1
|
Klasan A, Maerz A, Putnis SE, Ernat JJ, Ollier E, Neri T. Outcomes after multiligament knee injury worsen over time: A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39194423 DOI: 10.1002/ksa.12442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/04/2024] [Accepted: 08/04/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE Multiligament knee injuries (MLKIs) are devastating injuries that can have life-long consequences. A management plan requires the decision to perform surgery or not, timing of surgery, consideration of repair versus reconstruction, reconstruction technique and reconstruction graft choice. The purpose of this study was to analyze development of clinical outcomes of MLKIs over time at a minimum of 2 years of follow-up. METHODS Four databases were queried for surgical outcome-based studies of MLKIs published from 01/2000 through 09/2022 with a minimum 2-year follow-up. Technique articles, nonoperative treatment, arthroplasty, pediatric and review articles were excluded. Study characteristics including design, number of patients, age, follow-up period, anatomical region and posterior-cruciate ligament (PCL)-based injury were collected. Primary outcomes were Lysholm, International Knee Documentation Committee (IKDC) outcome scores and Tegner activity score. Random-effects model analysis was performed. RESULTS After the application of inclusion and exclusion criteria, 3571 patients in 79 studies were included in the analysis. The mean age at surgery was 35.6 years. The mean follow-up was 4.06 years (range 2-12.7). The mean Lysholm score at 2-year follow-up was 86.09 [95% confidence interval [CI]: 82.90-89.28], with a yearly decrease of -0.80 [95% CI: -1.47 -0.13], (p = 0.0199). The mean IKDC at 2 years was 81.35 [95% CI: 76.56-86.14], with a yearly decrease of -1.99 [95% CI: -3.14 -0.84] (p < 0.001). Non-PCL-based injuries had a higher IKDC 83.69 [75.55-91.82] vs. 75.00 [70.75-79.26] (p = 0.03) and Lysholm score 90.84 [87.10-94.58] versus 84.35 [82.18-86.52] (p < 0.01) than PCL-based injuries, respectively. CONCLUSION According to the present systematic review and meta-analysis of MLKIs with minimum 2-year follow-ups, the patients who suffered an MLKI can expect to retain around 80-85% of knee function at 2 years and can expect a yearly deterioration of knee function, depending on the score used. Inferior outcomes can be expected for PCL-based injuries at 2 years postoperative. LEVEL OF EVIDENCE Level IV meta-analysis.
Collapse
Affiliation(s)
- Antonio Klasan
- AUVA UKH Steiermark, Graz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Anne Maerz
- Johannes Kepler University Linz, Linz, Austria
| | - Sven E Putnis
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Justin J Ernat
- Department of Orthopedic Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Edouard Ollier
- University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Thomas Neri
- University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
- Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon - Jean Monnet, Saint-Étienne, France
| |
Collapse
|
2
|
Kern K, Sanii R, Peterson JC, Menge T. Autograft Versus Allograft in Posterolateral Corner Reconstruction: A Systematic Review and Meta-analysis. Orthop J Sports Med 2024; 12:23259671241247542. [PMID: 38840793 PMCID: PMC11151772 DOI: 10.1177/23259671241247542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/30/2023] [Indexed: 06/07/2024] Open
Abstract
Background Several approaches to surgical techniques and graft types exist in posterolateral corner (PLC) reconstruction. The literature lacks knowledge regarding outcomes after autograft versus allograft reconstruction for PLC injuries. Purpose To comprehensively review the current literature on PLC reconstruction and compare outcomes between autograft and allograft tissues. Study Design Systematic review; Level of evidence, 4. Methods The PubMed and Scopus online databases were searched with the terms "PLC,""posterolateral knee,""posterolateral corner," and "reconstruction" in varying combinations. Patient characteristics, graft type, graft failure, surgical techniques, functional outcome scores, and varus laxity on stress radiographs were reviewed and compared between PLC reconstruction with autografts versus allografts. Results Included were 22 studies comprising 33 cohorts: 16 autografts (n = 280 knees) and 17 allografts (336 knees). There were 69 isolated PLC reconstructions (58 allografts and 11 autografts) and 493 multiligament reconstructions (269 autografts and 224 allografts). There was no difference in the mean patient age (30.5 vs 33.5 years, respectively; P = .11) or mean follow-up (39.5 vs 37.7 months, respectively; P = .68) between the autograft and allograft groups. There was no evidence to suggest a difference in graft failures between graft types (pooled mean autograft vs allograft: 0.44 vs 0.41 failures; P = .95). There was a significant difference in the mean postoperative Lysholm scores for autografts versus allografts (89.6 vs 85.5, respectively; P = .04). There was no difference between the cohorts in preoperative or postoperative International Knee Documentation Committee (IKDC) scores or postoperative varus laxity. Conclusion Our review and meta-analysis indicated no significant differences in graft failure rates or objective outcomes after PLC reconstruction based on graft type alone. There was a significant difference in postoperative Lysholm scores in favor of the autograft group and no significant difference in IKDC subjective scores.
Collapse
Affiliation(s)
- Kent Kern
- Corewell Health/Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Ryan Sanii
- Corewell Health/Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - James C Peterson
- Corewell Health/Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Travis Menge
- Corewell Health/Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| |
Collapse
|
3
|
Colatruglio MR, Lamplot JD, Murphy J, Bernholt DL. There Is No Difference in Clinical Outcomes of Tibial-Based Versus Fibular-Based Posterolateral Corner Reconstruction: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00368-2. [PMID: 38776999 DOI: 10.1016/j.arthro.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To evaluate and analyze the current literature regarding clinical outcomes after posterolateral corner reconstruction (PLCR) using fibular-based and tibial-based techniques. METHODS A systematic review of the literature was performed to evaluate patient-reported outcomes after PLCR. Embase, PubMed, and Scopus were searched from their respective inception through October 25, 2022. Studies containing patient-reported outcome scores of tibial and fibular-based PLCR were included. Outcomes collected from each study were summarized using t tests for consistently reported Tegner, Lysholm, and International Knee Documentation Committee Score. RESULTS Twenty-four studies (16 with level of evidence IV, 6 with Level III, and 2 with Level II) met the inclusion criteria and included 669 patients in total. Four studies comprising 111 patients directly compared the results of tibial- and fibular-based PLCR. Mean clinical follow-up across all studies was 3.3 years. The 4 studies that reported on both tibial and fibular-based PLCR were found to have no significant differences in patient-reported outcomes with P values ranging from .0561 to .9881. CONCLUSIONS Analysis of the available literature regarding tibial- and fibular-based posterolateral corner reconstruction suggests no clinical differences. LEVEL OF EVIDENCE Level II-IV, review of systematic studies.
Collapse
Affiliation(s)
- Matthew R Colatruglio
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center - Campbell Clinic, Germantown, Tennessee, U.S.A
| | - Joseph D Lamplot
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center - Campbell Clinic, Germantown, Tennessee, U.S.A
| | - Jeff Murphy
- Murphy Statistical Services, Warsaw, Indiana, U.S.A
| | - David L Bernholt
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center - Campbell Clinic, Germantown, Tennessee, U.S.A..
| |
Collapse
|
4
|
Krause M, Weiss S, Kolb JP, Schwartzkopf B, Frings J, Püschel K, Cavaignac E, Sonnery-Cottet B, Frosch KH. Comparison of Arthroscopic versus Open Placement of the Fibular Tunnel in Posterolateral Corner Reconstruction. J Knee Surg 2022. [PMID: 35798341 DOI: 10.1055/s-0042-1748897] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Precise fibular tunnel placement in posterolateral corner (PLC) reconstruction is crucial in restoring rotational and lateral stability. Despite the recent progress of arthroscopic PLC reconstruction techniques, landmarks for arthroscopic fibular tunnel placement and a comparison to open tunnel placement have not yet been described. This study aimed to (1) identify reasonable soft-tissue and bony landmarks, which can be identified by either arthroscopy, fluoroscopy, or open surgery in anatomic fibular tunnel placement and (2) to compare accuracy and reliability of arthroscopic fibular tunnel placement with open surgery. MATERIALS AND METHODS In a retrospective study, 41 magnetic resonance images (MRIs) of the knee were analyzed with emphasis on distances of an ideal anatomic fibular tunnel to 11 soft-tissue and bony landmarks. Subsequently, in eight cadaver knees, the ideal fibular tunnel was created arthroscopically and with a standard open technique from antero-latero-inferior to postero-medio-superior with a 2-mm K-wire. Positions of both tunnels were compared on postinterventional computed tomography scans. RESULTS Based on MRI measurements, the anatomic tunnel entry should be 14.50 (±2.18) mm distal to the tip of the fibular styloid and 10.76 (±1.37) mm posterior to the anterior edge of the fibula. The anatomic fibular tunnel exit was located 12.89 (±2.35) mm below the tip of the fibular head. Arthroscopic fibular tunnel placement was reliable in all cases. Instead, in five out of the eight cases with open surgery, the fibular tunnel crossed the defined safety distance to the closest cortical edge/tibiofibular joint (distance < 8 mm). CONCLUSIONS Reliable soft-tissue and bony landmarks of the fibular head allow arthroscopic anatomic fibular tunnel placement in PLC surgery, which shows a lower risk of tunnel malposition compared with open surgical techniques. Future studies will have to show whether clinical results of arthroscopic PLC reconstruction are in line with this study's technical results. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Weiss
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Philipp Kolb
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ben Schwartzkopf
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jannik Frings
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Etienne Cavaignac
- Department of Orthopaedic Surgery and Trauma, Clinique Universitaire du Sport, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy; FIFA Medical Center of Excellence; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum, Hamburg, Germany
| |
Collapse
|
5
|
Senevirathna S, Stragier B, Geutjens G. Posterolateral Corner Reconstruction of the Knee Using Gracilis Autograft and Biceps Femoris. Arthrosc Tech 2022; 11:e741-e753. [PMID: 35646554 PMCID: PMC9134023 DOI: 10.1016/j.eats.2021.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/17/2021] [Indexed: 02/03/2023] Open
Abstract
We introduce our technique for posterolateral corner reconstruction, which is based on the principle described in Arciero's technique for anatomic reconstruction of lateral collateral ligament (LCL) and popliteofibular ligament (PFL) to gain static stability in varus strain and external rotation. This technique uses a doubled gracilis autograft to reconstruct the PFL and a split biceps tendon transfer to reconstruct the LCL. Using this technique an anatomical LCL and PFL reconstruction can be performed in combination with anterior cruciate ligament or posterior cruciate ligament reconstruction without contralateral graft harvest or allograft. The technique also enables an isolated reconstruction of LCL or PFL when required and can be performed to augment an acute repair.
Collapse
Affiliation(s)
- Shanaka Senevirathna
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom,Address correspondence to Shanaka Senevirathna, Royal Wolverhampton Hospitals NHS Trust, Wednesfield Road, Wolverhampton, United Kingdom, WV10 0QP.
| | | | | |
Collapse
|
6
|
Yeatts NC, Rao AJ, Trofa DP, Hong IS, Moorman CT, Piasecki DP, Fleischli JE, Saltzman BM. Comparable Subjective and Objective Clinical Outcomes After Fibular or Combined Tibial-Fibular-based Reconstruction of the Posterolateral Corner of the Knee: A Systematic Review and Meta-analysis. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202112000-00004. [PMID: 34860735 DOI: 10.5435/jaaosglobal-d-21-00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION To compare subjective and objective outcomes of fibular and combined tibial-fibular (TF)-based posterolateral corner (PLC) reconstruction. METHODS A systematic review of literature reporting outcomes of posterolateral corner reconstruction was conducted including outcome studies of surgically treated PLC injuries with a minimum 1-year follow-up, postoperative subjective and objective outcomes including the patient-reported outcome scorings of Lysholm score, International Knee Documentation Committee evaluation (subjective and objective), dial test, and varus stress radiographs. RESULTS The 32 studies included comprised 40 cohorts: 12 cohorts (n = 350 knees) used a fibular-based technique, and 28 cohorts (n = 593 knees) used a combined TF-based technique. No statistically significant differences were found in patient-reported outcomes or objective clinical measurements comparing the two techniques using the Lysholm score (P = 0.204, τ2 = 3.46), International Knee Documentation Committee evaluation (subjective P = 0.21 τ2 = 15.57; objective P = 0.398), dial test (P = 0.69), or varus stress radiographs (P = 0.98, τ2 = 0.08). CONCLUSIONS This study found no statistically significant differences in subjective or objective clinical outcome measurements after fibular-based versus combined TF-based PLC reconstruction. Further prospective evaluation comparing long-term clinical outcomes, complications, and surgical time may help to elucidate a preferred reconstructive technique.
Collapse
Affiliation(s)
- Nicholas C Yeatts
- From the OrthoCarolina-Sports Medicine Center (Dr. Yeatts, Dr. Rao, Mr. Hong, Dr. Moorman, Dr. Piasecki, Dr. Fleischli and Dr. Saltzman), Atrium Health-Musculoskeletal Institute, Charlotte, NC (Dr. Yeatts, Hong, Dr. Moorman, Dr. Piasecki, Dr. Fleischli, and Dr. Saltzman), and the Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY (Dr. Trofa)
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Maheshwer B, Drager J, John NS, Williams BT, LaPrade RF, Chahla J. Incidence of Intraoperative and Postoperative Complications After Posterolateral Corner Reconstruction or Repair: A Systematic Review of the Current Literature. Am J Sports Med 2021; 49:3443-3452. [PMID: 33502894 DOI: 10.1177/0363546520981697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posterolateral corner (PLC) injuries of the knee are being increasingly recognized and treated in current orthopaedic practice. While there are numerous systematic reviews evaluating the management and outcomes after PLC injuries, there are limited data investigating complications after PLC reconstruction or repair. PURPOSE To systematically review the literature to determine the incidence of postoperative complications after the surgical treatment of PLC injury. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008-2019), Embase (2008-2019), and MEDLINE (2008-2019) were queried for literature reporting on PLC reconstruction or repair, with or without concomitant ligamentous or meniscal surgery. Data including type of surgery performed, concomitant procedures, and follow-up time were extracted. Complications recorded included intra- and postoperative complications. RESULTS After the intra- and postoperative complication data of 60 studies (1747 cases) were combined, surgical management of PLC injuries was associated with an intraoperative complication rate of 0.34% (range, 0%-2.8%) and a postoperative complication rate of 20% (range, 0%-51.2%). The most common postoperative complication was arthrofibrosis (range, 0%-20%). The overall infection rate was 1.3% (range, 0%-10%). Four cases of postoperative common peroneal nerve palsy were reported. Failure of reconstruction or repair was reported in 164 (9.4%) of all cases examined (range, 0%-37.1%). CONCLUSION Although the intraoperative rate of complications during PLC reconstructions is low, postoperative complications rates of 20% can be expected, including arthrofibrosis, infection, and neurovascular injury. PLC structures repaired or reconstructed failed in 9.4% of the cases.
Collapse
Affiliation(s)
| | - Justin Drager
- Tufts University Medical Center, Boston, Massachusetts, USA
| | - Nalin S John
- University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | | | | | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
8
|
Lee YS, Cho JH, Lee MC, Han H, Kim TW. Can Anatomic Posterolateral Corner Reconstruction Using a Fibular Tunnel Restore Fibular Footprints of the Posterolateral Complex? A Cadaveric Study. Arthroscopy 2020; 36:1355-1362. [PMID: 31877333 DOI: 10.1016/j.arthro.2019.11.099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to (1) quantitatively analyze the fibular footprints of the lateral collateral ligament (LCL) and popliteofibular ligament (PFL) and (2) evaluate whether a fibular tunnel can restore the LCL and PFL fibular footprints simultaneously without modification in anatomic posterolateral corner reconstruction of the knee. METHODS In 20 cadaveric knees, anatomic characteristics, such as diameter, location and relationship with anatomic landmarks, of the LCL and PFL footprints were analyzed. Subsequently, a fibular tunnel that connected the LCL and PFL footprint centers was created with 1.5 mm drill bit, and tunnel depth, which is defined as the distance between the tunnel and the nearest cortex, was evaluated. An additional tunnel from the anteroinferior border of the LCL footprint to the posteroinferior border of the PFL footprint was created, and its tunnel depth was evaluated as well and compared with that of the original tunnel. RESULTS The LCL footprint was longitudinally ovoid (8.4 ± 1.0 × 13 ± 1.0 mm), and its inferior margin corresponded well with the lateral apex of the fibula (distance, 1.0 ± 0.7 mm). The PFL footprint was round (9.7 ± 1.3 × 9.0 ± 1.1 mm), and its center was very close to the tip of the fibular styloid process (1.2 ± 0.8 mm). The tunnel depth of the original fibular tunnel was 1.8 ± 0.7 mm, and it was very shallow for tunnel reaming. On the contrary, the tunnel depth of the modified fibular tunnel (6.4 ± 1.1 mm) was significantly higher than that of the original tunnel (P < 0.05), and it was relatively safe for tunnel reaming. CONCLUSIONS A single fibular tunnel cannot reproduce the LCL and PFL footprint centers simultaneously because the trajectory is too close to the cortex. A modified fibular tunnel, using the margins of the footprints, is recommended to avoid cortical blowout. CLINICAL RELEVANCE A modified fibular tunnel that covers only portions of the LCL and PFL footprints, from the anteroinferior LCL footprint to the posteroinferior PFL footprint, is less likely to blow out the lateral fibula than is a similar tunnel using the anatomic footprint centers.
Collapse
Affiliation(s)
- Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Jae Ho Cho
- Department of Orthopaedic Surgery, Hallym University, Chuncheon Sacred Heart Hospital, Seoul, South Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Heesoo Han
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
| |
Collapse
|
9
|
Anatomic, All-Arthroscopic Reconstruction of Posterolateral Corner of the Knee: A Cadaveric Biomechanical Study. Arthroscopy 2020; 36:1121-1131. [PMID: 31980202 DOI: 10.1016/j.arthro.2019.10.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/23/2019] [Accepted: 10/27/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the role of anatomic reconstruction of the posterolateral corner (PLC) of the knee arthroscopically in cadaveric knees with simulated isolated grade III posterolateral instability. METHODS A total of 12 nonpaired, fresh-frozen cadaveric knees were biomechanically subjected to a 10-Nm varus moment, 5-Nm external and internal rotation torques, and 134-N posterior tibial load at 0°, 15°, 30°, 60°, and 90° of knee flexion (0° for varus loading only). Testing was performed with an intact and sectioned PLC and after anatomic reconstruction of the PLC by an arthroscopic technique. Kinematics of each knee under various loading conditions was determined with a robotic universal force/moment sensor testing system. RESULTS After sectioning, significant increases were found in varus rotation at 0°, 15°, 30°, 60°, and 90° of knee flexion; in external rotation at 15°, 30°, 60°, and 90° of knee flexion; in internal rotation at 60° of knee flexion only; and in posterior translation at 15° and 30° of knee flexion. After reconstruction, full recovery of knee stability was observed in varus rotation, external rotation, internal rotation, and posterior translation at all selected flexion angles without any overconstraint of knee kinematics. CONCLUSIONS Anatomic reconstruction of the PLC can be performed arthroscopically with isolated grade III posterolateral instability of the knee, and nearly normal stability of the knee can be restored. CLINICAL RELEVANCE PLC reconstruction by an anatomic, all-arthroscopic technique achieves optimal stability control and kinematics of the knee.
Collapse
|
10
|
Posterolateral corner reconstruction in combined injuries of the knee: Improved stability with Larson's fibular sling reconstruction and comparison with LaPrade anatomical reconstruction. Knee 2020; 27:124-131. [PMID: 31883859 DOI: 10.1016/j.knee.2019.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 08/27/2019] [Accepted: 09/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The goal of this prospective cohort study was to present the clinical results of a two-year follow-up of a Larson's posterolateral corner reconstruction (fibular sling) in patients with symptomatic instability of the knee. These data were compared with data of an anatomical reconstruction of the posterolateral corner as described by LaPrade et al. (combined tibial tunnel and fibular sling) [1]. METHODS Eleven patients underwent a Larson's posterolateral corner reconstruction. Cruciate ligament ruptures were reconstructed if present. Multiple subjective knee outcome scores (VAS satisfaction score, Tegner, Lysholm, Noyes score, and IKDC subjective knee score) were obtained pre-operatively and two years after surgery. Laxity of the joint was measured using bilateral varus stress radiographs. RESULTS All patients had concomitant ACL or PCL surgery. VAS satisfaction, the Tegner, Noyes and the IKDC subjective knee score all improved significantly. Median varus laxity of the injured knee on varus stress radiographs improved significantly from 6.2° (3.1-10.1) to 3.9° (1.1-5.7), p = .0076. Post-operative varus laxity did not return to the level of the uninjured knee: 2.7° (1-5.7), p = .028. In comparison with our data on the reconstruction technique according to LaPrade, no statistically significant differences in clinical outcome were observed. CONCLUSION Reconstruction of the posterolateral corner in combined injuries of the knee using a Larson fibular sling technique results in improved varus stability but not to the level of the uninjured knee. Functional knee scores improved significantly. We found no differences in functional and radiological outcome between the Larson's fibular sling reconstruction and LaPrade anatomical reconstruction. LEVEL OF EVIDENCE IV.
Collapse
|
11
|
Satisfactory knee function after single-stage posterolateral corner reconstruction in the multi-ligament injured/dislocated knee using the anatomic single-graft technique. Knee Surg Sports Traumatol Arthrosc 2018; 26:1258-1265. [PMID: 28685303 DOI: 10.1007/s00167-017-4631-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Increasing importance has been placed on the posterolateral corner (PLC) in maintaining varus and rotational stability of the knee. The goal of this study was to evaluate knee function and clinical stability following a single-graft PLC reconstruction technique and identify factors associated with poor knee function. METHODS This study identified patients with a multi-ligament knee injury between 2006 and 2013. Patients who received a single-graft fibular collateral ligament and PLC reconstruction with a single-stage surgery during the study period and had a minimum follow-up of 2 years after surgery were included. Functional outcomes were assessed using Lysholm and IKDC scores. Varus and rotational knee laxity and range of motion were assessed using physical examination. RESULTS The final study cohort included 61 patients who underwent PLC reconstruction using a single-graft technique. The mean IKDC score was 74.1 (± 22.3) and the mean Lysholm score was 80.3 (± 21.8) at mean follow-up of 3.8 years (range 2-9 years). Mean range of motion at final follow-up measured from 0° to 126° [range flexion: 95-145, range extension: 0-5]. Fifty-eight patients (95%) had grade 0 varus laxity in full knee extension, and 54 patients (88.5%) had grade 0 varus laxity at 30° of knee flexion. Female gender was associated with a lower postoperative IKDC score (p = 0.04). CONCLUSION Surgical treatment of the PLC using a single-graft technique can result in satisfactory knee function and stable physical examination findings at minimum 2 years after surgery. Female gender was predictive of poor knee function after PLC reconstruction. Surgical treatment of PLC injuries should be individualized based on the timing of surgery, specific injured knee structures, and physical examination findings. This study helps validate the use of a single-graft technique for PLC reconstruction and can be used to help counsel patients about expected knee function after surgical treatment of PLC injuries. Level of evidence IV.
Collapse
|
12
|
Clinical outcomes after multiligament injured knees: medial versus lateral reconstructions. Knee Surg Sports Traumatol Arthrosc 2017; 25:524-531. [PMID: 27000392 DOI: 10.1007/s00167-016-4067-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 02/23/2016] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose of this study was to analyse the clinical outcomes of multiligament injured knees with respect to the medial collateral ligament and posteromedial corner (PMC) repair or reconstruction versus the posterolateral corner (PLC) reconstruction in patients operated according to a codified surgical protocol. METHODS Patients were divided into two groups depending on whether PMC or PLC was injured. Cruciate ligaments as well as PMC or PLC were reconstructed/repaired in a one-stage procedure. At minimum of 1-year follow-up, objective and subjective International Knee Documentation Committee (IKDC) forms, Lysholm score and sports activity level were recorded. RESULTS Thirty-nine patients with a median follow-up time of 57 months (range 12-129) were reviewed. No significant difference was found for functional scores between acute PMC and PLC subgroups. In Group PLC, subjective outcomes tend to be better in the acute than in chronic reconstruction subgroup. CONCLUSIONS A one-stage protocol with early surgery rather than delayed reconstruction produced better clinical outcomes whatever the injured collateral ligament, medial or lateral. In the future, early and chronic reconstructions as well as each injury pattern should be considered as separate entities in studies on multiple ligament injured knees to reach a better level of evidence. LEVEL OF EVIDENCE IV.
Collapse
|
13
|
Ishigooka H, Campbell ST, Quigley RJ, McGarry MH, Chen YJ, Gupta A, Bui CNH, Lee TQ. Anatomic Posterolateral Corner Reconstruction Using a Fibula Cross-Tunnel Technique: A Cadaveric Biomechanical Study. Arthroscopy 2016; 32:2300-2307. [PMID: 27209620 DOI: 10.1016/j.arthro.2016.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 02/18/2016] [Accepted: 03/11/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical properties of a fibula cross-tunnel technique for posterolateral corner (PLC) reconstruction with those of intact knees. METHODS Seven fresh-frozen cadaveric knees were tested while intact, after PLC tear, and after reconstruction. Testing of the parameters listed above was performed at 0°, 30°, 60°, and 90° of knee flexion. Reconstruction was performed using 2 independent tendon autografts. Afterward, the fibula and graft were loaded to failure. RESULTS Reconstruction restored external rotation (0°: 11.75° ± 2.02° to 9.81° ± 1.81°, P = .57; 30°: 17.91° ± 1.32° to 13.96° ± 2.84°, P = .12; 60°: 15.86° ± 1.68° to 13.26° ± 3.58°, P = .41; 90°: 15.53° ± 1.62° to 14.07° ± 2.95°, P = .54) to the intact state, and posterior translation (0°: 3.66 ± 0.85 mm to 3.31 ± 0.89 mm, P = .87; 60°: 3.15 ± 0.45 mm to 2.96 ± 0.45 mm, P = .73; 90°: 2.74 ± 0.33 mm to 3.05 ± 0.41 mm, P = .41) and varus angulation (0°: 0.92° ± 0.35° to 1.98° ± 0.42°, P = .55; 30°: 2.65° ± 0.27° to 1.09° ± 0.90°, P = .37; 90°: 4.29° ± 0.44° to 2.53° ± 1.13°, P = .19) under most conditions. During load to failure testing, the construct revealed properties similar to those of native structures (yield load: 330.4 ± 45.8 N; ultimate load: 420.9 ± 37.4 N). CONCLUSIONS This technique restored external rotation to the intact state after PLC injury in all testing conditions, as well as posterior translation at 0°, 60°, and 90° of flexion, and varus angulation under all conditions tested except 60° of flexion. CLINICAL RELEVANCE Clinically, this surgical technique may eliminate the need for a tibial tunnel for posterolateral corner reconstruction.
Collapse
Affiliation(s)
- Hideya Ishigooka
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, California, U.S.A.; Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sean T Campbell
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, California, U.S.A.; Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Ryan J Quigley
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, California, U.S.A
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, California, U.S.A
| | - Yu Jen Chen
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, California, U.S.A
| | - Akash Gupta
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, California, U.S.A
| | - Christopher N H Bui
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, California, U.S.A
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, California, U.S.A..
| |
Collapse
|
14
|
Wang D, Yamaguchi KT, Jones MH, Miniaci A. KOOS and IKDC scales may be inadequate in evaluating patients with multiple ligament knee injuries: a systematic review. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
15
|
Abstract
Injuries to the posterolateral corner (PLC) of the knee can be associated with a variety of additional ligamentous and soft-tissue injuries. The clinical outcome of a PLC injury is dependent on associated injuries, the chronicity of injury, and the method of reconstruction. This chapter discusses the current literature regarding outcomes of surgical treatment of acute and chronic injuries. The majority of the current literature includes level IV case series evidence. Anatomic reconstruction of the PLC with concomitant treatment of associated knee ligament injuries in acute and chronic cases is the preferred treatment. There are mixed outcomes with acute repair of injured tissues as well as advancement procedures. The surgical treatment must be tailored to the specific needs of the patient and the ligament injury pattern.
Collapse
|
16
|
Repair Versus Reconstruction in Acute Posterolateral Instability of the Knee. Sports Med Arthrosc Rev 2015; 23:22-6. [DOI: 10.1097/jsa.0000000000000050] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
17
|
Wajsfisz A, Bajard X, Plaweski S, Djian P, Demey G, Limozin R, Bousquet V, Rocheconcar G, Louis ML, Arndt J, Azar M, Sonnery-Cottet B, Boisrenoult P. Surgical management of combined anterior or posterior cruciate ligament and posterolateral corner tears: for what functional results? Orthop Traumatol Surg Res 2014; 100:S379-83. [PMID: 25455185 DOI: 10.1016/j.otsr.2014.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/10/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Management of combined anterior or posterior cruciate ligament and posterolateral corner tears is still poorly codified. The aim of this study was to evaluate functional outcome after complete surgical treatment. MATERIALS AND METHODS This retrospective multicenter study included 53 patients. Mean age was 29.8 yrs. (15-49). The anterior and posterior cruciate ligaments were involved in respectively 48 and 5 cases. Mean time to surgery was 25.6 months (0-184), and in 10 cases less than 21 days. Nine patients were sedentary workers and 29 non-sedentary (13 laborers). All ligament injuries were treated surgically. Mean follow-up was 49 months (12-146). Last follow-up assessment used IKDC, Lysholm and KOOS scores. RESULTS At last follow-up, IKDC score graded 14 patients A, 25 B, 8 C and 6 D, versus 0 A, 4 B, 25 C, 22 D and 2 ungraded preoperatively. Mean subjective IKDC and Lysholm scores were respectively 72.8 (11.5-100) and 77.5 (37-100). Mean KOOS scores (pain, symptoms, daily life, sports, quality of life) were respectively 78 (3-100), 70 (25-100), 88 (47-100), 53 (0-100) and 50 (0-100). Posterolateral laxity was corrected in all but two cases. All sedentary workers and 86.7% of non-sedentary workers could return to work. The job had to be changed in 10% of cases overall, but in 25% of cases for laborers. DISCUSSION The present results are comparable with those of the literature. The strategy of combined surgical treatment showed functional efficacy, usually associated with return to work except for some laborers. There was a non-significant trend in favor of acute-phase ligament reconstruction. LEVEL OF EVIDENCE IV (retrospective series).
Collapse
Affiliation(s)
- A Wajsfisz
- Clinique Drouot, 20, rue Laffitte, 75009 Paris, France
| | - X Bajard
- Hôpital d'instruction des Armées-Begin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - S Plaweski
- Service d'orthopédie traumatologie, centre hospitalier universitaire de Grenoble, hôpital Sud, 38434 Échirolles cedex, France
| | - P Djian
- Cabinet Goethe, 23, avenue Niel, 75017 Paris, France
| | - G Demey
- Lyon-ortho-clinic, 29B, avenue des Sources-Bâtiment-Trait-d'Union, 69009 Lyon, France
| | - R Limozin
- Médipole Garonne, 45, rue de Gironis, 31100 Toulouse, France
| | - V Bousquet
- Clinique du sport de merignac, 4, rue Negrevergne, 33700 Mérignac, France
| | - G Rocheconcar
- Service d'orthopédie traumatologie, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - M-L Louis
- Cabinet médical ICOS, 118, rue Jean-Mermoz, 13008 Marseille, France
| | - J Arndt
- Service d'orthopédie traumatologie, hôpitaux universitaire de Strasbourg, 67091 Strasbourg, France
| | - M Azar
- Service d'orthopédie traumatologie, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | | | - P Boisrenoult
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 78150 le Chesnay, France.
| | | |
Collapse
|
18
|
Abstract
BACKGROUND When associated with a knee dislocation, management of the medial ligamentous injury is challenging, with little literature available to guide treatment. QUESTIONS/PURPOSES We (1) compared MRI findings of medial ligament injuries between Schenck KDIIIM and KDIV injuries, (2) compared clinical outcomes and health-related quality of life as determined by Lysholm and Veterans Rand 36-Item Health Survey (VR-36) scores, respectively, of reconstructed KDIIIM and KDIV injured knees, and (3) determined reoperation rates of reconstructed KDIIIM and KDIV injured knees. METHODS Over a 12-year period, we treated 65 patients with knee dislocations involving bicruciate ligament injury and concomitant medial ligament injuries, without or with posterolateral corner injuries (Schenck KDIIIM and KDIV, respectively); 57% were available for followup at a mean of 6.2 years (range, 1.1-11.6 years). These patients were contacted, and prospectively measured clinical outcomes scores (Lysholm and VR-36) were obtained and compared between subsets of patients. Preoperative MRIs (available for review on 49% of the patients) were rereviewed to characterize the medial ligament injuries. RESULTS KDIIIM injuries more frequently had complete deep medial collateral ligament tears and posterior oblique ligament tears compared to KDIV injuries. KDIIIM knees had better Lysholm scores (88 versus 67, p = 0.027) and VR-36 scores (88 versus 70, p = 0.022) than KDIV knees. Female sex (Lysholm: 55 versus 85, p = 0.005; VR-36: 59 versus 85, p = 0.003) and an ultra-low-velocity mechanism (injury that occurs during activity of daily living in obese patients) (Lysholm: 55 versus 80-89, p = 0.002-0.013; VR-36: 60 versus 79-88, p = 0.001-0.017) were associated with worse outcomes. The overall reoperation rate was 28%, and the most common indication for reoperation was stiffness. CONCLUSIONS Medial ligament injury is common in knee dislocations. Females who sustain these injuries and patients who have an ultra-low-velocity mechanism should be counseled at the time of injury about the likelihood of inferior outcomes. As ROM deficits are the most commonly encountered complication, postoperative rehabilitation should focus on early ROM exercises as stability and wound healing allow. Future prospective studies are needed to definitively determine whether operative or nonoperative management is appropriate for particular medial ligamentous injury patterns.
Collapse
|
19
|
Lee DW, Jang HW, Lee YS, Oh SJ, Kim JY, Song HE, Kim JG. Clinical, Functional, and Morphological Evaluations of Posterior Cruciate Ligament Reconstruction With Remnant Preservation: Minimum 2-Year Follow-up. Am J Sports Med 2014; 42:1822-31. [PMID: 24944294 DOI: 10.1177/0363546514536680] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous posterior cruciate ligament (PCL) reconstruction techniques have evolved and have revealed satisfactory outcomes; however, the optimal operative method for PCL reconstruction remains controversial. HYPOTHESIS Transtibial PCL reconstruction with a remnant preservation technique would result in successful clinical, radiological, functional, and morphological outcomes. In addition, it was hypothesized that the results of combined PCL and posterolateral corner (PLC) reconstruction would be comparable with those of isolated PCL reconstruction. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 168 patients who underwent arthroscopic PCL reconstruction with or without reconstruction of the PLC between March 2006 and June 2011 were retrospectively reviewed. Ninety-two patients who met the inclusion criteria were enrolled, and 47 of 92 patients who underwent combined PCL and PLC reconstruction were evaluated as a subgroup. The PLC was reconstructed using the single fibular sling method. The patients were assessed by means of the Lysholm score, International Knee Documentation Committee (IKDC) subjective knee score, and Tegner activity score. Stability was evaluated using a KT-2000 arthrometer and Telos device. Proprioception was assessed using the Biodex System. Follow-up magnetic resonance imaging (MRI) was performed in 34 patients, and second-look arthroscopic surgery was conducted in 36 patients. RESULTS The minimum follow-up duration was 24 months in all patients. Clinical outcomes and posterior instability improved significantly. The mean Lysholm score improved from 56.7 ± 7.1 to 89.3 ± 7.3, the mean IKDC subjective knee score improved from 53.3 ± 9.6 to 86.2 ± 6.1, and the mean Tegner activity score was 2.5 ± 0.8 preoperatively and 5.1 ± 1.3 postoperatively (all P < .001). The mean side-to-side difference on posterior stress radiography with the Telos device improved significantly, decreasing from 12.1 ± 2.5 mm to 2.7 ± 1.3 mm (P < .001). The mean side-to-side difference on varus stress radiography was reduced from 5.9 ± 0.8 mm preoperatively to 1.3 ± 1.0 mm after combined PCL and PLC reconstruction (P < .001). Postoperative proprioception recovered to a level similar to that of the uninvolved side, and MRI and second-look arthroscopic surgery showed a high rate of complete healing and synovialization in patients who underwent either isolated PCL reconstruction or combined PLC and PCL reconstruction. CONCLUSION Transtibial PCL reconstruction with remnant preservation resulted in satisfactory clinical, functional, radiological, and morphological outcomes. The results of combined posterolateral rotatory instability were comparable with those for isolated PCL reconstruction with adequate PLC reconstruction.
Collapse
Affiliation(s)
- Dhong Won Lee
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Hyoung Won Jang
- Department of Orthopedic Surgery, Chung Hospital, Seongnam, Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Bundang Hospital, Seoul National University, Seongnam, Korea
| | - Soo Jin Oh
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Jae Young Kim
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Han Eui Song
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| |
Collapse
|