Posterolateral rotatory instability of the knee, usually accompanied by
other instabilities, is easily missed, misdiagnosed, and mistreated. The
correct diagnosis requires a complete examination of the knee, including
both the external rotation-recurvatum and posterolateral drawer tests. The
most effective operative approach when the lesion is interstitial or at the
site of the femoral attachment consists of advancing the arcuate ligament
complex and its osseous attachment anteriorly and distally on the femur to
support the arcuate ligament repair. When the lesion is distal and the
arcuate ligament attachment to the tibia and fibula is loose, this area
must be stabilized. In a consecutive series of 140 patients, 141 knees were
reconstructed with this procedure. Ninety-five patients (ninety-six knees),
with a follow-up of two to thirteen years, form the basis for this report.
Seventy-one of the patients had undergone a combined total of 112 prior
operations on the knee without functional recovery. After surgery directed
at the arcuate ligament complex, eighty-two knees (85 per cent) were
objectively rated as good; thirteen (14 per cent), as fair; and one, as
poor. Subjectively, seventy-five (78 per cent) of the patients considered
the result to be good; twenty-one (22 per cent), fair; and none, poor.
Functionally, seventy-seven (80 per cent) of the knees were rated by the
patient as good; sixteen (16 per cent), as fair; and three (4 per cent), as
poor. This is the first report on the long-term results of reconstruction
of the arcuate ligament complex for the correction of chronic
posterolateral rotatory instability. The results demonstrate the
effectiveness of the procedure.