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Clinical Comparisons of the Anatomical Reconstruction and Modified Biceps Rerouting Technique for Chronic Posterolateral Instability Combined with Posterior Cruciate Ligament Reconstruction
Sung-Jae Kim, MD, PhD1; Tai-Won Kim, MD1; Sul-Gee Kim, MD1; Hyeong-Pyo Kim, MD1; Yong-Min Chun, MD, PhD1
1 Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University Health System, CPO Box 8044, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea. E-mail address for Y.-K. Chun: min1201@hanmail.net. E-mail address for S.-J. Kim: sungjaekim@yuhs.ac. E-mail address for T.-W. Kim: dkoshsm@naver.com. E-mail address for S.-G. Kim: sgkim@yuhs.ac. E-mail address for H.-P. Kim: TS5107@paran.com
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University Health System, Seoul, South Korea

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 May 04;93(9):809-818. doi: 10.2106/JBJS.I.01266
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The purpose of this study was to describe a one-stage operation for posterior cruciate ligament reconstruction with use of an Achilles tendon-bone allograft and a posterolateral corner reconstruction with use of two different methods, with a comparison of clinical outcomes in the two groups.


Our study included forty-six patients who had undergone posterior cruciate ligament reconstruction with use of an Achilles tendon-bone allograft and posterolateral corner reconstruction with either anatomical reconstruction of the lateral collateral ligament and popliteus tendon with use of a tibialis posterior tendon allograft (twenty-one patients; Group A) or the modified biceps rerouting tenodesis (twenty-five patients; Group B) in an alternating fashion. Patients were assessed for knee instability with use of the dial test at 30° and 90°, together with varus and posterior stress radiography.


At the two-year follow-up evaluation, although no significant difference was found on posterior stress radiography (mean and standard error, 5.7 ± 0.4 mm for Group A compared with 4.8 ± 0.4 mm for Group B), Group A showed more improvement than Group B on the dial test (16° ± 1° vs. 13° ± 1° at 30° and 17° ± 1° vs. 14° ± 1° at 90°; p = 0.001 for both) and varus stress radiography (3.6 ± 0.3 mm vs. 2.6 ± 0.3 mm; p = 0.024), in the Lysholm (29.5 ± 2.4 vs. 22.3 ± 2.3; p = 0.037) and the International Knee Documentation Committee knee scores (p = 0.041), and less terminal flexion loss (4.0° ± 1.2° vs. 8.8° ± 1.3°; p = 0.013).


Combined with posterior cruciate ligament reconstruction, anatomical posterolateral corner reconstruction of the popliteus tendon and lateral collateral ligament showed better outcomes compared with the modified biceps rerouting tenodesis, although the mean differences of varus and external rotatory stability between the groups were relatively small. However, the overall difference might have been reduced by the negative value caused by overcorrection in Group B. This study demonstrated that anatomical posterolateral corner reconstruction is a reliable alternative method in addressing posterolateral corner and posterior cruciate ligament insufficiency of the knee, a finding that ideally should be tested in a randomized controlled trial.

Level of Evidence: 

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

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    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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