Incidence of Intraoperative and Postoperative Complications After Posterolateral Corner Reconstruction or Repair: A Systematic Review of the Current Literature

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.

Salvage Fixation With a Single Nitinol Compression Staple for a Lateralized Fibular Tunnel in Posterolateral Corner Reconstruction of the Knee

“…9 Technical difficulty and lack of familiarity with the procedure can both contribute to the high complication rate in PLC reconstruction; a recent systematic review demonstrated a complication rate of 20% in patients undergoing PLC reconstruction, with fibular head fracture being the most common intraoperative complication reported. 6 However, salvage methods to treat the complications of PLC reconstruction have rarely been described. 8 The use of a low-profile Nitinol staple for fracture fixation, osteotomy fixation, and arthrodesis in the hand, foot, and ankle has increased in recent years.…”

Postoperative complications following ACL reconstruction: Prevention and management

“…In comparison, a loss of less than 10% on quadriceps and hamstring strength is acceptable for progression into sport-specific skills and activities. If no isokinetic equipment is available, a 1-repetition maximal leg press may be used in its place [27] . If all phase goals are accomplished, including the patient obtaining less than a 20% deficit on quadriceps strength testing, functional hop testing can begin at least 12 weeks after surgery.…”

Superior Bone Microarchitecture in Anatomic Versus Nonanatomic Fibular Drill Tunnels for Reconstruction of the Posterolateral Corner of the Knee

“…19 Although PLC reconstruction techniques are well established and have been shown to adequately restore varus and external rotation stability to the knee, 9 bonerelated failure may occur (eg, intraoperative fracture, tunnel widening, cutout of the graft). 21,24 However, microarchitectural data on the proximal fibula overall are not available, let alone derived recommendations of fibulabased tunnel orientation. High-resolution peripheral quantitative computed tomography (HR-pQCT) represents an established technique to evaluate the microarchitectural features of different skeletal regions at a high spatial resolution (31 mm voxel size), which has been used in clinical practice and experimental cadaveric studies.…”