Andrew G Geeslin1, Samuel G Moulton2, Robert F LaPrade3. 1. Department of Orthopaedic Surgery, Homer Stryker M.D. School of Medicine, Western Michigan University, Kalamazoo, Michigan, USA. 2. Steadman Philippon Research Institute, Vail, Colorado, USA. 3. Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA drlaprade@sprivail.org.
Abstract
BACKGROUND: There is a paucity of outcome data to guide the surgical treatment of acute grade III posterolateral corner (PLC) knee injuries. PURPOSE: To systematically review the literature to compare clinical outcomes of the treatment for acute grade III PLC injuries. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review of the literature including Cochrane, PubMed, Medline, and Embase was performed. The following search terms were used: posterolateral corner knee, posterolateral knee, posterolateral instability, multiligament knee, and knee dislocation. Inclusion criteria were outcome studies of surgically treated acute PLC injuries with a minimum 2-year follow-up, subjective outcomes, objective outcomes including varus stability, and subgroup data on PLC injuries. Two investigators independently reviewed all abstracts. Accepted definitions of varus stability on examination or stress radiographs and the need for revision surgery were used to categorically define success and failure. RESULTS: Eight studies with a total of 134 patients were included. The mean patient age was reported in 7 studies (range, 21-31.5 years). The mean time to surgery was reported in 5 studies (range, 15-24.3 days); surgery was performed within 3 weeks in the other 3 studies. Four studies reported International Knee Documentation Committee scores (range, 78.1-91.3); 5 studies reported Lysholm scores (range, 87.5-90.3). Only 3 studies obtained bilateral varus stress radiographs. Based on an objective evaluation with varus stress examinations or radiographs, there was an overall success rate of 81% and failure rate of 19%. In 2 studies, the fibular collateral ligament and popliteus tendon were repaired and staged cruciate reconstruction performed in most patients; there were 17 failures of 45 patients (38%). In the remainder of the studies, patients were treated with local tissue transfer, hybrid repair for amenable structures or reconstruction for midsubstance tears, or reconstruction of all torn structures; the failure rate was 9%. CONCLUSION: The repair of acute grade III PLC injuries and staged treatment of combined cruciate injuries were associated with a substantially higher postoperative PLC failure rate. Further research is required to identify the reconstruction technique that provides optimal subjective and objective outcomes.
BACKGROUND: There is a paucity of outcome data to guide the surgical treatment of acute grade III posterolateral corner (PLC) knee injuries. PURPOSE: To systematically review the literature to compare clinical outcomes of the treatment for acute grade III PLC injuries. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review of the literature including Cochrane, PubMed, Medline, and Embase was performed. The following search terms were used: posterolateral corner knee, posterolateral knee, posterolateral instability, multiligament knee, and knee dislocation. Inclusion criteria were outcome studies of surgically treated acute PLC injuries with a minimum 2-year follow-up, subjective outcomes, objective outcomes including varus stability, and subgroup data on PLC injuries. Two investigators independently reviewed all abstracts. Accepted definitions of varus stability on examination or stress radiographs and the need for revision surgery were used to categorically define success and failure. RESULTS: Eight studies with a total of 134 patients were included. The mean patient age was reported in 7 studies (range, 21-31.5 years). The mean time to surgery was reported in 5 studies (range, 15-24.3 days); surgery was performed within 3 weeks in the other 3 studies. Four studies reported International Knee Documentation Committee scores (range, 78.1-91.3); 5 studies reported Lysholm scores (range, 87.5-90.3). Only 3 studies obtained bilateral varus stress radiographs. Based on an objective evaluation with varus stress examinations or radiographs, there was an overall success rate of 81% and failure rate of 19%. In 2 studies, the fibular collateral ligament and popliteus tendon were repaired and staged cruciate reconstruction performed in most patients; there were 17 failures of 45 patients (38%). In the remainder of the studies, patients were treated with local tissue transfer, hybrid repair for amenable structures or reconstruction for midsubstance tears, or reconstruction of all torn structures; the failure rate was 9%. CONCLUSION: The repair of acute grade III PLC injuries and staged treatment of combined cruciate injuries were associated with a substantially higher postoperative PLC failure rate. Further research is required to identify the reconstruction technique that provides optimal subjective and objective outcomes.
Authors: Andrew D Lynch; Terese Chmielewski; Lane Bailey; Michael Stuart; Jonathan Cooper; Cathy Coady; Terrance Sgroi; Johnny Owens; Robert Schenck; Daniel Whelan; Volker Musahl; James Irrgang Journal: Curr Rev Musculoskelet Med Date: 2017-09
Authors: Marcio B Ferrari; Jorge Chahla; Justin J Mitchell; Gilbert Moatshe; Jacob D Mikula; Daniel Cole Marchetti; Robert F LaPrade Journal: Arthrosc Tech Date: 2017-03-20
Authors: Thomas L Sanders; Nick R Johnson; Ayoosh Pareek; Aaron J Krych; Robert G Marx; Michael J Stuart; Bruce A Levy Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-07-06 Impact factor: 4.342
Authors: Luc M Fortier; Jack A Stylli; Matthew Civilette; Naim S Duran; Shadi Hanukaai; Heath Wilder; William F Sherman; Alan D Kaye Journal: Orthop Rev (Pavia) Date: 2022-05-31