2023 ISAKOS Biennial Congress ePoster
Techniques and Objective Outcomes in the Surgical Treatment of Chronic Posterolateral Corner Knee Injuries: An Updated Systematic Review Reflecting the 2019 Expert Consensus Statement
Garrett Jackson, MD, Columbia, MO UNITED STATES
Harkirat Jawanda, BS, Chicago, IL UNITED STATES
Enzo Salviato Mameri, MD, MSc, São Paulo, São Paulo BRAZIL
Anjay Batra, BS, Chicago, IL UNITED STATES
Derrick Michael Knapik, MD, Chesterfield, Missouri UNITED STATES
Robert F. LaPrade, MD, PhD, Edina, MN UNITED STATES
Nikhil N. Verma, MD, Chicago, IL UNITED STATES
Jorge Chahla, MD, PhD, Hinsdale, IL UNITED STATES
Rush University Medical Center, Chicago, IL, UNITED STATES
FDA Status Not Applicable
Summary
Failure rate according to side-to-side difference of 3 mm or more of lateral gapping on post-operative varus stress radiographs following PLC reconstruction overall was 14.8%, with no significant difference between anatomic versus nonanatomic reconstruction techniques. Despite continued heterogeneity in surgical techniques, anatomic reconstruction of the PLC structures represents the most commonly
ePosters will be available shortly before Congress
Abstract
Purpose
To systematically review and update the literature regarding outcomes following surgical management of chronic, grade III PLC injuries, with an emphasis on estimating failure rate based upon objective parameters in light of the 2019 expert consensus, while secondarily comparing the failure rates of anatomic versus nonanatomic reconstruction techniques.
Methods
A literature search was performed using PubMed, Embase, MEDLINE and Cochrane Library databases. Inclusion criteria consisted of level I-IV human clinical studies reporting subjective and objective outcomes in patients following surgical management for chronic (> 6 weeks from injury) grade III PLC injuries, with a minimum two-year follow-up. The criterion for objective surgical failure was based on the 2019 consensus emphasis on the use of post-operative varus stress radiographs and defined as side-to-side difference of 3 mm or more of lateral gapping.
Results
A total of 6 studies, consisting of 10 separate cohorts encompassing a total of 230 patients, were identified. PLC reconstruction was performed in all cohorts, with 80% (n = 8/10) of these cohorts utilizing an anatomic reconstruction technique. Utilizing objective varus laxity to define operative success versus failure, a failure rate of 14.8% (n = 34/230) was found. Subgroup analysis revealed a failure rate of 13.6% (n=25/184) for anatomic reconstruction techniques, whereas a 19.6% (n= 9/46) failure rate was found for non-anatomic reconstruction (p = .30302). Arthrofibrosis was the most common complication (1.7%; n = 4/230 cases) following surgery. A total of 4/230 patients (1.7%) required a revision PLC surgery.
Conclusion
Failure rate according to side-to-side difference of 3 mm or more of lateral gapping on post-operative varus stress radiographs following PLC reconstruction overall was 14.8%, with no significant difference between anatomic versus nonanatomic reconstruction techniques. Despite continued heterogeneity in surgical techniques, anatomic reconstruction of the PLC structures represents the most commonly reported surgical approach for the treatment of chronic grade III PLC injuries.
Level of Evidence: IV; Systematic Review.