[Treatment of combined anterolateral posterolateral rotary instability without PLC reconstruction]

ABSTRACT

Combined anterolateral and posterolateral rotary instability are treated by correcting knee alignment, Anterior Cruciate Ligament [ACL] reconstruction and repair or reconstruction of the Posterolateral Complex [PLC]. Because of technical difficulties encountered in these operations and the need for more than two stages, and considering the controversy among the importance of Posterolateral Complex [PLC] in valgue knee, this study was performed to treat this instability by ACL reconstruction alone, after correction of varus, without reconstruction of the posterolateral complex and further extra-articular manipulation. This clinical trial was performed on 29 patients [29 knees] with combined anterolateral and posterolateral rotary instability. Instability signs were recorded. Arthroscopy was then performed. To correct alignment, a valgus osteotomy was done and then an ACL reconstruction carried out. Results after a mean of 23 months follow-up, were compared to the ones of before surgery. Fisher Exact test, chi [2] and Wilcoxon tests were used to analyze data. Pain was relieved in more than half and locking disappeared in all of the patients. giving way diminished from 79.3% to 6.9%. Special instability tests showed a significant improvement after surgery [P<0.001]. Most of the patients returned to the preinjury level of work or sports. Based on the results of this study, after correcting varus, ACL-reconstruction alone, without further invasive procedures on extra-articular structures and posterolateral complex, is sufficient to cure this instability, avoiding unneeded complications and longer rehabilitation