Posterolateral knee reconstruction with an anatomical bone-patellar tendon-bone reconstruction of the fibular collateral ligament

Abstract

Background: The authors have long advocated a graft reconstruction of the fibular collateral ligament, believing that direct suture repair or augmentation procedures do not provide a stable construct.

Purpose: To describe an operative technique and determine the clinical outcome of a bone-patellar tendon-bone graft anatomical replacement of the fibular collateral ligament in a consecutive series of knees.

Study design: Case series; Level of evidence, 4.

Methods: A consecutive group of knees undergoing anatomical posterolateral reconstruction that included a fibular collateral ligament reconstruction with a bone-patellar tendon-bone graft was prospectively followed to determine the functional outcome and failure rate. Thirteen patients (14 posterolateral reconstructions) were observed 2 to 13.7 years postoperatively. All major posterolateral structures were surgically restored. The procedure represented a primary reconstruction in 7 patients and a revision in 6 patients. Anterior cruciate ligament ruptures were found in 7 patients and bicruciate ruptures in 5 patients, all of which were reconstructed. The rehabilitation protocol allowed immediate knee motion from 0 degrees to 90 degrees but included protection against lateral joint loads to prevent graft stretching and failure. The results were determined by a knee examination, stress radiography, KT-2000 arthrometer, the Cincinnati Knee Rating System, and the International Knee Documentation Committee Rating System.

Results: Significant improvements were found at follow-up for pain (P = .0001), swelling (P = .02), patient rating of the overall knee condition (P < .001), walking (P < .05), and stair climbing (P < .05). Thirteen of the 14 (93%) reconstructions restored normal or nearly normal lateral joint opening and external tibial rotation and 1 failed. The anterior cruciate ligament reconstructions were normal or nearly normal in 11 knees and abnormal in 1 knee.

Conclusions: The anatomical posterolateral procedure was effective in restoring normal limits to lateral joint opening and external tibial rotation, allowed immediate knee motion, and appeared to protect other soft tissue repairs.