J Knee Surg
DOI: 10.1055/s-0038-1632377
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Posterolateral Corner Reconstruction using the Anatomical Two-Tailed Graft Technique: Clinical Outcomes in the Multiligament Injured Knee

Jarret M. Woodmass
1  Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
,
Thomas L. Sanders
1  Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
,
Nick R. Johnson
1  Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
,
Isabella T. Wu
1  Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
,
Aaron J. Krych
1  Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
,
Michael J. Stuart
1  Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
,
Bruce A. Levy
1  Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
› Author Affiliations
Further Information

Publication History

30 June 2017

07 January 2018

Publication Date:
14 February 2018 (eFirst)

Abstract

Injury to the posterolateral corner (PLC) of the knee can lead to both varus and rotational instability. Multiple PLC reconstruction techniques have been described, including one-tailed graft (fibula-based constructs) or two-tailed graft (combined fibula- and tibia-based constructs). The purpose of our study was to evaluate the clinical outcomes of anatomical two-tailed graft reconstruction of the PLC in the setting of multiligament knee injuries (MKLIs) with grade III varus instability. Patients were identified through a prospective MLKI database between 2004 and 2013. Patients who received fibular collateral ligament and PLC reconstructions using a two-tailed graft and had a minimum follow-up of 2 years were included. Patients were assessed for clinical laxity grade, range of motion, and functional outcomes using Lysholm and International Knee Documentation Committee (IKDC) scores. Twenty patients (16 male, 4 female) with a mean age of 30.7 (range: 16–52) and a mean follow-up of 52.2 months (range: 24–93 months) were included. Knee dislocation (KD) grades included: 4 KD-1, 10 KD 3-L, 5 KD-4, and 1 KD-5. No patients had isolated PLC injuries. Mean IKDC and Lysholm score were 73.1 ± 25.8 and 78 ± 26, respectively. Mean range of motion was –1.1 to 122.8. In full extension, two patients (10%) had grade 1 laxity to varus stress. In 30 degrees of knee flexion, five (25%) patients had grade 1 laxity, and two (10%) had grade 2 laxity. Anatomical two-tailed PLC reconstruction can reliably restore varus stability when performed on patients with MLKIs and type C posterolateral instability with hyperextension external rotation recurvatum deformity. Satisfactory functional outcome scores were achieved in the majority of patients. This study supports the use of an anatomical two-tailed PLC reconstruction in the multiligament injured knee. The level of evidence is IV, case series.