Management of Combined Anterior Cruciate Ligament-Posterolateral Corner Tears: A Systematic Review.
BACKGROUND
A consensus on the treatment of combined anterior cruciate ligament (ACL) and posterolateral corner (PLC) injuries is still lacking.


OBJECTIVE
To review the available literature on the management of these combined lesions to investigate the influence that injuries of knee posterolateral structures play in the outcome of an ACL lesion.


METHODS
Systematic review; Level of evidence, 4.


METHODS
A comprehensive search was performed on PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: "posterolateral corner," "plc," "posterolateral instability," "posterolateral injury," "anterior cruciate ligament," and "acl."


RESULTS
A total of 6 studies involving 95 patients were included. For those with PLC lesions, 14 patients were treated nonoperatively, 9 underwent an early anatomic repair, while the remaining 72 underwent a reconstruction. In all 95 patients, an ACL reconstruction was performed. Sixty-seven of the 72 patients who underwent a PLC reconstruction were assessed for anteroposterior laxity, with a mean side-to-side difference of 1.5 ± 1.1 mm. Evaluated by the objective International Knee Documentation Committee (IKDC) Knee Form, 88% of the patients who underwent a PLC reconstruction were graded as good/excellent (A/B). The 9 patients who underwent an early surgical repair of the PLC lesion were evaluated by means of the objective IKDC score, with 3 patients (33%) graded as good/excellent (A/B), and by means of a clinical evaluation, with 5 of 9 patients (56%) graded as 1+ for varus laxity. For the 14 patients who were managed nonoperatively for PLC injuries, the only clinical score available was the subjective IKDC score, with a mean value of 80.5 (87.8 for the 6 patients with type A PLC injuries and 75.0 for type B PLC injuries).


CONCLUSIONS
There is a paucity of literature focused on the management of combined ACL and PLC injuries. Combined ACL and PLC reconstruction seems to be the most effective approach to these combined lesions. However, future work is needed to explore the long-term outcome of the different treatment options.
Clinica Ortopedica e Traumatologica II, Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy t.bonanzinga@gmail.com.
Tommaso
T
Bonanzinga
Clinica Ortopedica e Traumatologica II, Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy Dipartimento di Scienze Anatomiche Umane e Fisiopatologia dell'Apparato Locomotore, Università di Bologna, Alma Mater Studiorum, Bologna, Italy.
Stefano
S
Zaffagnini
Clinica Ortopedica e Traumatologica II, Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy.
Alberto
A
Grassi
Clinica Ortopedica e Traumatologica II, Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy.
Giulio Maria
GM
Marcheggiani Muccioli
Clinica Ortopedica e Traumatologica II, Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy.
Maria Pia
MP
Neri
Clinica Ortopedica e Traumatologica II, Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy Dipartimento di Scienze Anatomiche Umane e Fisiopatologia dell'Apparato Locomotore, Università di Bologna, Alma Mater Studiorum, Bologna, Italy.
Maurilio
M
Marcacci
D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001696:Biomechanical Phenomena; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D007718:Knee Injuries / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D016119:Posterior Cruciate Ligament / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D014945:Wound Healing
anterior cruciate ligament; knee; multiligament; posterolateral corner; reconstruction; review