Abstract
Injury to the posterolateral corner (PLC) of the knee can lead to both varus and rotational
instability. Multiple PLC reconstruction techniques have been described, including
one-tailed graft (fibula-based constructs) or two-tailed graft (combined fibula- and
tibia-based constructs). The purpose of our study was to evaluate the clinical outcomes
of anatomical two-tailed graft reconstruction of the PLC in the setting of multiligament
knee injuries (MKLIs) with grade III varus instability. Patients were identified through
a prospective MLKI database between 2004 and 2013. Patients who received fibular collateral
ligament and PLC reconstructions using a two-tailed graft and had a minimum follow-up
of 2 years were included. Patients were assessed for clinical laxity grade, range
of motion, and functional outcomes using Lysholm and International Knee Documentation
Committee (IKDC) scores. Twenty patients (16 male, 4 female) with a mean age of 30.7
(range: 16–52) and a mean follow-up of 52.2 months (range: 24–93 months) were included.
Knee dislocation (KD) grades included: 4 KD-1, 10 KD 3-L, 5 KD-4, and 1 KD-5. No patients
had isolated PLC injuries. Mean IKDC and Lysholm score were 73.1 ± 25.8 and 78 ± 26,
respectively. Mean range of motion was –1.1 to 122.8. In full extension, two patients
(10%) had grade 1 laxity to varus stress. In 30 degrees of knee flexion, five (25%)
patients had grade 1 laxity, and two (10%) had grade 2 laxity. Anatomical two-tailed
PLC reconstruction can reliably restore varus stability when performed on patients
with MLKIs and type C posterolateral instability with hyperextension external rotation
recurvatum deformity. Satisfactory functional outcome scores were achieved in the
majority of patients. This study supports the use of an anatomical two-tailed PLC
reconstruction in the multiligament injured knee. The level of evidence is IV, case
series.
Keywords
knee - posterolateral corner - knee dislocation
