Clinical results after arthroscopic reconstruction of the posterolateral corner of the knee: A prospective randomized trial comparing two different surgical techniques

Abstract

Introduction Arthroscopic reconstruction techniques of the posterolateral corner (PLC) of the knee have been developed in recent years. Reconstruction techniques for higher-grade PLC injuries have not yet been validated in clinical studies. This study aimed to compare clinical outcomes of two different techniques and to present results of the first prospective randomized clinical trial of patients to undergo these novel procedures. Materials and methods 19 patients with Fanelli Type B posterolateral corner injuries and additional posterior cruciate ligament ruptures were included in this prospective study. They were randomly assigned to one of two novel arthroscopic reconstruction techniques, based on open surgeries developed by Arciero (group A) and LaPrade (group B). Follow-up was conducted at 6 and 12 months postoperatively and included clinical examinations for lateral, rotational and posterior stability, range of motion and subjective clinical outcome scores (IKDC Subjective Score, Lysholm Score, Tegner Activity Scale and Numeric Rating Scale for pain). Results At 6 and 12 months postoperative, all patients in both groups presented stable to varus, external rotational and posterior forces, there were no significant differences between the two groups. At 12-month follow-up, group A patients showed significantly higher maximum flexion angles (134.17° ± 3.76° vs. 126.60° ± 4.22°; p = 0.021) compared to patients of group B. Duration of surgery was significantly longer in Group B patients than in group A (121.88 ± 11.63 vs. 165.00 ± 35.65 min; p = 0.003). Posterior drawer (side-to-side difference) remained more reduced in group A (2.50 ± 0.69 mm vs. 3.27 ± 0.92 mm; p = 0.184). Subjective patient outcome scores showed no significant differences between groups (Lysholm Score 83.33 ± 7.79 vs. 86.40 ± 9.21; p = 0.621). Conclusions This study indicates sufficient restoration of posterolateral rotational instability, varus instability and posterior drawer after arthroscopic posterolateral corner reconstruction without neurovascular complications. Increased postoperative range of motion and a shorter and less invasive surgical procedure could favor the arthroscopic reconstruction technique according to Arciero over LaPrade’s technique in future treatment considerations.

Posterolateral Corner of the Knee: An Update on Current Evaluation and Management Strategies

“…1 Reconstruction has demonstrated excellent clinical results with high Lysholm knee scores, high International Knee Documentation Committee subjective knee scores, and good range of motion postoperatively. 33,34 Various techniques-open versus all arthroscopic, nonanatomic versus anatomic (tibiofibular-based versus fibular-based), and autograft versus allograft have all been described for reconstruction. Arthroscopic techniques can produce biomechanically sound constructs.…”

“…Arthroscopic techniques can produce biomechanically sound constructs. Weiss et al 33 in their randomized controlled trial concluded that arthroscopic PLC reconstruction sufficiently restores posterolateral rotational, varus, and posterior drawer stability without neurovascular complications. Li et al 35 found that arthroscopic PT reconstruction demonstrated similar subjective and objective clinical outcomes compared with the open procedure.…”

“…1 Reconstruction has demonstrated excellent clinical results with high Lysholm knee scores, high International Knee Documentation Committee subjective knee scores, and good range of motion postoperatively. 33,34…”

“…37 As for clinical outcomes, Sharma et al 34 found equally satisfactory clinical results between the modified Larson technique (fibular-based) and the LaPrade technique (tibiofibular-based). In fact, Weiss et al 33 found that the Arciero (fibular-based) technique had increased postoperative range of motion and was a shorter and less invasive surgical procedure compared to the LaPrade technique (tibiofibular-based). In a recent systematic review and meta-analysis, both constructs had comparable clinical outcomes and were equally effective at restoring varus and rotational stability for PLC knee injuries.…”

Preoperatively Predict the Minimum Autograft Length Necessary for Reconstructive Surgery of the Posterolateral Corner: A Cadaveric Study.

“…[11] In recent years, arthroscopic reconstruction techniques have been developed to provide stability while utilizing the bene ts of arthroscopic compared to open surgeries. [12,13] There are different types of reconstructive surgery depending on the type of injury-for example: arthroscopic popliteus tenodesis, bula-based anatomic PLC reconstruction (technique according to Arciero), arthroscopic-assisted anatomic PLC reconstruction, tibia and bula-based anatomic PLC reconstruction (technique according to LaPrade). [12] The LaPrade technique addresses the 3 primary stabilizing structures of the PLC: FCL, PLT, PFL.…”