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Document Title: Noyes-AJSM-Sep06.shtml
Article Title: An Analysis of the Causes of Failure in 57 Consecutive Posterolateral Operative Procedures
Authors: Frank R. Noyes, MD, Sue D. Barber-Westin, and Jay C. Albright, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: September 2006
Volume 34, pages 1419-1430
Keywords: PLC/PLS/PLL, posterolateral corner/structures/ligaments, varus malalignment, bow-leggedness
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: This penetratingly insightful study highlights the importance of having a full complement of functionally intact tensile structures in the knee. The authors note that in a multi-ligament-injured knee, the cruciate ligaments need to be reconstructed, and any bony malalignments (in particular bowleggedness, also known as genu varum) must be corrected first. Otherwise, the posterolateral reconstruction can be guaranteed to fail.
ABSTRACT
Purpose: To investigate 57 failed posterolateral procedures in 30 consecutive knees to determine factors that may have contributed to the failure.
Study Design: Case series; Level of evidence, 4.
Methods: Thirty patient records were reviewed by an independent surgeon. The index posterolateral operations were done for 13 acute and 17 chronic knee injuries. The anterior cruciate ligament was ruptured in 17 knees, the posterior cruciate ligament was torn in 5 knees, and both cruciates were ruptured in 8 knees. In 25 knees, 46 revision posterolateral procedures had been performed, of which 27 had also failed (in 21 knees). Five knees did not undergo revision of the posterolateral structures.
Results: In 22 knees, multiple factors were identified that most likely contributed to the failure of the posterolateral procedures. The most common factors were nonanatomical graft reconstruction (23 knees), untreated varus malalignment (10 knees), and failure to successfully reconstruct all ruptured knee ligaments, including cruciates (27 knees). Thirty-nine anterior cruciate ligament procedures were done in 24 knees, including 24 primary and 15 revision operations. Seventeen posterior cruciate ligament procedures were done in 13 knees, including 13 primary and 4 revision operations. At the time of writing, 16 of 24 knees had a functional anterior cruciate ligament graft and 5 of 13 had a functional posterior cruciate ligament graft.
Conclusion: The results suggest greater emphasis during the index operation for anatomical graft reconstruction of one or more of the posterolateral structures as necessary, restoration of all ruptured cruciate ligaments, and correction of varus malalignment.
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