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Knee Surgery, Sports Traumatology, Arthroscopy

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01-10-2015 | Knee

Is PLC repair of a peel-off femoral lesion an effective option in a multiligament setting?

Authors: Tommaso Bonanzinga, Hui Zhang, Guan-yang Song, Jin Zhang, Cecilia Signorelli, Hua Feng

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2015

Abstract

Purpose

Treatment of posterolateral corner (PLC) injury in the multiligament-injured knee is still controversial. The aim of this study was to investigate the clinical outcome of acute or sub-acute surgical repair of Type 1 and 2 PLC peel-off lesions in a multiligament setting.

Methods

Mini-open direct repair of the PLC was performed in 13 patients. Combined PCL, ACL and MCL injuries were simultaneously managed. Telos valgus and varus stress radiographs at 30° of flexion with 150 N load were used to investigate medial and lateral joint opening. Posterior stress radiograph with 150 N load was used to investigate the function of the PCL. External rotational laxity was assessed with a dial test at 30° of knee flexion, and photographs were taken to measure angles. Anterior displacement was examined using the manual maximum test performed with a KT-1000 arthrometer.

Results

A statistically significant reduction between pre- and postoperative laxity values was achieved for every test. Particularly, lateral joint opening side-to-side difference reduced from 10.3 ± 4.0 to 1.0 ± 3.2 mm and external rotation reduced from 15 ± 8° to 0° ± 6° more than that of the contralateral uninjured knee. The medial joint opening side-to-side difference reduced from 11.5 ± 5.6 to 2.6 ± 2.7 mm in the 7 patients surgically managed for MCL lesion. The anterior tibial displacement side-to-side difference reduced from 14.0 ± 5.0 to 3.0 ± 5.0 mm in the 9 patients surgically managed for ACL lesion. The posterior tibial translation side-to-side difference reduced from 11.1 ± 5.1 to 4.4 ± 3.9 mm in the 11 patients treated for PCL lesion.

Conclusion

The main finding of the current study is that acute repair of Type 1 and 2 PLC peel-off injury proved to be an effective procedure to restore PLC function in a multiligament-injured knee. These data enabled the current literature with an effective treatment option to face such a complex and various scenarios such as multiligament-injured knee.

Level of evidence

IV.

American Medical Association (1968) Standard nomenclature of athletic injuries. American Medical Association, Committee on the Medical Aspects of Sports, Chicago, pp 99–100

Baker CL, Norwood LA, Hughston JC (1983) Acute combined posterior cruciate and posterolateral instability of the knee. Am J Sports Med 11:308–314CrossRef

Black BS, Stannard JP (2015) Repair versus reconstruction in acute posterolateral instability of the knee. Sports Med Arthrosc 23(1):22–26CrossRefPubMed

Chhabra A, Cha PS, Rihn JA, Cole B, Bennett CH, Waltrip RL, Harner CD (2005) Surgical management of knee dislocations: surgical technique. J Bone Jt Surg Am 87 Suppl 1(Pt 1):1–21

Clancy WG Jr, Shepard MF, Cain EL Jr (2003) Posterior lateral corner reconstruction. Am J Orthop 32:171–176PubMed

Corten K, Bellemans J (2008) Cartilage damage determines intermediate outcome in the late multiple ligament and posterolateral corner-reconstructed knee: a 5- to 10-year follow-up study. Am J Sports Med 36(2):267–275CrossRefPubMed

Covey DC (2001) Current concepts review: injuries of the posterolateral corner of the knee. J Bone Jt Surg 83:106–118CrossRef

Fanelli GC, Edson CJ (2002) Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2- to 10- years follow-up. Arthroscopy 18:703–714CrossRefPubMed

Fanelli GC, Orcutt DR, Edson CJ (2005) The multiple-ligament injured knee: evaluation, treatment, and results. Arthroscopy 21(4):471–486CrossRefPubMed

10.

Feng H, Zhang H, Hong L, Wang XS, Cheng KB, Zhang J (2011) Femoral peel-off lesions in acute posterolateral corner injuries: incidence, classification, and clinical characteristics. Arthroscopy 27(7):951–958CrossRefPubMed

11.

Feng H, Zhang H, Hong L, Wang XS, Zhang J (2009) The “lateral gutter drive-through” sign: an arthroscopic indicator of acute femoral avulsion of the popliteus tendon in knee joints. Arthroscopy 25:1496–1499CrossRefPubMed

12.

Geeslin AG, LaPrade RF (2011) Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries: a prospective case series and surgical technique. J Bone Joint Surg Am 21; 93(18):1672–1683

13.

Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study. J Bone Jt Surg Am 69:233–242

14.

Ibrahim SA, Ahmad FH, Salah M, Al Misfer AR, Ghaffer SA, Khirat S (2008) Surgical management of traumatic knee dislocation. Arthroscopy 24(2):178–187CrossRefPubMed

15.

Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613PubMed

16.

Krukhaug Y, Molster A, Rodt A, Strand F (1998) Lateral ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc 6:21–25CrossRefPubMed

17.

LaPrade RF (1997) Arthroscopic evaluation of the lateral compartment of knees with grade III posterolateral knee complex injuries. Am J Sports Med 25:596–602CrossRefPubMed

18.

LaPrade RF (2006) Posterolateral knee injuries: anatomy, evaluation, and treatment. Thieme, New York, pp 1–8

19.

LaPrade RF, Gilbert TJ, Bollom TS, Wentorf F, Chaljub G (2000) The magnetic resonance imaging appearance of individual structures of the posterolateral knee. Am J Sports Med 28:191–199PubMed

20.

Levy BA, Dajani KA, Morgan JA, Shah JP, Dahm DL, Stuart MJ (2010) Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med 38(4):804–809CrossRefPubMed

21.

Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ, Boyd JL, MacDonald PA, Marx RG (2009) Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy 25(4):430–438CrossRefPubMed

22.

Levy BA, Fanelli GC, Whelan DB, Stannard JP, MacDonald PA, Boyd JL, Marx RG, Stuart MJ, Knee Dislocation Study Group (2009) Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg 17(4):197–206PubMed

23.

Liow RY, McNicholas MJ, Keating JF, Nutton RW (2003) Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Jt Surg Br 85:845–851

24.

Liu X, Feng H, Zhang H, Hong L, Wang XS, Zhang J, Shen JW (2013) Surgical treatment of subacute and chronic valgus instability in multiligament-injured knees with superficial medial collateral ligament reconstruction using Achilles allografts: a quantitative analysis with a minimum 2-year follow-up. Am J Sports Med 41(5):1044–1050CrossRefPubMed

25.

Marcacci M, Zaffagnini S, Bonanzinga T, Pizzoli A, Manca M, Caiaffa E (2012) Surgical technique: articulated external fixator for treatment of complex knee dislocation. Clin Orthop Relat Res 470(3):869–876CrossRefPubMedPubMedCentral

26.

Markolf KL, Graves BR, Sigward SM, Jackson SR, McAllister DR (2007) How well do anatomical reconstructions of the posterolateral corner restore varus stability to the posterior cruciate ligament-reconstructed knee? Am J Sports Med 35(7):1117–1122CrossRefPubMed

27.

Noyes FR, Barber-Westin SD (2005) Posterior cruciate ligament revision reconstruction, part 1: causes of surgical failure in 52 consecutive operations. Am J Sports Med 33:646–654CrossRefPubMed

28.

Shelbourne KD, Haro MS, Gray T (2007) Knee dislocation with lateral side injury: results of an en masse surgical repair technique of the lateral side. Am J Sports Med 35(7):1105–1116CrossRefPubMed

29.

Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo MS (1991) Arthrofibrosis in acute anterior cruciate ligament reconstruction: the effect of timing of reconstruction and rehabilitation. Am J Sports Med 19:332–336CrossRefPubMed

30.

Stannard JP, Brown SL, Farris RC, McGwin G Jr, Volgas DA (2005) The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med 33(6):881–888CrossRefPubMed

31.

Veltri DM, Warren RF (1994) Operative treatment of posterolateral instability of the knee. Clin Sports Med 13:615–627PubMed

32.

Zhang H, Hong L, Wang XS, Zhang J, Geng XS, Liu X, Feng H (2010) Single-bundle posterior cruciate ligament reconstruction and mini-open popliteofibular ligament reconstruction in knees with severe posterior and posterolateral rotation instability: clinical results of minimum 2-year follow-up. Arthroscopy 26(4):508–514CrossRefPubMed

Title: Is PLC repair of a peel-off femoral lesion an effective option in a multiligament setting?
Authors: Tommaso Bonanzinga
Hui Zhang
Guan-yang Song
Jin Zhang
Cecilia Signorelli
Hua Feng
Publication date: 01-10-2015
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-015-3741-2

At a glance: The STEP trials

Springer Medicine

Is PLC repair of a peel-off femoral lesion an effective option in a multiligament setting?

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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