Modified anatomical posterolateral corner reconstruction of the knee using combined fibula-and tibia-based anatomic reconstruction with tibial posterior cortical fixation using a titanium staple

Purpose
The purpose of this study is to evaluate the results of the anatomical reconstruction of a posterolateral corner (PLC) using a technique of combined fibula-and tibia-based anatomic reconstruction using a single semitendinosus autograft with posterior tibial cortical surface fixation using a titanium staple.
Patients and methods
Between August 2016 and July 2018, 13 male patients with chronic PLC injury underwent a PLC reconstruction of the knee by a modified anatomical PLC reconstruction using a technique of combined fibula-and tibia-based anatomic reconstruction using a single semitendinosus autograft with posterior tibial cortical fixation using a titanium staple. Instability was the main complaint, the mean age was 27.54 ± 4.63 with motorcycle accident being the most common cause of injury in five (38.5%) patients, contact sport was the second common cause of injury in four (30.8%) patients, twisting injury represented 15.4%, and motor vehicle injury in 15.4%. The mean time from injury to surgery was 3.54 ± 1.51 months, all cases had associated injuries; seven cases presented as combined PLC and anterior cruciate ligament injuries with one case having chondral lesion and another case having medial meniscal injury; the other five cases had combined PLC and posterior cruciate ligament injury with one case having a medial meniscal injury. The mean follow-up period was 11.31 ± 2.78 months. Before surgery as well as at the final follow-up, all study patients completed the subjective Lysholm and International Knee Documentation Committee (IKDC) questionnaires. The side-to-side difference (SSD) of the lateral joint opening in stress varus radiographs and external rotation angle (dial test) were measured.
Results
The final results at the end of the follow-up period showed marked improvement in IKDC and Lysholm score presented as a significant improvement of IKDC score from the preoperative mean score 25.92 ± 7.02–71.08 ± 4.39 (P<0.001) and Lysholm score improvement from 33.4 ± 5.7 to 87.7 ± 8.5 (P<0.001). Improvement of SSD of lateral joint opening in stress radiographs from 6.1 ± 0.6 to 3.4 ± 0.3 mm (P<0.001) and SSD of the external rotation angle (dial test) improved from 26.5 ± 3.8° preoperatively to 7.7 ± 3.3° postoperatively (P<0.001).
Conclusion
Anatomical PLC reconstruction using the fibular tunnel technique using a single semitendinosus graft with posterior cortical fixation at the tibial side using a titanium staple is a simple technique that gives excellent short-term follow-up results that need long-term follow-up to determine the graft function, especially in cases of multiple-ligament injured knee.