Midterm Clinical Outcome of Combined Posterior Cruciate Ligament Reconstruction and Posterolateral Corner Surgery Using Second-Look Arthroscopic "Lateral Gutter Drive-Through" Test as an Adjunctive Evaluation

Abstract

Objectives: The arthroscopic "lateral gutter drive-through" (LGDT) sign is reported to diagnose popliteus tendon (PT) injury with high sensitivity and specificity. However, no study has provided a postoperative evaluation of combined posterior cruciate ligament (PCL) and posterolateral corner (PLC) injuries using the LGDT test.

Methods: From January 2012 to January 2015, a total of 80 consecutive patients who underwent combined PCL reconstruction and PLC surgeries were identified. Fifty eligible patients were included in this study for evaluation with subjective scoring systems, physical examinations, posterior and varus stress radiographs, and second-look arthroscopic surgeries during hardware removal operation.

Results: Forty-nine patients were available for a mean of 31.5 ± 9.3 months follow-up (range, 24.0-81.0 months). In terms of PLC injury pattern, there were 27 type A, 10 type B, and 12 type C patients, with 21 acute cases and 28 chronic cases. At the final follow-up, subjective scores were all significantly improved. The side-to-side difference (SSD) of posterior tibial translation (PTT) improved from 18.4 ± 9.2 mm (range, 12.9-25.6 mm) to 5.2 ± 5.0 mm (range, -5.0-18.5 mm, P < 0.001), and the SSD of tibial external rotation by dial test (ER) decreased from 18.0° ± 14.4° (range, 13.0°-22.0°) to 1.2° ± 7.5° (range, -9.0°-22.0°, P < 0.001). In patients with type C injury, the SSD of the lateral opening decreased from 14.2 ± 6.6 mm (range, 22-10.2 mm) to 0.9 ± 3.1 mm (range, -4.4-6 mm, P < 0.001). In a comparison between patients with positive and negative LGDT signs, the LGDT-negative patients had significant superiority in subjective scores, SSD of PTT, and SSD of ER. The sensitivity and specificity of the LGDT test in detecting postoperative posterolateral rotational instability (PLRI) were calculated as 100% and 88.4%, respectively.

Conclusions: In the series of surgically treated patients with PCL and PLC injury: (i) patients had improved subjective and objective clinical outcome after combined PCL reconstruction and PLC surgery at a minimum of 24-months follow-up; and (ii) second arthroscopic LGDT sign testing had high sensitivity and specificity in detecting postoperative PLRI, and a positive LGDT sign was related with inferior subjective and objective results.

Keywords: Lateral gutter drive through test; Popliteal tendon; Posterior cruciate ligament reconstruction; Posterolateral corner.