title: Management of combined anterior or posterior cruciate ligament and posterolateral corner injuries: a systematic review.
abstract: BACKGROUND
  Combined injuries to the posterolateral corner and cruciate ligaments are uncommon. The heterogeneity of injury patterns in many studies complicates the assessment of outcomes.
  
  
  OBJECTIVE
  To assess the prognosis and functional outcomes after surgery for combined injuries to the posterolateral corner and to the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL).
  
  
  METHODS
  We systematically reviewed the literature for articles reporting outcomes 1 year or more after surgery for combined injuries to the posterolateral corner and ACL (n=4) or PCL (n=9). Patients with bicruciate injuries were not studied.
  
  
  RESULTS
  Overall, 65% of patients were IKDC A or B after surgery. The mean Lysholm score improved from 67 to 90. Mean time to surgery was 4.43 months in the group with ACL tears and 18.4 months in the group with PCL tears, and mean follow-up was 34.4 and 40.7 months in these two groups, respectively. In the groups with ACL and PCL tears, the proportions of patients classified as IKDC A or B at last follow-up were 81.6% and 81.0%, respectively, whereas 88% and 99% of patients, respectively, were IKDC grade C or D before surgery. The mean Lysholm score improved from 77 to 92 in the group with ACL tears and from 65 to 89 in the group with PCL tears. Improvements in laxity ranged from 28% to 79% in the group with PCL tears.
  
  
  CONCLUSIONS
  Most of the articles selected for our review provided level III or IV evidence. Functional outcomes were satisfactory but less good than those reported after surgical reconstruction of isolated cruciate ligament tears. Full reconstruction seems the best strategy in patients with combined ACL/posterolateral corner injuries. Outcomes were also good but more variable in the group with PCL/posterolateral corner injuries. The time to surgery, which reflected the time to diagnosis, was shorter in patients with ACL than with PCL tears in addition to the posterolateral corner injury.
  
  
  METHODS
  Level III (systematic literature review).
authors.affiliation: Service d'Orthopédie Traumatologie, Centre Hospitalo-Universitaire de Caen, avenue de la Côte de Nacre, 14033 Caen Cedex 9, France.
authors.forename: G
authors.initials: G
authors.lastname: Rochecongar
authors.affiliation: Service d'Orthopédie Traumatologie, Centre Hospitalier Universitaire de Grenoble, Hôpital Sud, 38434 Echirolles Cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Plaweski
authors.affiliation: Service d'Orthopédie Traumatologie, Centre Hospitalo-Universitaire de Caen, avenue de la Côte de Nacre, 14033 Caen Cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Azar
authors.affiliation: Lyon-Ortho-Clinic, 29 B, avenue des Sources, bâtiment Trait d'Union, 69009 Lyon, France.
authors.forename: G
authors.initials: G
authors.lastname: Demey
authors.affiliation: Service d'Orthopédie Traumatologie, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France.
authors.forename: J
authors.initials: J
authors.lastname: Arndt
authors.affiliation: Cabinet Médical ICOS, 118, rue Jean-Mermoz, 13008 Marseille, France.
authors.forename: M-L
authors.initials: ML
authors.lastname: Louis
authors.affiliation: Médipole Garonne, 45, rue de Gironis, 31100 Toulouse, France.
authors.forename: R
authors.initials: R
authors.lastname: Limozin
authors.affiliation: Cabinet Goethe, 23, avenue Niel, 75017 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Djian
authors.affiliation: Centre Santy, 24, avenue Paul-Santy, 69008 Lyon, France.
authors.forename: B
authors.initials: B
authors.lastname: Sonnery-Cottet
authors.affiliation: Clinique du Sport de Merignac, 4, rue Negrevergne, 33700 Mérignac, France.
authors.forename: V
authors.initials: V
authors.lastname: Bousquet
authors.affiliation: Hôpital d'Instruction des Armées Begin, 69, avenue de Paris, 94160 Saint-Mandé, France.
authors.forename: X
authors.initials: X
authors.lastname: Bajard
authors.affiliation: Clinique Drouot, 20, rue Laffitte, 75009 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Wajsfisz
authors.affiliation: Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, 78150 Le Chesnay, France. Electronic address: pboisrenoult@ch-versailles.fr.
authors.forename: P
authors.initials: P
authors.lastname: Boisrenoult
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D007718:Knee Injuries / Q000150:complications / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods*; D016119:Posterior Cruciate Ligament / Q000293:injuries* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*
keywords: Anterior cruciate ligament; Knee; Multiligamentous knee injury; Posterior cruciate ligament; Posterolateral corner; Reconstruction; Systematic literature review