dial test, >=4mm of increased lateral compartment opening during varus stress radiographs) was performed. The patients were evaluated subjectively with Lysholm, IKDC, and Tegner subjective scores and objectively with varus stress radiographs at 20° of knee flexion, IKDC objective scores, and recurvatum evaluation. A paired Student’s t-test was used to compare preoperative and postoperative Lysholm subjective scores and the Wilcoxon test was used to compare preoperative and postoperative IKDC subjective scores, Tegner score and varus stress X-rays. The chi-square test and the Fisher’s exact test were used to compare the preoperative and postoperative IKDC objective scores and recurvatum.

Results

Twenty-nine patients were available for follow-up at an average of 31.9 ± 12.3 months (range 24 to 59 months) postoperatively. The observed power was 75% and the effect size 35%. Twenty-five patients underwent multiple-ligament reconstruction without prior osteotomy. No patient had an isolated PLC knee reconstruction, 14 had a concurrent reconstruction of the anterior cruciate ligament (ACL), 12 had a concurrent reconstruction of the posterior cruciate ligament (PCL), four had concurrent reconstruction of PCL followed by a second stage ACL reconstruction, and three had concurrent reconstructions of the PCL and medial collateral ligament, being one associated to a posterior oblique ligament capsular shift, followed by a second stage ACL reconstruction. The average comparative preoperative and postoperative outcomes were, respectively: Lysholm 49.7 ± 10.3, 81.2 ± 12.8, p<0.001, IKDC 36.7 ± 8.3, 70.4 ± 19.8, p<0.001, Tegner 6.6 ± 1.3, 5.5 ± 1.6, p<0.001, varus stress radiograph 7.1 ± 3.1mm, 1.8 ± 1.8mm, p<0.001. A significant improvement, p<0.001, was found between preoperative and postoperative IKDC objective scores for varus opening at 0 and 30° and external rotation measured by the dial test at 30°. Recurvatum was also improved: preoperatively, 52% had a low grade and 48% had a high grade recurvatum, while postoperatively, 100% were classified as low grade, p<0.001.

Conclusion

The use of autografts for the presented anatomic PLC reconstruction is a valid technique in the patient with a multi- ligamentous knee injury involving the PLC, improving subjective outcomes and objective stability in patients with a chronic PLC knee injury.