2015 ISAKOS Biennial Congress ePoster #1119
Clinical Outcomes After Reconstruction of Acute Complete Posterolateral Corner Injuries in Multiligament Knee Injuries: A Comparative Analysis
Brian C. Werner, MD, Charlottesville, VA UNITED STATES
Sean Higgins, BS, Charlottesville, VA UNITED STATES
Frank Winston Gwathmey, MD, Charlottesville, VA UNITED STATES
Mark D. Miller, MD, Charlottesville, VA UNITED STATES
University of Virginia, Charlottesville, VA, USA
FDA Status Not Applicable
Summary: Reconstruction of the posterolateral corner in multiligament knee injuries provides a reliable method to achieve reasonable clinical outcomes, however, female patients, patients with high velocity or ultra-low velocity injury mechanisms, and those with KD-IIIL injury patterns have significantly inferior results.
Objectives: There has been a paucity of literature reporting mid to long-term clinical outcomes after reconstruction of acute complete posterolateral corner injuries in multiligament knee injured patients. The goal of the present study was to evaluate two to thirteen-year clinical outcomes after posterolateral corner reconstruction in combined ligament-injured knees.
Retrospective cohort study. Patients with posterolateral corner injury over a 12-year period with minimum 2-year follow-up were included in the final analysis, including Schenck KD-I (54%), KD-IIIL (25%) and KD-IV (21%). All patients underwent reconstruction of their complete posterolateral corner. In patients with acute injuries, a primary repair was performed in addition to a reconstruction. Patient demographics were determined from chart review. Clinical outcome measures, including Lysholm, IKDC, VR-36 and VAS were prospectively obtained. Outcomes were compared among patients by dividing the cohort according to ligament injury pattern, mechanism of injury, presence of peroneal nerve injury, gender, age, and graft source. Multivariate regression was also performed.
147 patients met the inclusion criteria, and 102 were available for clinical follow-up (71%) at an average of 6.0 yrs (range 2.0 – 13.0 yrs) postoperatively. Average age was 32.3 yrs and BMI 34.4 kg/m2. 73% were male and 21.8% had a peroneal nerve injury. Overall outcomes were IKDC, 64.8; Lysholm, 71.2; VR-36, 78.0; and VAS, 2.2. 44.2% of patients required reoperation, with removal of lateral hardware (27.9% of patients) being the most common indication.
Female patients had significantly lower IKDC (p = 0.015), Lysholm (p = 0.003), VR-36 (p = 0.039) and VAS (p = 0.014) than male patients. Patients with ultra-low velocity mechanisms had significantly lower IKDC, Lysholm, VR-36 and VAS scores compared to low velocity and high velocity mechanism patients (p < 0.0001 to p = 0.024), while patients with low velocity mechanisms had significantly improved IKDC and VAS over other groups (Table IB). KD-IIIL ligament injury patterns had significantly lower Lysholm and higher pain scores than KD-I and KD-IV patterns (p = 0.006 to p = 0.022). There were no significant differences in clinical outcomes when patients were stratified by graft type (allograft or autograft), or presence or absence of peroneal nerve injury.
Multivariate linear regression found that age (p = 0.019) and gender (p = 0.009) were independent predictors of the final IKDC score.
Management of the posterolateral corner in multiligament knee injuries remains a challenging endeavor. Reconstruction (in addition to primary repair of injured structures) provides a reliable method to achieve reasonable clinical outcomes. Female patients, patients with high velocity or ultra-low velocity injury mechanisms, and those with KD-IIIL injury patterns have significantly inferior results after posterolateral corner reconstruction. Age and gender are independent predictors of final clinical outcome after posterolateral corner reconstruction in multiligament knee injuries.