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Control of Laxity in Knees With Combined Posterior Cruciate Ligament and Posterolateral Corner Deficiency

Comparison of Single-Bundle Versus Double-Bundle Posterior Cruciate Ligament Reconstruction Combined With Modified Larson Posterolateral Corner Reconstruction

Sunil Apsingi, MS, MRCS^*,, Trung Nguyen, FRACS, Anthony M. J. Bull, PhD, Andrew Unwin, FRCS(Orth), David J. Deehan, MD, FRCS(Orth)^* and Andrew A. Amis, DSc(Eng)^,

From ^* Freeman Hospital, Newcastle, United Kingdom, Imperial College London, London, United Kingdom, and Windsor Orthopaedic Clinic, Windsor, United Kingdom

Address correspondence to Andrew A. Amis, DSc(Eng), Mechanical Engineering Department, Imperial College London, London SW7 2AZ, United Kingdom (e-mail: a.amis{at}imperial.ac.uk).

Background: Although many posterior cruciate ligament (PCL) injuries are in combination with posterolateral corner (PLC) injuries, there has been little research on combined injury reconstruction; the literature includes differing recommendations.

Hypothesis: Combined PCL plus PLC reconstruction corrects the abnormal posterior translation, varus, and external rotation laxities caused by combined PCL plus PLC deficiency. Furthermore, double-bundle PCL plus PLC reconstruction restores laxity closer to normal than single-bundle PCL plus PLC reconstruction.

Study Design: Controlled laboratory study.

Methods: Cadaveric knee kinematics were measured electromagnetically in 9 knees with posterior drawer, external rotation, and varus rotation loads applied at sequential stages: intact, PCL-deficient, PCL plus PLC-deficient, double-bundle PCL plus modified Larson PLC reconstruction, and single-bundle PCL plus modified Larson PLC reconstruction. Each graft was tensioned using a laxity-matching protocol.

Results: There was no significant difference between single-bundle and double-bundle PCL reconstruction, in combination with the modified Larson reconstruction, at any angle of flexion. Both combined reconstructions restored posterior drawer, external rotation, and varus laxity so that they did not differ significantly from normal.

Conclusion: In combined PCL plus PLC deficiency, combined PCL plus PLC reconstruction restored all major laxity limits to normal across the range of knee flexion examined. Double-bundle PCL reconstruction was not better than single-bundle reconstruction in this context.

Clinical Relevance: The added complexity of double-bundle reconstruction does not seem to be justified by these results. In combined PCL plus PLC-deficient knees, combined single-bundle PCL plus modified Larson PLC reconstruction was sufficient to restore posterior drawer, external rotation, and varus laxity to normal.

Key Words: posterior cruciate ligament • posterolateral corner • ligament reconstruction • double-bundle reconstruction • translation and rotational laxity