Chronic posterolateral rotatory instability of the knee

Area of Science:

• Orthopedic Surgery
• Knee Biomechanics
• Sports Medicine

Background:

• Posterolateral rotatory instability (PLRI) of the knee is frequently overlooked, leading to misdiagnosis and mistreatment.
• Accurate diagnosis relies on comprehensive knee examination, including specific rotational and drawer tests.
• PLRI often coexists with other knee instabilities, complicating management.

Purpose of the Study:

• To report the long-term outcomes of surgical reconstruction of the arcuate ligament complex for chronic PLRI.
• To evaluate the effectiveness of a specific operative technique involving anterior and distal advancement of the arcuate ligament complex.

Main Methods:

• A consecutive series of 141 knee reconstructions in 140 patients with chronic PLRI were performed.
• The surgical technique involved advancing the arcuate ligament complex and its osseous attachment.
• Ninety-six knees with a follow-up of 2 to 13 years form the basis of this report, including patients with prior failed surgeries.

Main Results:

• Objectively, 85% of reconstructed knees were rated as good, 14% as fair, and 1% as poor.
• Subjectively, 78% of patients reported good outcomes, 22% fair, and none poor.
• Functionally, 80% of knees were rated good by patients, 16% fair, and 4% poor.

Conclusions:

• Surgical reconstruction of the arcuate ligament complex is an effective procedure for correcting chronic posterolateral rotatory instability.
• The described operative approach yields favorable long-term objective, subjective, and functional results.
• This study provides the first long-term evidence supporting the efficacy of arcuate ligament complex reconstruction for chronic PLRI.