Reconstruction of the lateral collateral ligament of the knee with patellar tendon allograft. Report of a new technique in combined ligament injuries.
This is a retrospective study of 10 patients with combined cruciate ligament and posterolateral instability who underwent surgical reconstruction between 1991 and 1994. All knees had at least 20 degrees increased external rotation at 30 degrees of knee flexion and from 1+ to 3+ varus instability. Five knees with posterior cruciate ligament ruptures had at least a 2+ Lachman test result. (One knee had both anterior and posterior cruciate ligament injuries). In all cases the lateral collateral ligament was reconstructed with a bone-patellar tendon-bone allograft secured with interference screws. Fixation tunnels were placed in the fibular head and at the isometric point on the femur. The cruciate ligaments were reconstructed with autograft or allograft material. The average follow-up was 28 months. Excessive external rotation at 30 degrees of flexion was corrected in all but one knee. Six patients had no varus laxity, and four patients had 1+ varus laxity at 30 degrees of flexion. The posterior drawer test result decreased, on average, to 1+, and the Lachman test result decreased to between 0 and 1+. The average Tegner score was 4.6, with five patients returning to their preinjury level of activity and four returning to one level lower. These results indicate that this is a promising new procedure for patients with instability resulting from lateral ligament injuries of the knee.
Kerlan-Jobe Orthopaedic Clinic, Los Angeles, CA 90045-1539, USA.
H A
HA
Latimer
J E
JE
Tibone
N S
NS
ElAttrache
P J
PJ
McMahon
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D001863:Bone Screws; D017885:Collateral Ligaments / Q000293:injuries* / Q000601:surgery; D005269:Femur / Q000601:surgery; D005360:Fibula / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D017847:Patellar Ligament / Q000637:transplantation*; D016119:Posterior Cruciate Ligament / Q000293:injuries* / Q000601:surgery; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012399:Rotation; D012421:Rupture; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous