COMBINED ANTERIOR CRUCIATE & POSTEROLATERAL CORNER INJURY - A PROSPECTIVE STUDY OF FUNCTIONAL OUTCOME

Abstract

This prospective case-controlled study evaluates the outcome of chronic combined anterior cruciate ligament (ACL) & posterolateral corner (PLC) knee reconstruction.

Twenty-six patients (23 male) underwent combined ACL & PLC reconstruction between October 2001 and October 2006 (Group ACL/PLC). Mean age 30.2 years (range 17–44). Mean follow-up 51 months (range 27–109). The commonest mode of injury was football. Seven patients had concomitant lateral, and 9 medial meniscal procedures, 1 osteochondral defect was micro-fractured. All procedures were performed at the same operation. Prospective scoring was done pre-operatively and 3,6,12, and 24 months post-op using Lysholm, IKDC 2000 and KOOS scoring systems. These scores were compared to an age, sex and injury matched control group of patients who also underwent ACL reconstruction without posterolateral corners injury (Group ACL).

Functional scores showed a significant improvement in all patients in both ACL/PLC and ACL groups postop (p< 0.05). Pre-op scores for Lysholm (p=0.005), IKDC (p=0.03), KOOS sports (p=0.03) and quality of life (QOL) (p=0.03) were significantly lower in Group ACL/PLC compared to Group ACL. Other significantly reduced KOOS scores were - sports 12 (p=0.04) & 24 months (p=0.004); and QOL 12 (p=0.01) & 24 months (p=0.006).

Conclusions: Injury to the posterolateral stabilizing structures of the knee usually occurs in association with other ligamentous injuries. The recognition and adequate management of this injury is crucial. Knees with combined ACL & PLC injuries have reduced function compared to ACL injuries alone. Patients undergoing combined ACL & PLC reconstruction should be made aware that the nature of their injury is such that postoperatively they may have ongoing functional limitations with respect to return to sport and quality of life.