Woodmass Jarret M, Sanders Thomas L, Johnson Nick R, Wu Isabella T, Krych Aaron J, Stuart Michael J, Levy Bruce A
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota.
J Knee Surg. 2018 Nov;31(10):1031-1036. doi: 10.1055/s-0038-1632377. Epub 2018 Feb 14.
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.
膝关节后外侧角（PLC）损伤可导致内翻和旋转不稳定。已描述了多种PLC重建技术，包括单尾移植物（基于腓骨的结构）或双尾移植物（基于腓骨和胫骨的联合结构）。我们研究的目的是评估在伴有III级内翻不稳定的多韧带膝关节损伤（MKLI）情况下，PLC解剖双尾移植物重建的临床结果。通过前瞻性MKLI数据库确定2004年至2013年间的患者。纳入使用双尾移植物进行腓侧副韧带和PLC重建且至少随访2年的患者。使用Lysholm评分和国际膝关节文献委员会（IKDC）评分评估患者的临床松弛度等级、活动范围和功能结果。纳入了20例患者（16例男性，4例女性），平均年龄30.7岁（范围：16 - 52岁），平均随访52.2个月（范围：24 - 93个月）。膝关节脱位（KD）分级包括：4例KD - 1，10例KD 3 - L，5例KD - 4，1例KD - 5。无患者为单纯PLC损伤。IKDC和Lysholm评分的平均值分别为73.1±25.8和78±26。平均活动范围为 - 1.1至122.8。在完全伸直时，2例患者（10%）对内翻应力有1级松弛。在膝关节屈曲30度时，5例（25%）患者有1级松弛，2例（10%）有2级松弛。对伴有C型后外侧不稳定和伸直位外旋反屈畸形的MKLI患者进行解剖双尾PLC重建时，可可靠地恢复内翻稳定性。大多数患者获得了满意的功能结果评分。本研究支持在多韧带损伤膝关节中使用解剖双尾PLC重建。证据级别为IV级，病例系列。
