Long-Term Assessment of Posterolateral Ligament Femoral-Fibular Reconstruction in Chronic Multiligament Unstable Knees

Abstract

Background: The authors previously reported the initial results of a femoral-fibular posterolateral reconstruction in which an Achilles tendon allograft was passed through a fibular tunnel adjacent to the anatomical fibular attachment site of the fibular collateral ligament and a femoral tunnel anterior and posterior to its femoral attachment site. Purpose: To compare the short-term results (mean, 3.5 years) to the long-term results (mean, 14 years) of posterolateral femoral-fibular knee ligament reconstructions in regard to restoration of posterolateral knee stability. Study Design: Case series; Level of evidence, 4. Methods: The authors report on 21 patients who underwent a posterolateral femoral-fibular reconstruction after sustaining multiligament ruptures with chronic instability. The results were determined by a comprehensive knee examination, stress radiographs, standing posteroanterior radiographs, knee arthrometer testing, the Cincinnati Knee Rating System, and the International Knee Documentation Committee rating system. Results: In the short-term analysis, the posterolateral reconstruction restored normal or nearly normal lateral joint opening and external tibial rotation according to International Knee Documentation Committee criteria in 16 of 21 patients (76%), whereas the other 5 were deemed early failures. Fourteen of these patients were followed 10.0 to 19.4 years postoperatively. Retention of normal or nearly normal lateral joint opening and external tibial rotation was found, and there were no significant differences between evaluations for symptoms, sports and daily activity functions, overall knee ratings, and knee ligament function. At the long-term follow-up evaluation, 71% had no symptoms with low-impact sports. However, concurrent arthritis affected 14% who had symptoms with sports (but no symptoms with daily activities) and 14% who had symptoms with daily activities. Conclusion: The long-term success rate of the femoral-fibular procedure in restoring posterolateral stability warrants consideration of this procedure, particularly in acute cases or when operative time is prolonged and a more simplified procedure is indicated.