Summary

Fibular based techniques have similar outcomes to tibiofibular based techniques for posterolateral corner injuries. The fibular-based technique seems to be the more viable treatment option in view of being less technically demanding and invasive and requiring fewer grafts with a quicker operative time.

Abstract

Background

Anatomical reconstruction is the gold standard treatment for posterolateral corner (PLC) injuries of the knee. They are classified into either fibular- or tibiofibular-based reconstructions based upon distal constructs. Despite comparable outcomes in biomechanical studies, clinical results comparing these constructs remain elusive with no consensus reached regarding the best treatment option.

Purpose

To perform a systematic review and meta-analysis to compare if one construct is superior to the other in both clinical outcomes and restoration of stability.

Study Design: Meta-Analysis

Methods

The Cochrane Controlled Register of Trials, PubMed, Medline and Embase were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms (‘posterolateral corner’ OR ‘fibular collateral ligament’ OR ‘lateral collateral ligament’ OR ‘popliteus tendon’ OR ‘popliteofibular ligament’) AND (‘reconstruction’ OR ‘LaPrade’ OR ‘Larson’ OR ‘Arciero’). Data pertaining to all patient reported outcome measures (PROMs), post-operative complications and valgus and rotational stability were extracted from each study. The pooled outcome data were analysed by random- and fixed-effects models.

Results

After abstract and full-text screening, 6 clinical studies were included. In total there were 183 anatomical reconstructions of which 90 were fibular-based and 93 tibiofibular-based.
The majority of studies had similar surgical technique regarding tunnel orientation, attachment sites and graft fixation sequence. There were no differences between the groups in terms of PROMs at a mean of 20.3 months (range, 3.6 to 27.9 months). They were both equally effective in restoring varus and rotational stability, but there was a trend in quicker operative time with the fibular-based technique. Subgroup analysis revealed the stability of a posterior cruciate ligament reconstruction post-operatively was not affected by either anatomical construct.

Conclusion

Both constructs had comparable clinical outcomes and were equally as effective in restoring varus and rotational stability for PLC knee injuries. The fibular-based technique seems to be the more viable treatment option in view of being less technically demanding and invasive and requiring fewer grafts with a quicker operative time. However, further higher-quality studies are required to reinforce or refute such conclusions, as majority of studies in this review were poor to fair quality.