Abstract
Injuries of the posterolateral corner (PLC) of the knee are uncommon, but can lead to chronic disability from persistent instability and resultant articular cartilage degeneration if not appropriately treated. Although numerous reconstructive techniques have been described in the literature, there is no consensus on a single surgical approach due to a lack of consistent, long-term clinical outcomes. Nonanatomic reconstructions, in particular, have produced variable results, while anatomic reconstructions offer the most promise by restoring normal knee stability and kinematics and are now favoured by most.
We describe the novel use of the BICEPTOR™ Tenodesis screw (Smith & Nephew) as an effective and technically straight forward means of performing a PLC reconstruction. We describe the technique and present the first 10 consecutive cases from a single surgeon series. All of the patients had a positive dial test pre-operatively with increased external rotation of 10 degrees or more at 30 degrees of knee flexion indicating clinical PLC injury. They all had the PLC reconstructed at the same time as an arthroscopic ACL reconstruction. Mean time from injury to surgery was 4 months (range 2–12). Patients were seen in clinic at maximum follow-up (11.1 months mean, range 6–24 months) and assessed clinically using the dial test at 30 and 90 degrees of knee flexion. Lysholm Knee Questionnaire and Tegner Activity Scale were also performed at maximum follow-up. Mean Lysholm Score was 68 (range 32–96). Mean Tegner Score pre-operatively was 3.5 (range 3–6) and at maximum follow-up was 4.5 (range 3–7). Of particular note only one patient reported any symptoms at all of giving way at maximum follow-up. Dial test was negative on all patients.
Further work is warranted but we describe this as an effective and straight forward means of performing a PLC reconstruction.
