2015 ISAKOS Biennial Congress ePoster #1115

Acute Multiligament Knee Injuries: A Worse Prognosis Associated With Posterolateral Corner Lesions

Philippe Boisrenoult, MD, Le Chesnay FRANCE
Philippe Teissier, MD, Le Chesnay FRANCE
Nicolas Tardy, MD, Le Chesnay FRANCE
Philippe Beaufils, MD, Versailles FRANCE
Nicolas Pujol, MD, Le Chesnay FRANCE
Versailles Hospital Center, Versailles, FRANCE

FDA Status Cleared

Summary: This retrospective study compare outcomes of two groups of acute multiligament knee injuries treated according to the same principles, but only differing by the type of peripherical lesions. Posterolateral corner lesions were associated with a worse prognosis in terms of functional results than posteromedial corner lesions.

Abstract:

Introduction

Inferior outcomes after acute multiligament knee injuries involving posterolateral corner is not currently demonstrated by literature. The purpose of this retrospective study was to compare the results of two groups of acute multiligament knee injuries treated according to the same principles, but only differing by the type of peripherical lesions.

Material And Methods

Group 1 (posteromedial corner lesions) consisted of 23 lesions (17 bicruciate lesions) and group 2 (posterolateral corner lesions) consisted of 16 bicruciate lesions. Delay before surgery was 16 days in means (10-30). In both groups, PCL lesions were treated using a synthetic ligament (LARS®) and in cases of ACL lesions, an autologous BPTB reconstruction was performed. In group 1, posteromedial corner lesions were repaired in 11 cases and reconstructed in 12 cases. In group 2, an autologous anatomical posterolateral corner reconstruction was used in all cases. Evaluation included Lysholm and IKDC scores and radiological evaluation including dynamics radiographies and frontal standing long legs X-rays under bipodal and unipodal load. Mean follow up was 75 months (24-144) in group 1 versus 25.4 months (7-60) in group 2.

Results

Four complications were noted, only in group 1 (1 infection and 3 knee stiffness requiring 1 mobilization and 2 arthroscopic arthrolysis). At the last follow-up, means IKDC and Lysholm scores were respectively 89.6 and 81.6 points (group 1) versus 79 and 59.5 points (group 2). In group 1, IKDC grade included 12B, 3C, and 1D versus 7B, 8C and 1D in group 2. Mean range of motion was respectively 131° (110-150°) on operated side and 146° (130-150°) on opposite side in group 1 versus 123° (90-140 °) and 139 ° (135-150 °) in group 2. Mean frontal laxity consisted in 1.5 °of valgus (group 1) versus 2° of varus (group 2). In group 2, mean external rotation appreciated using dial test at 30° and 90°, was reduced by 6 °. In group 1, 8 patients had mild or moderate radiological osteoarthritis signs. Axial malalignement was only present in group 2 associated with a mean varus increase to 1°.

Conclusions

Our one stage treatment strategy in cases of acute multiligament knee injuries was effective regardless of the initial lesions. Nevertheless, posterolateral corner lesions were associated with a worse prognosis in terms of functional results than posteromedial corner lesions.