title: Clinical comparisons of the anatomical reconstruction and modified biceps rerouting technique for chronic posterolateral instability combined with posterior cruciate ligament reconstruction.
abstract: BACKGROUND
  The purpose of this study was to describe a one-stage operation for posterior cruciate ligament reconstruction with use of an Achilles tendon-bone allograft and a posterolateral corner reconstruction with use of two different methods, with a comparison of clinical outcomes in the two groups.
  
  
  METHODS
  Our study included forty-six patients who had undergone posterior cruciate ligament reconstruction with use of an Achilles tendon-bone allograft and posterolateral corner reconstruction with either anatomical reconstruction of the lateral collateral ligament and popliteus tendon with use of a tibialis posterior tendon allograft (twenty-one patients; Group A) or the modified biceps rerouting tenodesis (twenty-five patients; Group B) in an alternating fashion. Patients were assessed for knee instability with use of the dial test at 30° and 90°, together with varus and posterior stress radiography.
  
  
  RESULTS
  At the two-year follow-up evaluation, although no significant difference was found on posterior stress radiography (mean and standard error, 5.7 ± 0.4 mm for Group A compared with 4.8 ± 0.4 mm for Group B), Group A showed more improvement than Group B on the dial test (16° ± 1° vs. 13° ± 1° at 30° and 17° ± 1° vs. 14° ± 1° at 90°; p = 0.001 for both) and varus stress radiography (3.6 ± 0.3 mm vs. 2.6 ± 0.3 mm; p = 0.024), in the Lysholm (29.5 ± 2.4 vs. 22.3 ± 2.3; p = 0.037) and the International Knee Documentation Committee knee scores (p = 0.041), and less terminal flexion loss (4.0° ± 1.2° vs. 8.8° ± 1.3°; p = 0.013).
  
  
  CONCLUSIONS
  Combined with posterior cruciate ligament reconstruction, anatomical posterolateral corner reconstruction of the popliteus tendon and lateral collateral ligament showed better outcomes compared with the modified biceps rerouting tenodesis, although the mean differences of varus and external rotatory stability between the groups were relatively small. However, the overall difference might have been reduced by the negative value caused by overcorrection in Group B. This study demonstrated that anatomical posterolateral corner reconstruction is a reliable alternative method in addressing posterolateral corner and posterior cruciate ligament insufficiency of the knee, a finding that ideally should be tested in a randomized controlled trial.
authors.affiliation: Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University Health System, CPO Box 8044, 134, Shinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea.
authors.forename: Sung-Jae
authors.initials: SJ
authors.lastname: Kim
authors.forename: Tai-Won
authors.initials: TW
authors.lastname: Kim
authors.forename: Sul-Gee
authors.initials: SG
authors.lastname: Kim
authors.forename: Hyeong-Pyo
authors.initials: HP
authors.lastname: Kim
authors.forename: Yong-Min
authors.initials: YM
authors.lastname: Chun
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation; D000328:Adult; D002908:Chronic Disease; D005097:Exostoses, Multiple Hereditary; D005260:Female; D006801:Humans; D006819:Hyaline Membrane Disease; D007593:Joint Instability / Q000473:pathology / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000601:surgery; D058627:Megalencephaly; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D009333:Neck / Q000002:abnormalities; D006831:Polyhydramnios; D016119:Posterior Cruciate Ligament / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D013848:Thigh; D055815:Young Adult