Posterolateral Knee Reconstruction Versus Repair.

BACKGROUND: Recent literature has shown that posterolateral corner injuries of the knee have poor results when treated with repair, when compared to reconstruction. Our study sought to compare outcomes of posterolateral knee injuries treated with repair versus reconstruction and report results from our institution, with the hypothesis that acute repairs have comparable results to reconstructions. METHODS: We identified patients with posterolateral knee reconstruction or repair from January 1, 2000 to March 1, 2012. Patients returned for outcome measures, clinical exam and varus stress radiographs. Further, each patient underwent a chart review. Varus stress radiographs were obtained in 20 control knees, with no history of knee trauma, to our two cohort groups. RESULTS: 26 knees in 25 patients (17 reconstructions and 9 repairs) were evaluated in clinic at mean of 42 months postoperatively for repairs and 38 months postoperatively for reconstructions. Average IKDC scores for reconstruction and repair were 68 and 71, respectively. Average Lysholm scores for these groups were 83 for reconstructions and 83 for repairs. No statistically significant differences existed. Average varus gapping at zero degrees was 8.21 and 8.84 millimeters (mm) for reconstructions and repairs, respectively. Average varus gapping at 20 degrees knee flexion was 11.25 mm for reconstructions and 10.34 mm for repairs. No statistically significant differences were observed in varus gapping between the two groups. Each patient chart was reviewed for complications. There were 2 failures in the 44 patient reconstruction group (4.7%) and 2 failures in the 18 patient repair group (11.1%). We noted a high rate (10/19 patients) of primarily distally-based injuries in our repair group. All failures were treated with revision reconstructions. CONCLUSION: We found low failure rates in both groups. All knees in the repair group were operated within three weeks of injury. Our repair knees had a high rate of distally based avulsion and, were felt to have acceptable tissue that could be successfully repaired. We recommend posterolateral knee repair in cases with distally based avulsions that can be operatively treated within 3 weeks of injury, and have good tissue quality at the time of surgery. LEVEL OF EVIDENCE: IV.

Duke Scholars

Author Annunziato Amendola Orthopaedic Surgery