Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee

Am J Sports Med. 2010 Apr;38(4):804-9. doi: 10.1177/0363546509352459. Epub 2010 Jan 31.

Abstract

Background: Treatment of the multiligament-injured knee remains controversial.

Purpose: To compare clinical and functional outcomes of a consecutive series of multiligament-injured knees that underwent repair of the fibular collateral ligament (FCL) and posterolateral corner (PLC), followed by delayed cruciate ligament reconstructions, with those that had single-stage multiligament reconstruction.

Study design: Cohort study; Level of evidence, 3. Methods Patients with multiligament knee injury treated by a single surgeon were identified in our prospective database. Between February 2004 and May 2005, patients underwent repair of medial- and lateral-sided injuries, followed by delayed cruciate ligament reconstructions. Between May 2005 and February 2007, patients underwent single-stage multiligament knee reconstruction. All patients followed a standard rehabilitation protocol. Inclusion criteria were minimum 2-year follow-up and multiligament knee injury including the FCL/PLC. International Knee Documentation Committee subjective and Lysholm scores and objective clinical data were documented.

Results: We identified 45 knees (42 patients); 17 knees (14 patients) were excluded, leaving 28 knees (28 patients) in the study. The repair/staged group (10 knees in 10 patients) had a mean follow-up of 34 months (range, 24-49 months). The reconstruction group (18 knees in 18 patients) had a mean follow-up of 28 months (range, 24-41 months). Four of the 10 FCL/PLC repairs (40%) and 1 of the 18 FCL/PLC reconstructions (6%) failed (P = .04). After revision reconstructions, there were no statistically significant differences between mean International Knee Documentation Committee subjective scores (79 vs. 77, P = .92) and mean Lysholm scores (85 vs 88, P = .92). Regression analysis showed no effect on failure based on age, sex, injury mechanism, time to surgery, interval between stages, total number of ligaments injured, or location of tear.

Conclusion: Our series demonstrated a statistically significant higher rate of failure for repair compared with reconstruction of the FCL/PLC. Reconstruction of the FCL/PLC structures is a more reliable option than repair alone in the setting of a multiligament knee injury.

Publication types

  • Comparative Study

MeSH terms

  • Cohort Studies
  • Collateral Ligaments / injuries*
  • Collateral Ligaments / surgery*
  • Female
  • Fibula / physiopathology
  • Fibula / surgery*
  • Humans
  • Joint Instability / surgery
  • Knee Dislocation / surgery
  • Knee Injuries / physiopathology
  • Knee Injuries / surgery*
  • Male
  • Prospective Studies
  • Range of Motion, Articular
  • Reconstructive Surgical Procedures*
  • Recovery of Function*