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Scientific Articles   |    
Effect of Physiological Posterolateral Rotatory Laxity on Early Results of Posterior Cruciate Ligament Reconstruction with Posterolateral Corner Reconstruction
Sung-Jae Kim, MD1; Sung-Guk Kim, MD1; In-Sung Lee, MD1; Hee-Don Han, MD1; Ihn Hwa Chung, MD1; Sung-Hwan Kim, MD1; Venkat Gorthi, MS1
1 Department of Orthopaedic Surgery and the Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea. E-mail address for S.-G. Kim: p10001@hanmail.net
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Investigation performed at the Department of Orthopaedic Surgery and the Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, South Korea



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution (s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jul 03;95(13):1222-1227. doi: 10.2106/JBJS.L.00861
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Abstract

Background: 

The purpose of this study was to evaluate the influence of physiological posterolateral rotatory laxity on posterior cruciate ligament (PCL) reconstruction in terms of posterior stability and clinical outcomes.

Methods: 

We retrospectively reviewed the records of sixty-five patients who had undergone arthroscopic PCL reconstruction with simultaneous reconstruction of the posterolateral corner from March 2004 to April 2009. Patients were categorized into three groups according to the amount of tibial external rotation at 90° of knee flexion on the uninjured side: Group 1 (<40°; n = 26), Group 2 (between 40° and 50°; n = 21), and Group 3 (>50°; n = 18). Knee instability was assessed with posterior and varus stress radiographs as well as with the dial test at 30° and 90° of knee flexion. Functional scores were assessed with use of the Lysholm score and the International Knee Documentation Committee (IKDC) score preoperatively and at the time of final follow-up.

Results: 

At the time of follow-up, there was no significant difference among the three groups with regard to the mean side-to-side difference in posterior translation as measured with Telos stress radiography (Group 1: 3.6 ± 1.3 mm, Group 2: 3.3 ± 1.6 mm, and Group 3: 4.3 ± 1.6 mm; p = 0.098). There was also no significant difference among the groups with respect to knee stability as assessed on the varus stress radiographs or with the dial test at 30° and 90° of flexion. Finally, there was no significant difference among the groups with respect to the Lysholm or IKDC functional scores.

Conclusions: 

This study suggests that the instability of knees that have PCL and posterolateral corner injuries with physiological posterolateral rotatory laxity can be controlled successfully with PCL reconstruction and simultaneous reconstruction of the posterolateral corner. Physiological posterolateral rotatory laxity should not be considered a risk factor for abnormal knee laxity after PCL reconstruction with simultaneous reconstruction of the posterolateral corner.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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