Outcome of surgical reconstruction for posterior cruciate and posterolateral instabilities of the knee.
OBJECTIVE
To evaluate the clinical outcome and the incidence of degenerative changes in 25 patients with 25 knees undergoing surgical reconstruction for combined posterior cruciate ligament (PCL) and posterolateral instabilities of the knee with 2-5-year follow-up.


METHODS
This series included 16 men and 9 women with an average age of 28 years. The average time from injury to surgery was 10 (range 2-24) months, and the average follow-up time was 40 (range 32-60) months. The mechanisms of injury were 88% due to trauma, and 12% sports related. Arthroscopic single bundle posterior cruciate reconstruction and reconstruction of the posterolateral structures were performed in all cases. Clinical evaluations included functional assessment, ligament laxity and radiograph of the knee. The results were correlated with the duration of injury, the severity of ligament laxity and the follow-up time.


RESULTS
The overall results were 68% satisfactory (28% excellent and 40% good) and 32% unsatisfactory (20% fair and 12% poor). Despite functional improvement, complete restoration of ligament stability was observed in only 44% of the knees, while 36% of the knees showed mild (<5 mm), and 20% moderate (5-10 mm) ligament laxity. There was no correlation of the clinical outcome with the duration from injury to surgery. The incidence of degenerative changes of the affected knee was 44%, and the rate correlated with the severity of ligament laxity, the duration from injury to surgery and the length of follow-up time.


CONCLUSIONS
Despite the functional improvement, the currently devised surgical techniques only have modest success in restoration of ligament stability in knees with combined PCL and posterolateral instabilities. Further improvement in surgical technique including a dynamic reconstruction of the popliteus tendon complex seems necessary. The rate of degenerative changes of the affected knee appeared proportional to the duration of injury, the severity of ligament laxity and the length of follow-up time. The results of this study led us to recommend early surgical reconstruction for knees with combined posterior cruciate and posterolateral instabilities.
Wang
Ching-Jen
CJ
Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Kaohsiung, 123 Ta-Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan. w281211@adm.cgmh.org.tw
Chen
Han-Shiang
HS
Huang
Ting-Wen
TW
Yuan
Li-Jen
LJ
D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000209:etiology; D016119:Posterior Cruciate Ligament / Q000503:physiopathology / Q000601:surgery*; D011184:Postoperative Period; D011859:Radiography; D016059:Range of Motion, Articular; D016896:Treatment Outcome