Skip to main content

Advertisement

Log in

Functional assessment of combined reconstruction of the anterior cruciate ligament and posterolateral corner with a single femoral tunnel: a two-year minimum follow-up

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

A technique for combined reconstruction of the anterior cruciate ligament (ACL) and posterolateral corner (PLC) with a single femoral tunnel was recently described. This technique aims to avoid tunnel confluence in the lateral femoral condyle. Because there have been no studies on the functional outcomes and possible complications of this technique, our goal is to demonstrate a two-year minimum follow-up of patients who underwent this type of reconstruction.

Methods

Nine patients were prospectively evaluated. The ACL was reconstructed with an anatomic single bundle, and the PLC structures reconstructed were the lateral collateral ligament, the popliteus tendon, and the popliteofibular ligament. Patients were evaluated using the objective and subjective International Knee Documentation Committee (IKDC) and the Lysholm and Tegner scales before and after the surgical procedure.

Results

The mean follow-up period of the studied patients was 27.3 months. The mean subjective IKDC score rose from 43.6 to 84.0, and the Lysholm score rose from 62.1 to 90.8. In the final assessment, six patients were classified as IKDC A and three as IKDC B. According to the Tegner scale, five patients were able to return to their level of activity prior to the injury. There were no reconstruction failures. One patient experienced postoperative infection and pain in the lateral scar.

Conclusions

The results of the reconstruction of ACL injuries associated with PLC with a single femoral tunnel produced a good functional outcome and a low incidence of complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Angelini FJ, Helito CP, Tozi MR, Pozzobon L, Bonadio MB, Gobbi RG, Pecora JR, Camanho GL (2013) Combined reconstruction of the anterior cruciate ligament and posterolateral corner with a single femoral tunnel. Arthrosc Tech 2:e285–e288

    Article  PubMed Central  PubMed  Google Scholar 

  2. Angelini FJ, Bonadio MB, Helito CP, da Mota E, Albuquerque RF, Pécora JR, Camanho GL (2014) Description of the posterolateral rotatory drawer maneuver for the identification of posterolateral corner injury. Arthrosc Tech 3:e299–e302

    Article  PubMed Central  PubMed  Google Scholar 

  3. Arnold MP, Duthon V, Neyret P, Hirschmann MT (2013) Double incision iso-anatomical ACL reconstruction: the freedom to place the femoral tunnel within the anatomical attachment site without exception. Int Orthop 37:247–251

    Article  PubMed Central  PubMed  Google Scholar 

  4. Bonadio MB, Helito CP, Gury LA, Demange MK, Pecora JR, Angelini FJ (2014) Correlation between magnetic resonance imaging and physical exam in assessment of injuries to posterolateral corner of the knee. Acta Ortop Bras 22:124–126

    Article  PubMed Central  PubMed  Google Scholar 

  5. Bonanzinga T, Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Neri MP, Marcacci M (2013) Management of combined anterior cruciate ligament-posterolateral corner tears: a systematic review. Am J Sports Med 42:1496–1503

    Article  PubMed  Google Scholar 

  6. Dhillon M, Akkina N, Prabhakar S, Bali K (2012) Evaluation of outcomes in conservatively managed concomitant type A and B posterolateral corner injuries in ACL deficient patients undergoing ACL reconstruction. Knee 19:769–772

    Article  PubMed  Google Scholar 

  7. Fanelli GC, Larson RV (2002) Practical management of posterolateral instability of the knee. Arthrosc 18:1–8

    Article  Google Scholar 

  8. Garofalo R, Mouhsine E, Chambat P, Siegrist O (2006) Anatomic anterior cruciate ligament reconstruction: the two-incision technique. Knee Surg Sports Traumatol Arthrosc 33:510–516

    Article  Google Scholar 

  9. Gelber PE, Erquicia JI, Sosa G, Ferrer G, Abat F, Rodriguez-Baeza A, Segura-Cros C, Monllau JC (2013) Femoral tunnel drilling angles for the posterolateral corner in multiligamentary knee reconstructions: computed tomography evaluation in a cadaveric model. Arthrosc 29:257–265

    Article  Google Scholar 

  10. Harner CD, Vogrin TM, Hoher J, Ma CB, Woo SL (2000) Bio-mechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med 28:32–39

    CAS  PubMed  Google Scholar 

  11. Hefti F, Muller W, Jakob RP, Staubi HU (1993) Evaluation of knee ligament injuries with IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234

    Article  CAS  PubMed  Google Scholar 

  12. Helito CP, Bonadio MB, Demange MK, Albuquerque RF, Pécora JR, Camanho GL, Angelini FJ (2014) Screw loosening and iliotibial band friction after posterolateral corner reconstruction. Knee 21:769–773

    Article  PubMed  Google Scholar 

  13. Ibrahim SA, Ghafar S, Salah M, Abo Alnas M, Al Misfer A, Farouk H, Al Haran H, Khirait S (2013) Surgical management of traumatic knee dislocation with posterolateral corner injury. Arthrosc 29:733–741

    Article  Google Scholar 

  14. Kim SJ, Chang CB, Choi CH, Yoo YS, Kim SH, Ko JH, Park KK (2013) Intertunnel relationships in combined anterior cruciate ligament and posterolateral corner reconstruction: an in vivo 3-dimensional anatomic study. Am J Sports Med 41:849–857

    Article  PubMed  Google Scholar 

  15. LaPrade RF, Resig S, Wentorf F, Lewis JL (1999) The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. A biomechanical analysis. Am J Sports Med 27:469–475

    CAS  PubMed  Google Scholar 

  16. LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A (2004) An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med 32:1405–1414

    Article  PubMed  Google Scholar 

  17. Lee SH, Jung YB, Jung HJ, Song KS, Ko YB (2010) Combined reconstruction for posterolateral rotatory instability with anterior cruciate ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc 18:1219–1225

    Article  PubMed  Google Scholar 

  18. Logan JS, Elliot RR, Wilson AJ (2012) Translateral ACL reconstruction: a technique for anatomic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:1289–1292

    Article  CAS  PubMed  Google Scholar 

  19. Mahmoud SS, Odak S, Coogan S, McNicholas MJ (2014) A prospective study to assess the outcomes of revision anterior cruciate ligament reconstruction. Int Orthop 38:1489–1494

    Article  PubMed  Google Scholar 

  20. Maynard MJ, Deng X, Wickiewicz TL, Warren RF (1996) The popliteofibular ligament. Rediscovery of a key element in posterolateral stability. Am J Sports Med 24:311–316

    Article  CAS  PubMed  Google Scholar 

  21. Pacheco RJ, Ayre CA, Bollen SR (2011) Posterolateral corner injuries of the knee: a serious injury commonly missed. J Bone Joint Surg Br 93:194–197

    Article  CAS  PubMed  Google Scholar 

  22. Ross G, DeConciliis GP, Choi K, Scheller AD (2004) Evaluation and treatment of acute posterolateral corner/anterior cruciate ligament injuries of the knee. J Bone Joint Surg Am 86-A(Suppl 2):2–7

    PubMed  Google Scholar 

  23. Shuler MS, Jasper LE, Rauh PB, Mulligan ME, Moorman CT 3rd (2006) Tunnel convergence in combined anterior cruciate ligament and posterolateral corner reconstruction. Arthrosc 22:193–198

    Article  Google Scholar 

  24. Stannard JP, Brown SL, Farris RC, McGwin G Jr, Volgas DA (2005) The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med 33:881–888

    Article  PubMed  Google Scholar 

  25. Stannard JP, Brown SL, Farris RC, McGwin G Jr, Volgas DA (2005) Reconstruction of the posterolateral corner of the knee. Arthrosc 21:1051–1059

    Article  Google Scholar 

  26. Taketomi S, Inui H, Hirota J, Nakamura K, Sanada T, Masuda H, Tanaka S, Nakagawa T (2013) Iliotibial band irritation caused by the EndoButton after anatomic double-bundle anterior cruciate ligament reconstruction: report of two cases. Knee 20:291–294

    Article  PubMed  Google Scholar 

  27. Tegner Y, Lysholm J (1985) Rating system in evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    PubMed  Google Scholar 

  28. Veltri DM, Deng XH, Torzilli PA, Maynard MJ, Warren RF (1996) The role of the popliteofibular ligament in stability of the human knee. A biomechanical study. Am J Sports Med 24:19–27

    Article  CAS  PubMed  Google Scholar 

  29. Wadia FD, Pimple M, Gajjar SM, Narvekar AD (2003) An anatomic study of the popliteofibular ligament. Int Orthop 27:172–174

    PubMed Central  CAS  PubMed  Google Scholar 

  30. Wahl CJ, Nicandri G (2008) Single-Achilles allograft posterior cruciate ligament and medial collateral ligament reconstruction: a technique to avoid osseous tunnel intersection, improve construct stiffness, and save on allograft utilization. Arthrosc 24:486–489

    Article  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Camilo Partezani Helito.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Helito, C.P., Bonadio, M.B., Demange, M.K. et al. Functional assessment of combined reconstruction of the anterior cruciate ligament and posterolateral corner with a single femoral tunnel: a two-year minimum follow-up. International Orthopaedics (SICOT) 39, 543–548 (2015). https://doi.org/10.1007/s00264-014-2576-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2576-7

Keywords

Navigation