Affiliation:
1. Department of Orthopaedic Surgery University Hospitals Cleveland Medical Center 11100 Euclid Ave 44106 Cleveland OH USA
2. Department of Orthopaedic Surgery Washington University and Barnes‐Jewish Orthopedic Center 14532 South Outer Forty Drive 63017 Chesterfield MO USA
3. Department of Orthopaedic Surgery Rush University Medical Center 1611 W Harrison St. Suite 300 60612 Chicago IL USA
4. Midwest Orthopaedics at Rush 1611 W Harrison St. 60612 Chicago IL USA
5. Twin Cities Orthopaedics 4010 W 65th St. 55435 Edina MN USA
Abstract
AbstractPurposeThere remains controversy regarding the optimal surgical treatment for acute complete (grade III) posterolateral corner (PLC) injuries. The purpose of this article is to systematically review the contemporary literature regarding surgical options and subsequent outcomes of acute grade III PLC injuries.MethodsA systematic review was performed using the following search terms: posterolateral corner knee, posterolateral knee, posterolateral instability, multi‐ligament knee, and knee dislocation. Inclusion criteria consisted of studies with level I–IV evidence, reporting on human patients with acute grade III PLC injuries undergoing operative management within 4 weeks from injury, with subjective and/or objective outcomes (including varus stress examinations or varus stress radiographs) reported at a minimum 2‐year follow‐up. Two investigators independently performed the search by sequentially screening articles. Accepted definitions of varus stability on examination or stress radiographs and revision surgery were used to determine success and failure of treatment.ResultsA total of 12 studies, consisting of 288 patients were included. Ten studies reported primary repair, while reconstruction techniques were reported in seven studies. Overall, 43% (n = 125/288) of injuries involved the PLC, ACL and PCL. Staged reconstruction was reported in 25% (n = 3/12) of studies. The Lysholm score was the most commonly reported outcome measure. An overall failure rate of 12.4% (n = 35/282) was observed. Surgical failure was significantly higher in patients undergoing repair (21.9%; n = 21/96) compared to reconstruction (7.1%; n = 6/84) (p = 0.0058). Return to sport was greater in patients undergoing reconstruction (100%; n = 22/22) compared to repair (94%; n = 48/51) (n.s). The most common post‐operative complication was arthrofibrosis requiring manipulation under anesthesia (8.7%; n = 25/288). A total of 3.8% (n = 11/288) of patients underwent revision PLC reconstruction.ConclusionThere remains substantial heterogeneity in the surgical techniques of acute, grade III PLC injuries with an overall failure rate of 12.4%. Failure rates were significantly lower, and return to sport rates higher in patients undergoing PLC reconstruction compared to repair. The most common postoperative complication was arthrofibrosis requiring manipulation under anesthesia.Level of evidenceLevel IV.
Subject
Orthopedics and Sports Medicine,Surgery