ANATOMICAL RECONSTRUCTION OF POSTEROLATERAL COMPLEX IN TREATMENT OF MULTI-LIGAMENT INJURY OF KNEES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Dongliang , WANG Lei , CAO Jiangang , LIU Jun.

Department of Joint Surgery, Tianjin Union Medical Center, Nankai University People’s Hospital, Tianjin, 300121, P.R.China. Corresponding author: LIU Jun, E-mail: drliujun@hotmail.com;

Corresponding author：

Keywords：

Knee joint; Posterolateral complex; Multi-ligament injury; Anatomical reconstruction

DOI：

10.7507/1002-1892.20130101

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Objective To evaluate the short-term effectiveness after static anatomical reconstruction of posterolateral complex (PLC) in the treatment of traumatic multi-ligament injury of the knee. Methods Between June 2007 and July 2011, 23 cases of multi-ligament injury of the knee were treated. There were 15 males and 8 females with an average age of 41 years (range, 19-56 years). The injury was caused by traffic accident in 9 cases, sprain in 7 cases, bruise in 3 cases, and falling from height in 4 cases. The time between injury and operation was 13-78 days (mean, 32 days). The results of posterior drawer test and Lachman test were positive, and all cases complicated by varus and external rotation instability. The Lysholm score of the knee was 43.4 ± 5.7. According to International Knee Documentation Committee (IKDC) scoring, all were rated as grade D. According to Fanelli typing, all were classified as type C. The X-ray films showed that load-induced posterior motion of the knee was (13.3 ± 4.2) mm; the lateral joint space was (15.1 ± 2.4) mm. Anterior cruciate ligament/posterior cruciate ligament and PLC were reconstructed simultaneously with auto-semitendinosus, gracilis tendon, and allogeneic tendon. Results All incisions healed by first intention, and no complication occurred. All patients were followed up 12-56 months (mean, 28 months). At last follow-up, the results of posterior drawer test and Lachman test were negative; 3 cases had varus instability, and 2 cases had external rotation instability. The Lysholm score of the knee was 85.6 ± 16.7, showing significant difference when compared with preoperative score (t=11.469, P=0.000). According to IKDC scoring, 7 cases were rated as grade A, 12 as grade B, and 4 as grade C; significant difference was found when compared with preoperative value (Z=4.285, P=0.000). The load-induced posterior motion of the knee was (5.1 ± 4.4) mm, the lateral joint space was (3.2 ± 2.8) mm, showing significant differences when compared with preoperative ones (P lt; 0.05). Conclusion In the treatment of traumatic multi-ligament injury of the knee, the anatomical reconstruction of the PLC using auto-semitendinosus, gracilis tendon, or allogeneic tendon can obtain good short-term effectiveness.

Citation： ZHANG Dongliang,WANG Lei,CAO Jiangang,LIU Jun.. ANATOMICAL RECONSTRUCTION OF POSTEROLATERAL COMPLEX IN TREATMENT OF MULTI-LIGAMENT INJURY OF KNEES. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(4): 436-439. doi: 10.7507/1002-1892.20130101 Copy

1.	Ayala-Mejías JD, García-Estrada GA, Rodríguez-Hernández C, et al. Description of an arthroscopic and percutaneous technique to repair posterolateral corner knee lesions. Acta Ortop Mex, 2011, 25(6): 396-402.
2.	Dhillon M, Akkina N, Prabhakar S, et al. Evaluation of outcomes in conservatively managed concomitant Type A and B posterolateral corner injuries in ACL deficient patients undergoing ACL reconstruction. Knee, 2012, 19(6): 769-772.
3.	Zantop T, Schumacher T, Diermann N, et al. Anterolateral rotational knee instability: role of posterolateral structures. Arch Orthop Trauma Surg, 2007, 127(9): 743-752.
4.	Kim SJ, Choi DH, Hwang BY. The influence of posterolateral rotatory instability on ACL reconstruction: comparison between isolated ACL reconstruction and ACL reconstruction combined with posterolateral corner reconstruction. J Bone Joint Surg (Am), 2012, 94(3): 253-259.
5.	Fanelli GC, Larson RV. Practical management of posterolateral instability of the knee. Arthroscopy, 2002, 18(2 Suppl 1): 1-8.
6.	赵金忠. 膝关节重建外科学. 郑州: 河南科学技术出版社, 2007: 155-178.
7.	Lee SH, Jung YB, Lee HJ, et al. Evaluation of tunnel position of posterolateral corner reconstruction using 3-Dimensional computed tomogram. Arthroscopy, 2012, 28(6): 844-854.
8.	LaPrade RF, Ly TV, Wentorf FA, et al. The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med, 2003, 31(6): 854-860.
9.	Stannard JP, Brown SL, Robinson JT, et al. Reconstruction of the posterolateral corner of the knee. Arthroscopy, 2005, 21(9): 1051-1059.
10.	Petrigliano FA, Lane CG, Suero EM, et al. Posterior cruciate ligament and posterolateral corner deficiency results in a reverse pivot shift. Clin Orthop Relat Res, 2012, 470(3): 815-823.
11.	Ellingson CI, Kurtz CA, Sekiya JK. Non surgical management of lateral side injuries of the knee. Spors Med Arthrosc, 2006, 14(1): 20-22.
12.	Gardner MJ, Yacoubian S, Geller D, et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma, 2005, 19(2): 79-84.
13.	Sekiya JK, Kurtz CA. Posterolateral corner reconstruction of the knee: surgical technique utilizing a bifid Achilles tendon allograft and a double femoral tunnel. Arthroscopy, 2005, 21(11): 1400.
14.	Feng H, Hong L, Geng XS, et al. Posterolateral sling reconstruction of the popliteus tendon: an all-arthrescopic technique. Arthroscopy, 2009, 25(7): 800-805．.
15.	Kim SJ, Kim TW, Kim SG, et al. Clinical comparisons of the anatomical reconstruction and modified biceps rerouting technique for chronic posterolateral instability combined with posterior cruciate ligament reconstruction. J Bone Joint Surg (Am), 2011, 93(9): 809-818．.
16.	Levy BA, Dajani KA, Morgan JA, et al. Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med, 2010, 38(4): 804-809.
17.	LaPrade RF, Johansen S, Agel J, et al. Outcomes of all anatomic posterolateral knee reconstruction. J Bone Joint Surg (Am), 2010, 92(1): 16-22.
18.	张辉, 洪雷, 王雪松, 等. 膝关节创伤性多发韧带损伤中后外复合体重建的临床疗效. 中华创伤骨科杂志, 2010, 12(4): 308-313．.

1. Ayala-Mejías JD, García-Estrada GA, Rodríguez-Hernández C, et al. Description of an arthroscopic and percutaneous technique to repair posterolateral corner knee lesions. Acta Ortop Mex, 2011, 25(6): 396-402.
2. Dhillon M, Akkina N, Prabhakar S, et al. Evaluation of outcomes in conservatively managed concomitant Type A and B posterolateral corner injuries in ACL deficient patients undergoing ACL reconstruction. Knee, 2012, 19(6): 769-772.
3. Zantop T, Schumacher T, Diermann N, et al. Anterolateral rotational knee instability: role of posterolateral structures. Arch Orthop Trauma Surg, 2007, 127(9): 743-752.
4. Kim SJ, Choi DH, Hwang BY. The influence of posterolateral rotatory instability on ACL reconstruction: comparison between isolated ACL reconstruction and ACL reconstruction combined with posterolateral corner reconstruction. J Bone Joint Surg (Am), 2012, 94(3): 253-259.
5. Fanelli GC, Larson RV. Practical management of posterolateral instability of the knee. Arthroscopy, 2002, 18(2 Suppl 1): 1-8.
6. 赵金忠. 膝关节重建外科学. 郑州: 河南科学技术出版社, 2007: 155-178.
7. Lee SH, Jung YB, Lee HJ, et al. Evaluation of tunnel position of posterolateral corner reconstruction using 3-Dimensional computed tomogram. Arthroscopy, 2012, 28(6): 844-854.
8. LaPrade RF, Ly TV, Wentorf FA, et al. The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med, 2003, 31(6): 854-860.
9. Stannard JP, Brown SL, Robinson JT, et al. Reconstruction of the posterolateral corner of the knee. Arthroscopy, 2005, 21(9): 1051-1059.
10. Petrigliano FA, Lane CG, Suero EM, et al. Posterior cruciate ligament and posterolateral corner deficiency results in a reverse pivot shift. Clin Orthop Relat Res, 2012, 470(3): 815-823.
11. Ellingson CI, Kurtz CA, Sekiya JK. Non surgical management of lateral side injuries of the knee. Spors Med Arthrosc, 2006, 14(1): 20-22.
12. Gardner MJ, Yacoubian S, Geller D, et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma, 2005, 19(2): 79-84.
13. Sekiya JK, Kurtz CA. Posterolateral corner reconstruction of the knee: surgical technique utilizing a bifid Achilles tendon allograft and a double femoral tunnel. Arthroscopy, 2005, 21(11): 1400.
14. Feng H, Hong L, Geng XS, et al. Posterolateral sling reconstruction of the popliteus tendon: an all-arthrescopic technique. Arthroscopy, 2009, 25(7): 800-805．.
15. Kim SJ, Kim TW, Kim SG, et al. Clinical comparisons of the anatomical reconstruction and modified biceps rerouting technique for chronic posterolateral instability combined with posterior cruciate ligament reconstruction. J Bone Joint Surg (Am), 2011, 93(9): 809-818．.
16. Levy BA, Dajani KA, Morgan JA, et al. Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med, 2010, 38(4): 804-809.
17. LaPrade RF, Johansen S, Agel J, et al. Outcomes of all anatomic posterolateral knee reconstruction. J Bone Joint Surg (Am), 2010, 92(1): 16-22.
18. 张辉, 洪雷, 王雪松, 等. 膝关节创伤性多发韧带损伤中后外复合体重建的临床疗效. 中华创伤骨科杂志, 2010, 12(4): 308-313．.

Chinese Journal of Reparative and Reconstructive Surgery

ANATOMICAL RECONSTRUCTION OF POSTEROLATERAL COMPLEX IN TREATMENT OF MULTI-LIGAMENT INJURY OF KNEES

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