title: Posterolateral corner reconstruction using the single fibular sling method for posterolateral rotatory instability of the knee.
abstract: BACKGROUND
  Recently, posterolateral corner (PLC) reconstruction techniques have been developed based on an anatomic study of cadaveric dissections. However, the best operative method for various anatomic reconstructions remains controversial.
  
  
  OBJECTIVE
  The anatomic single fibular sling method for PLC reconstruction would be sufficiently strong to control posterolateral rotatory instability without an additional tibial sling.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  This retrospective cohort study analyzed 60 knees in 60 patients who underwent anatomic PLC reconstruction using the single fibular sling method with a tibialis anterior allograft, with a minimum follow-up period of 2 years. Ninety percent of the patients had concomitant reconstruction of one or both cruciate ligaments. Preoperative and postoperative dial test, varus stress test, and subjective clinical outcomes including Lysholm score, International Knee Documentation Committee (IKDC) subjective scores, and stress radiographs, including varus and posterior stress, were compared. In addition, intraoperative arthroscopic findings were analyzed.
  
  
  RESULTS
  The mean length of clinical follow-up was 35.6 months (range, 24-65 months). Forty-two (70%) patients showed no rotational instability postoperatively. Varus laxity improved, with 96.7% of the patients assessed as grade 0 or 1. The mean side-to-side difference in varus stress test was reduced from 2.32 ± 1.33 mm preoperatively to 0.37 ± 1.48 mm postoperatively. Posterior stress radiography in combined posterior cruciate ligament reconstruction showed a mean posterior tibial translation of 14.7 ± 2.83 mm preoperatively and 4.06 ± 1.40 mm at final follow-up. The Lysholm and IKDC subjective scores improved from 52 ± 6.7 to 87.7 ± 12.3 and from 44.8 ± 6.3 to 77.6 ± 14.2 (P < .001), respectively. There were no significant differences in clinical outcome or varus laxity between isolated PLC and combined injuries.
  
  
  CONCLUSIONS
  Anatomic PLC reconstruction using a single fibular sling method is an effective and relatively simple procedure for most patients with posterolateral rotatory instability, with the exception of those with severe multiple injuries.
authors.affiliation: Department of Orthopedic Surgery, Bundang Chuk Hospital, Gyeonggi-do, Korea.
authors.forename: Byoung Se
authors.initials: BS
authors.lastname: Yang
authors.forename: Woo Han
authors.initials: WH
authors.lastname: Bae
authors.forename: Jeong Ku
authors.initials: JK
authors.lastname: Ha
authors.forename: Dhong Won
authors.initials: DW
authors.lastname: Lee
authors.forename: Hyoung Won
authors.initials: HW
authors.lastname: Jang
authors.forename: Jin Goo
authors.initials: JG
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D001178:Arthroplasty / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D055815:Young Adult
keywords: anatomic reconstruction; posterolateral corner; posterolateral rotatory instability