title: Medium-term (5-year) comparison of the functional outcomes of combined anterior cruciate ligament and posterolateral corner reconstruction compared with isolated anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  To present a 5-year comparison of the functional outcomes of combined anterior cruciate ligament (ACL) and posterolateral corner (PLC) reconstruction with those of isolated ACL reconstruction.
  
  
  METHODS
  All patients were reviewed clinically and completed knee function questionnaires prospectively, by use of the International Knee Documentation Committee (IKDC) 2000, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm scoring systems, preoperatively and at 1, 2, and 5 years postoperatively. Patients who underwent combined ACL-PLC reconstruction were identified and reviewed. These patients had intact lateral collateral ligaments. A comparison group was created from a group of patients who underwent isolated ACL reconstruction. The ACL group was selected to have the same profile with regard to age, sex, and meniscal procedure.
  
  
  RESULTS
  There were 25 patients in the ACL-PLC group and 100 in the ACL group. All patients underwent restoration of their PLC function as shown on dial testing. The preoperative values for all KOOS measures and the Lysholm score were significantly lower in the ACL-PLC group than in the ACL group (P < .001). The IKDC score was not significantly different. All knee scores showed a significant improvement in both groups postoperatively at 1, 2, and 5 years (P < .001). At 5 years, the KOOS symptoms subscore (P < .001), KOOS pain subscore (P < .001), KOOS sports subscore (P < .001), KOOS quality-of-life subscore (P < .05), KOOS activities-of-daily living subscore (P < .001), aggregate score for all KOOS parameters (P < .001), and Lysholm score (P < .001) were significantly lower in the ACL-PLC group than in the ACL group. At 5 years, the IKDC scores were not significantly different. All patients in the ACL-PLC group resumed preinjury employment, and 23 of 25 had resumed sports.
  
  
  CONCLUSIONS
  Combined ACL-PLC injuries have greater morbidity than isolated ACL injuries. However, return to work and sporting activity is possible in most cases after combined ACL-PLC reconstruction. The KOOS for sport outcomes suggests that sports were resumed at lower functional levels.
  
  
  METHODS
  Level III, case-control study.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, England. Electronic address: mctdoc@hotmail.com.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cartwright-Terry
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Royal Liverpool and Broadgreen University Teaching Hospitals, Liverpool, England.
authors.forename: Jonny
authors.initials: J
authors.lastname: Yates
authors.affiliation: Lam Wah Ee Hospital, Penang, Singapore.
authors.forename: Chin K
authors.initials: CK
authors.lastname: Tan
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, England.
authors.forename: Ioannis P
authors.initials: IP
authors.lastname: Pengas
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Royal Liverpool and Broadgreen University Teaching Hospitals, Liverpool, England.
authors.forename: Joanne V
authors.initials: JV
authors.lastname: Banks
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, England; School of Health Care Professions, University of Salford, Salford, England.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: McNicholas
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects / Q000379:methods*; D001265:Athletic Injuries / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000601:surgery; D017063:Outcome Assessment, Health Care; D016119:Posterior Cruciate Ligament / Q000293:injuries* / Q000601:surgery; D011183:Postoperative Complications; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D053656:Tenodesis / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult