Mid-term results of isolated posterolateral corner reconstruction

Isolated posterolateral corner (PLC) tears are relatively rare events. Various surgical techniques to treat posterolateral knee instability have been described; because surgical results are very much linked to cruciate reconstructions to date it is difficult to define whether one surgical procedure has better prognosis than another. The goal of this study is to determine the clinical outcome of PLC reconstruction following fibular-based technique. MATERIALS AND METHODS: We retrospectively evaluated a case series of patients who had received isolated PLC reconstruction between March 2005 and January 2007. 12 patients were surgically treated for isolated injuries and 10 patients were available for follow-up (9 male/1 female), the average patient age was 27,4 years (range: 16-47 years). Exclusion criteria were: ACL/PCL deficient or pregressive ligaments reconstruction. The patients were referred for surgical consideration after it was determined that the nonoperative physical therapy had failed. The associated injury included 3 meniscus tears, 2 patellar chondropathy; no patients at time of injury had fracture associate. All patients were treated following the fibular based technique: double femoral tunnel was performed on six patient, while in the remaining four patients, the reconstruction of the PLC was performed with a single femoral tunnel. The choice of the graft was based upon the availability of allograft material. However, for all patients, the semitendinous graft was used. All patients had the same evaluation and the same rehabilitation protocol. RESULTS: The mean follow up period was 27,5 months (range 18-40). The mean ROM was 143,5° for the flexion (range 135°-150°) and 0,5° for the extension (range 0°- 3°). Any failure of the graft and any surgical complication was observed at follow-up. Three patients showed a 1+ at the varus stress test while at the Dial Test other 3 patients showed a 10° reduction of the extra-rotation compared with controlateral knee. The average Lysholm knee score was 94 points (range 83-100) and the mean IKDC subjective result was 88,48 (range 74-96,5). Based on Lysholm knee scoring system, the results were excellent in 8 knees, good in 2 knees. At the IKDC evaluation, 2 patients were grade A and 8 were grade B. The main VAS score for pain rating was 0,85 (range 0-3). CONCLUSIONS: These results show the effectiveness of reconstruction of PLC following fibular-based technique, suggesting that PLC can adequately restore the joint stability and the knee pain. Single or double femoral tunnel does not affect the final clinical result and the patient’s satisfaction. We suggest that fibular-based technique should be used for PLC reconstruction as this surgical procedure can restore the varus stability and the knee function with good patient compliance and without significant surgical complications.