The aim of this study was to assess the results of combined arthroscopically assisted posterior cruciate ligament reconstruction and open reconstruction of the posterolateral corner in patients with chronic (3 months or more) symptomatic instability and pain. A retrospective analysis of all the patients who had a combined reconstruction of the posterior cruciate ligament and the posterolateral corner between 1996 and 2003 was carried out. Nineteen patients who had the combined reconstruction were identified from the database. All the patients were assessed pre- and post-operatively by physical examination and three different ligament rating scores. All the patients also had weight bearing radiographs, MRI scans and an examination under anaesthesia and arthroscopy pre-operatively. The PCL reconstruction was performed using an arthroscopically assisted single anterolateral bundle technique and the posterolateral corner structures were reconstructed using an open Larson type of tenodesis.Objective
Patients & methods
Early stabilisation after an anterior cruciate ligament (ACL) rupture reduces future meniscal injury. We may therefore expect protection of articular cartilage from ACL reconstruction, but this has yet to be shown. Our aim wasto determine the effect of meniscal injury on the long term risk of osteoarthritis (OA) following ACL reconstruction using Single Photon Emission Computed Tomography (SPECT, a 3 dimensional radionuclide scan). We studied a prospective series of 31 patients (mean age at injury of 29 years) who had bone-patellar tendon-bone ACL reconstruction for unstable, ACL deficient knees. Mean follow-up was 10 years (range 9-13). Patients were separated into two groups according to the status of their menisci at the time of ACL reconstruction, those with intact menisci in group 1 (n=15) and those who required partial meniscectomy in group 2 (n=16). The contra-lateral normal knee was used as a control. All knees were clinically stable with high clinical scores (mean Lysholm score 93 and mean Tegner activity score 6). In group 1 (intact menisci) only one patient (7%) had clinical symptoms of OA and was the only patient with increased uptake on SPECT compatible with early OA. In group 2 (partial meniscectomy), two had clinical symptoms of osteoarthritis, and five patients (32%) had increased uptake on SPECT compatible with early OA. None of the control knees had early OA on SPECT. The prevalence of OA 10 years post ACL reconstruction, using the most sensitive investigation available, is very low in patients who had intact menisci (7%), but increases 5 fold (32%) if a meniscal tear was present. We recommend early ACL reconstruction to preserve the menisci to minimise the long term risk of OA.
