Camilo Partezani Helito1, Marcel Faraco Sobrado2, Pedro Nogueira Giglio3, Marcelo Batista Bonadio3, Marco Kawamura Demange3, José Ricardo Pécora3, Gilberto Luis Camanho3, Fabio Janson Angelini3. 1. Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Hospital Sírio Libanês, São Paulo, Brazil. 2. Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: marcel.sobrado@usp.br. 3. Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Abstract
BACKGROUND: To report the functional outcomes and complications from reconstructing the knee posterolateral complex (PLC), associated with one-stage opening-wedge tibial valgus osteotomy, and discuss the technical feasibility of this procedure. METHODS: Five patients with chronic PLC injuries and varus deviation of the mechanical axis, associated with central pivot injuries or not, underwent medial opening-wedge high tibial osteotomy combined with PLC reconstruction. The lateral collateral ligament, popliteal tendon, and popliteofibular ligament were reconstructed using a single femoral tunnel. Patients were assessed on physical examination, range-of-motion and functional scales, and radiographs. The International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee Injury and Osteoarthritis Outcome score (KOOS) were determined. RESULTS: Five patients were evaluated: four presented with central pivot injury, and one had an isolated PLC injury. The mean time between injury and surgery was 40 ± 6.5 months (± is indicating standard deviation value). Four patients had minimal residual instability on physical examination, with a lateral opening at varus stress of ±3+ at 30° flexion. The means of the IKDC score, Lysholm score, and KOOS were 67.8 ± 9.2, 83.0 ± 9.3, and 79.2 ± 5.9, respectively. All patients showed satisfactory consolidation of osteotomy in 2.6 ± 0.9 months. CONCLUSIONS: The results of this series indicate that one-stage PLC ligament reconstruction associated with medial opening-wedge valgus osteotomy is feasible and shows satisfactory functional results with a low rate of complications. A one-stage procedure might be indicated for young patients with high functionality and more pronounced posterolateral instabilities.
BACKGROUND: To report the functional outcomes and complications from reconstructing the knee posterolateral complex (PLC), associated with one-stage opening-wedge tibial valgus osteotomy, and discuss the technical feasibility of this procedure. METHODS: Five patients with chronic PLC injuries and varus deviation of the mechanical axis, associated with central pivot injuries or not, underwent medial opening-wedge high tibial osteotomy combined with PLC reconstruction. The lateral collateral ligament, popliteal tendon, and popliteofibular ligament were reconstructed using a single femoral tunnel. Patients were assessed on physical examination, range-of-motion and functional scales, and radiographs. The International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee Injury and Osteoarthritis Outcome score (KOOS) were determined. RESULTS: Five patients were evaluated: four presented with central pivot injury, and one had an isolated PLC injury. The mean time between injury and surgery was 40 ± 6.5 months (± is indicating standard deviation value). Four patients had minimal residual instability on physical examination, with a lateral opening at varus stress of ±3+ at 30° flexion. The means of the IKDC score, Lysholm score, and KOOS were 67.8 ± 9.2, 83.0 ± 9.3, and 79.2 ± 5.9, respectively. All patients showed satisfactory consolidation of osteotomy in 2.6 ± 0.9 months. CONCLUSIONS: The results of this series indicate that one-stage PLC ligament reconstruction associated with medial opening-wedge valgus osteotomy is feasible and shows satisfactory functional results with a low rate of complications. A one-stage procedure might be indicated for young patients with high functionality and more pronounced posterolateral instabilities.