Repair of Acute Grade 3 Combined Posterolateral Corner Avulsion Injuries Using an Enhanced Fixation Technique

• Published in: Orthopaedic journal of sports medicine Vol. 10; no. 11; p. 23259671221131817
• Main Authors: Moran, Jay, Kahan, Joseph B., Schneble, Christopher A., McLaughlin, William M., Green, Joshua S., Gillinov, Stephen M., Cheng, Ryan, Patel, Rohan R., Jimenez, Andrew E., LaPrade, Robert F., Schenck, Robert C., Medvecky, Michael J.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-11-2022; Sage Publications Ltd
• Subjects: Injuries; Knee; Orthopedics; Patients; Sports medicine; posterolateral corner repair; peroneal nerve injury; posterolateral corner injury; reconstruction; enhanced technique; knee dislocation; multiligament knee injury
• ISSN: 2325-9671; 2325-9671
• DOI: 10.1177/23259671221131817

Background:
Previous studies have suggested that surgical repair of the posterolateral corner (PLC) may be inferior to reconstruction.
Hypothesis:
We hypothesized that acute repair (<3 weeks) of avulsion-type PLC multiligament knee injuries with no midsubstance injury would lead to lower failure rates than previously reported for PLC repair.
Study Design:
Case series; Level of evidence, 4.
Methods:
A total of 28 patients with multiligament knee injuries who underwent acute repair between January 2007 and June 2018 of a PLC avulsion injury with no evidence of midsubstance tearing were included. All PLC avulsion injuries were treated using a transosseous Krackow suture pull-through technique without graft augmentation. Outcome metrics included lateral joint-space widening with varus stress, patient-reported clinical varus instability, patient-reported outcome measures (PROMs), and any subsequent revision or salvage procedure.
Results:
The mean time from injury to repair was 8.1 ± 5 days. At a mean follow-up of 2 years (range, 3-90 months), clinical varus stress examination at 30° demonstrated a significant reduction in lateral compartment opening, from 9 ± 3 mm preoperatively to 0 ± 3 mm (P < .0001). The failure rate was calculated to be 10.7% (3/28), which was significantly lower than the failure rate from a 2016 systematic review (38%, 17/45; P = .015). Of the 28 patients, 21 (75%) had PROM scores. Patients who underwent staged bi-cruciate reconstructions (n = 5) had significantly higher subjective International Knee Documentation Committee (IKDC) (87.2 vs 65.5; P = .014) and Lysholm (90.5 vs 75.2; P = .029) scores compared to patients with untreated bi-cruciate injuries (n = 9). Patients with peroneal nerve injury (n = 4) had significantly lower IKDC (58.2 vs 80.8; P = .0045) and Tegner (3.2 vs 5.4; P = .047) scores than those without peroneal nerve injury (n = 17). The mean IKDC and Lysholm scores at final follow-up were 73.4 ± 24.0 and 80.8 ± 23.1 at 7.1 years (range, 2.3-10.6 years) of follow-up.
Conclusion:
Repair of acute grade 3 combined PLC avulsion injuries using a transosseous Krackow suture pull-through technique demonstrated a failure rate of 10.7%. Patients who underwent a staged cruciate reconstruction(s) had higher subjective outcome scores than those who had cruciate injuries left untreated. Peroneal nerve injury was associated with lower outcome scores.