Single-Bundle Posterior Cruciate Ligament Reconstruction and Mini-Open Popliteofibular Ligament Reconstruction in Knees With Severe Posterior and Posterolateral Rotation Instability: Clinical Results of Minimum 2-Year Follow-up

Purpose

The aim of this study was to assess the clinical outcome of arthroscopy-assisted posterior cruciate ligament (PCL) reconstruction and mini-open popliteofibular ligament (PFL) reconstruction for severe posterior and posterolateral rotation instability of the knee with lateral collateral ligament intact.

Methods

Arthroscopic PCL reconstruction and mini-open PFL reconstruction were performed consecutively in 24 patients with chronic posterior and posterolateral rotation instability of the knee. The inclusion criteria for surgery were a side-to-side difference in posterior translation of more than 12 mm measured with stress radiography and tibial external rotation of 10° more than that of the contralateral uninjured knee without varus laxity. The exclusion criterion was combined anterior cruciate ligament injury. The patients underwent single-bundle PCL reconstruction with Achilles tendon allograft. A mini-open PFL reconstruction was performed with anterior tibialis allograft. A 2-cm incision was made on the lateral epicondyle to build the femoral tunnel, and a 3-cm incision was made near the fibular head for the fibular tunnel.

Results

The minimum follow up was 2 years. At final follow up, 18 patients (75% [18 of 24]) were enrolled in the study group and 6 patients were lost. Postoperatively, mean posterior tibial translation (side-to-side difference) in our patients was reduced from 17.3 ± 4.1 mm to 4.6 ± 3.2 mm. Tibial external rotation was decreased from a mean of 14.7° ± 4.6° to −2.8° ± 3.8°, as compared with the contralateral uninjured knee. These differences were statistically significant. The International Knee Documentation Committee grade preoperatively was grade D in all 18 patients, whereas postoperatively, 5 were classified as grade A, 8 as grade B, and 5 as grade C.

Conclusions

In this small clinical series, single-bundle PCL reconstruction combined with mini-open PFL reconstruction was proven to correct pathologic excessive posterior and posterolateral rotation instability.

Level of Evidence

Level IV, therapeutic case series (no control or historical group).