Summary

We describe clinical and radiological outcomes of two-tailed posterolateral (PLC) reconstruction with the use of suture anchors for fibular head docking, in the setting of multi-ligament knee injury after knee dislocation. We also describe a technique tip for concomitant distal biceps femoris tendon repair or augmentation.

Abstract

Background

Treatment of Posterolateral corner (PLC) instability in the setting of multi-ligament knee injuries (MLKI) is key to improved functional outcomes. The two-tailed PLC reconstruction is one of the most common techniques used, but mostly described with the use of interference screws. Data on the use of suture anchors for fibular head-based PLC reconstruction in the setting of MLKI is still limited. Theoretical advantages of suture anchors use are related to patients with small fibular head or presenting with fibular head fractures.

Purpose

To describe clinical and radiological outcomes of two-tailed PLC reconstruction using suture anchors as fixation method of choice for fibular head docking, and to describe a technique tip for biceps femoris tendon repair in case of concomitant rupture. The secondary objective was to compare outcomes between acute (< 6 weeks) and chronic reconstructions.

Study Design: case series; Level of evidence, 4.

Methods

Demographic data, clinical and radiological outcomes were collected from 60 patients who underwent two-tailed PLC reconstruction in the setting of MLKI between 2017 and 2021. Patients were assessed for range of motion (ROM) and functional outcomes including Tegner, Lysholm and International Knee Documentation Committee (IKDC) scores. Complications and reoperations were also reported. Radiographic parameters focused on measurements of the lateral femorotibial space in varus stress views to evaluate stability and determine failure rate. Analysis based on time from injury to reconstruction was additionally performed.

Results

With two (3.3%) loss to follow-up, 58 patients with a mean age of 33.8 and a mean follow-up of 15.1 months (range: 4.2 – 44.8) were included. 65% were men. Knee dislocation grades included KD 3-L, 4 and 5. No isolated PLC reconstructions were performed. 25 patients (43.1%) underwent acute reconstruction and 5 (8.6%) presented with a neurovascular injury. 75% had concomitant meniscal tears requiring repair. The mean post-operative ROM was 1.7 – 133.2 degrees. Mean Tegner, Lysholm, and IKDC scores were 5.1 ± 2.3, 84.6 ± 12.1, and 73.4 ± 18.2, respectively. The mean lateral femorotibial space on varus stress views was 0.3 ± 1.2 mm. 14 (24.1%) patients required revision surgery for hardware removal, stiffness, or clinical failure, and 6 (10.3%) had complications including infection (5/6) and anchor pull-out (1/6). In addition, patients with acute reconstructions had better functional outcomes compared to those who presented with a chronic injury.

Conclusion

The use of suture anchors as fixation method of choice for fibular head docking in two-tailed PLC reconstruction can reliably restore varus stability and provide fair functional outcomes in patients with either acute or chronic MLKI with posterolateral instability, associated with a low rate of implant-specific complications.

Keywords: Posterolateral corner; multi-ligament knee injuries; PLC reconstruction; two-tailed reconstruction; suture anchors