Non-anatomical reconstruction of chronic posterolateral corner knee injuries show failure rates from 0% to 36% versus 4.3% to 24.2% for anatomic reconstruction techniques: An updated systematic review reflecting the 2019 expert consensus statement

Garrett R Jackson; Enzo S Mameri; Joshua Condon; Daniel DeWald; Anjay Batra; Luis M Salazar; Filippo Familiari; Matthew Matava; Derrick M Knapik; Nikhil N Verma; Robert F LaPrade; Jorge Chahla

doi:10.1016/j.jisako.2023.11.010

Non-anatomical reconstruction of chronic posterolateral corner knee injuries show failure rates from 0% to 36% versus 4.3% to 24.2% for anatomic reconstruction techniques: An updated systematic review reflecting the 2019 expert consensus statement

J ISAKOS. 2024 Jun;9(3):362-370. doi: 10.1016/j.jisako.2023.11.010. Epub 2023 Dec 1.

Authors

Affiliations

¹ Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA.
² Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA; Instituto Brasil de Tecnologia da Saúde, 407 Visconde de Piraja St, Rio de Janeiro, RJ 22410, Brazil; Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), 740 Botucatu St, São Paulo, SP 04023, Brazil.
³ Department of Orthopaedic and Trauma Surgery, Magna Graecia University of Catanzaro, Viale Europa, 88100 Catanzaro CZ, Italy.
⁴ Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, 14532 South Outer Forty Drive, Chesterfield, MO 63017, USA.
⁵ Twin Cities Orthopedics, 4010 West 65th Street, Edina, MN 55435, USA.
⁶ Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA. Electronic address: [email protected].

PMID: 38042407
DOI: 10.1016/j.jisako.2023.11.010

Abstract

Objective: To review and update the literature regarding outcomes following surgical management of chronic, grade III posterolateral corner (PLC) injuries, with an emphasis on estimating failure rates based upon objective parameters in light of the 2019 expert consensus, while secondarily comparing the failure rates of anatomic versus non-anatomic reconstruction techniques.

Methods: A literature search was performed using the PubMed, Embase, MEDLINE, and Cochrane Library databases. Inclusion criteria consisted of level I-IV human clinical studies reporting subjective and objective outcomes in patients following surgical management for chronic (>6 weeks from injury) grade III PLC injuries, with a minimum two-year follow-up. The criterion for objective surgical failure was based on post-operative varus stress radiographs and defined as a side-to-side difference of 3 mm or more of lateral gapping.

Results: A total of six studies, consisting of 10 separate cohorts encompassing a total of 230 patients, were identified. PLC reconstruction was performed in all cohorts, with 80 % (n = 8/10) of these cohorts utilising an anatomic reconstruction technique. A failure rate ranging from 4.3 % to 36 % was found. Subgroup analysis revealed a failure rate of 4.3 %-24.2 % for anatomic reconstruction techniques, whereas a 0 %-36 % failure rate was found for non-anatomic reconstruction. Arthrofibrosis was the most common complication (range, 0 %-12.1 %) following surgery. 0 %-8 % of patients required revision PLC surgery.

Conclusion: PLC reconstruction yields a wide variability in failure rates according to the side-to-side difference of 3 mm or more of lateral gapping on post-operative varus stress radiographs, with low revision rates following anatomic and non-anatomic reconstruction techniques.

Level of evidence: IV; Systematic Review of Level III and IV studies.

Keywords: Anatomic reconstruction; Fibular collateral ligament; Knee; Popliteofibular ligament; Popliteus tendon; Posterolateral corner.

Publication types

Systematic Review
Review

MeSH terms

Consensus
Female
Humans
Knee Injuries* / surgery
Knee Joint / surgery
Male
Plastic Surgery Procedures* / methods
Treatment Failure