Summary

This study reported that the 2 so-called anatomic reconstruction procedures were significantly more effective than the modified Larson for external rotation control. Consequently, it remains preferable to use anatomic techniques in multiligament injuries involving the PLC.

Abstract

Background

While injuries to the posterolateral corner (PLC) of the knee are often overlooked, these lesions required reconstruction in order to restore varus and rotational stability. Among PLC reconstructions techniques (anatomical or not), the modified Larson (LMR), the LaPrade reconstruction (LR) and the “Versailles” reconstruction (VR) procedures are commonly used.

Hypothesis

The hypothesis was that anatomical reconstructions (VR and LR procedures) of the PLC provides better restoration and control of external rotational laxity.
Patients and Methods: Fifteen fresh-frozen cadaveric knees were tested to compare the 3 procedures. Varus laxity on stress radiographs in full knee extension and external rotatory laxity with dial test at 30° of flexion were quantified during 3 phases: intact knee, PLC sectioned and PLC reconstructed.

Results

Mean varus values did not differ significantly regardless the technique used in the intact knees (p = .14), after sectioning the PLC (p = .14) or after PLC reconstruction (p = .17). After PLC reconstruction, varus laxity was restored with no statistical difference from the intact testing between LMR, VR and LR (respectively, -1.0, -1.3 and -1.5, p = .98). Mean external rotation laxity in the 3 groups was not significantly different when dial test at 30° of knee flexion was quantified on intact knees (p = .32) or after sectioning the PAPL (p = .15). After PLC reconstruction, the modified Larson technique was found to be significantly less effective to restore rotational stability compared with VR and LR (p = .025).

Discussion

The VR provides similar outcomes to the LR for restoring stability in varus and external rotation. This study reported that the 2 so-called anatomic reconstruction procedures (VR and LR) were significantly more effective than the modified Larson for external rotation control. Consequently, it remains preferable to use anatomic techniques in multiligament injuries involving the PLC.