Stannard, Am J Sports Med 2005 - The Posterolateral Corner of the Knee: Repair versus Reconstruction - Article Summary

The Posterolateral Corner of the Knee: Repair versus Reconstruction

Stannard, Volgas, et al.·Am J Sports Med·2005·392 citations·Prospective cohort

Background

Injuries to the posterolateral corner of the knee are disabling. Despite improved understanding of this group of tendons and ligaments, the best surgical treatment of an unstable corner is not clear.

Purpose

Hypothesis: Surgical repair of acute tears of the posterolateral corner has outcomes that are as good as those from reconstruction combined with an early motion rehabilitation protocol.

Methods

Study Design: Cohort study; Level of evidence, 2.

63 patients with 64 posterolateral corner tears were included in this study, with 39 posterolateral corner repairs and 25 reconstructions using the modified 2-tailed technique. Patients were evaluated with clinical and KT-2000 arthrometer examinations, as well as with Lysholm, International Knee Documentation Committee, and Short Form–36 scores.

Results

56 patients with 57 corner tears had minimum clinical follow-up of 24 months (range, 24-59 months).
Acute primary repairs were performed on 35 patients, with 22 successful outcomes and 13 (37%) failures.
Primary reconstructions were performed on 22 patients, with 20 successful outcomes and 2 (9%) failures.
The difference in stability on clinical examination between repairs and reconstructions was significant (P < .05).
14 of 15 patients with failures of the primary posterolateral corner repair or reconstruction underwent successful revision reconstruction.
The final patient with failure of the primary repair elected not to have a revision reconstruction.
The final mean Lysholm knee score for both repair and reconstruction patients was 88.7 (range, 53-100).
Final International Knee Documentation Committee objective scores yielded 14 (26%) normal, 28 (52%) near-normal, 9 (17%) abnormal, and 3 (6%) severely abnormal knees; the mean score was 60 at the most recent clinical evaluation.

Conclusions

Results with repair followed by early motion rehabilitation have been significantly inferior when compared with results from reconstruction using the modified 2-tailed technique. The authors now use reconstruction rather than repair in the majority of patients who sustain posterolateral corner tears after high-energy injuries.

Core

The Posterolateral Corner of the Knee: Repair versus Reconstruction

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The Posterolateral Corner of the Knee: Repair versus Reconstruction

Stannard, Volgas, et al.·Am J Sports Med·2005·392 citations·Prospective cohort

DOI·PubMed

Background

Injuries to the posterolateral corner of the knee are disabling. Despite improved understanding of this group of tendons and ligaments, the best surgical treatment of an unstable corner is not clear.

Purpose

Hypothesis: Surgical repair of acute tears of the posterolateral corner has outcomes that are as good as those from reconstruction combined with an early motion rehabilitation protocol.

Methods

Study Design: Cohort study; Level of evidence, 2.

Results

56 patients with 57 corner tears had minimum clinical follow-up of 24 months (range, 24-59 months).
Acute primary repairs were performed on 35 patients, with 22 successful outcomes and 13 (37%) failures.
Primary reconstructions were performed on 22 patients, with 20 successful outcomes and 2 (9%) failures.
The difference in stability on clinical examination between repairs and reconstructions was significant (P < .05).
14 of 15 patients with failures of the primary posterolateral corner repair or reconstruction underwent successful revision reconstruction.
The final patient with failure of the primary repair elected not to have a revision reconstruction.
The final mean Lysholm knee score for both repair and reconstruction patients was 88.7 (range, 53-100).
Final International Knee Documentation Committee objective scores yielded 14 (26%) normal, 28 (52%) near-normal, 9 (17%) abnormal, and 3 (6%) severely abnormal knees; the mean score was 60 at the most recent clinical evaluation.

Conclusions

Background

Injuries to the posterolateral corner of the knee are disabling. Despite improved understanding of this group of tendons and ligaments, the best surgical treatment of an unstable corner is not clear.

Purpose

Hypothesis: Surgical repair of acute tears of the posterolateral corner has outcomes that are as good as those from reconstruction combined with an early motion rehabilitation protocol.

Methods

Study Design: Cohort study; Level of evidence, 2.

Results

56 patients with 57 corner tears had minimum clinical follow-up of 24 months (range, 24-59 months).
Acute primary repairs were performed on 35 patients, with 22 successful outcomes and 13 (37%) failures.
Primary reconstructions were performed on 22 patients, with 20 successful outcomes and 2 (9%) failures.
The difference in stability on clinical examination between repairs and reconstructions was significant (P < .05).
14 of 15 patients with failures of the primary posterolateral corner repair or reconstruction underwent successful revision reconstruction.
The final patient with failure of the primary repair elected not to have a revision reconstruction.
The final mean Lysholm knee score for both repair and reconstruction patients was 88.7 (range, 53-100).
Final International Knee Documentation Committee objective scores yielded 14 (26%) normal, 28 (52%) near-normal, 9 (17%) abnormal, and 3 (6%) severely abnormal knees; the mean score was 60 at the most recent clinical evaluation.

Conclusions

Background

Injuries to the posterolateral corner of the knee are disabling. Despite improved understanding of this group of tendons and ligaments, the best surgical treatment of an unstable corner is not clear.

Purpose

Hypothesis: Surgical repair of acute tears of the posterolateral corner has outcomes that are as good as those from reconstruction combined with an early motion rehabilitation protocol.

Methods

Study Design: Cohort study; Level of evidence, 2.

Results

56 patients with 57 corner tears had minimum clinical follow-up of 24 months (range, 24-59 months).
Acute primary repairs were performed on 35 patients, with 22 successful outcomes and 13 (37%) failures.
Primary reconstructions were performed on 22 patients, with 20 successful outcomes and 2 (9%) failures.
The difference in stability on clinical examination between repairs and reconstructions was significant (P < .05).
14 of 15 patients with failures of the primary posterolateral corner repair or reconstruction underwent successful revision reconstruction.
The final patient with failure of the primary repair elected not to have a revision reconstruction.
The final mean Lysholm knee score for both repair and reconstruction patients was 88.7 (range, 53-100).
Final International Knee Documentation Committee objective scores yielded 14 (26%) normal, 28 (52%) near-normal, 9 (17%) abnormal, and 3 (6%) severely abnormal knees; the mean score was 60 at the most recent clinical evaluation.