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Pioger C, Bouché PA, Haen TX, Pujol N. Comparison of three surgical techniques of posterolateral knee reconstruction: A cadaver study. Orthop Traumatol Surg Res 2022; 108:103414. [PMID: 36126872 DOI: 10.1016/j.otsr.2022.103414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Injuries to the posterolateral corner (PLC) of the knee are often overlooked but, require reconstruction in order to restore stability in varus and external rotation. Among the many anatomic and non-anatomic PLC reconstruction techniques available, the modified Larson (mLR), LaPrade (LPR) and Versailles reconstruction (VR) procedures are widely used. HYPOTHESIS The hypothesis was that anatomic PLC reconstruction (VR and LPR procedures) provides better restoration and control of external rotation. PATIENTS AND METHODS Fifteen fresh-frozen cadaveric knees were tested to compare the 3 procedures. Varus laxity on stress radiographs in full knee extension and external rotatory laxity on dial test at 30° flexion were quantified at 3 phases: intact knee, PLC sectioned and PLC reconstructed. RESULTS Mean varus laxity did not differ significantly between techniques in intact knees (p=.14), after PLC sectioning (p=.14) or after PLC reconstruction (p=.17). After PLC reconstruction, varus laxity was restored, with no statistical difference between mLR, VR and LPR compared to intact test values (respectively, -1.0, -1.3 and -1.5; p=.98). In all 3 groups, mean external rotation laxity on dial test at 30° flexion did not significantly differ between intact knees (p=.32) and after PLC sectioning (p=.15). After PLC reconstruction, the mLR technique was significantly less effective in restoring rotational stability than the VR and LPR techniques (p=.025). DISCUSSION The VR technique provided similar outcomes to LPR for restoring stability in varus and external rotation. The 2 "anatomic" reconstruction procedures (VR and LPR) were significantly more effective than the modified Larson technique for external rotation control, confirming the study hypothesis. Consequently, it remains preferable to use anatomic techniques in multiligament injuries involving the PLC. LEVEL OF EVIDENCE IV, cadaver study.
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Affiliation(s)
- Charles Pioger
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Pierre-Alban Bouché
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France
| | - Thomas-Xavier Haen
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Nicolas Pujol
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
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Yeatts NC, Rao AJ, Trofa DP, Hong IS, Moorman CT, Piasecki DP, Fleischli JE, Saltzman BM. Comparable Subjective and Objective Clinical Outcomes After Fibular or Combined Tibial-Fibular-based Reconstruction of the Posterolateral Corner of the Knee: A Systematic Review and Meta-analysis. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202112000-00004. [PMID: 34860735 DOI: 10.5435/jaaosglobal-d-21-00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION To compare subjective and objective outcomes of fibular and combined tibial-fibular (TF)-based posterolateral corner (PLC) reconstruction. METHODS A systematic review of literature reporting outcomes of posterolateral corner reconstruction was conducted including outcome studies of surgically treated PLC injuries with a minimum 1-year follow-up, postoperative subjective and objective outcomes including the patient-reported outcome scorings of Lysholm score, International Knee Documentation Committee evaluation (subjective and objective), dial test, and varus stress radiographs. RESULTS The 32 studies included comprised 40 cohorts: 12 cohorts (n = 350 knees) used a fibular-based technique, and 28 cohorts (n = 593 knees) used a combined TF-based technique. No statistically significant differences were found in patient-reported outcomes or objective clinical measurements comparing the two techniques using the Lysholm score (P = 0.204, τ2 = 3.46), International Knee Documentation Committee evaluation (subjective P = 0.21 τ2 = 15.57; objective P = 0.398), dial test (P = 0.69), or varus stress radiographs (P = 0.98, τ2 = 0.08). CONCLUSIONS This study found no statistically significant differences in subjective or objective clinical outcome measurements after fibular-based versus combined TF-based PLC reconstruction. Further prospective evaluation comparing long-term clinical outcomes, complications, and surgical time may help to elucidate a preferred reconstructive technique.
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Affiliation(s)
- Nicholas C Yeatts
- From the OrthoCarolina-Sports Medicine Center (Dr. Yeatts, Dr. Rao, Mr. Hong, Dr. Moorman, Dr. Piasecki, Dr. Fleischli and Dr. Saltzman), Atrium Health-Musculoskeletal Institute, Charlotte, NC (Dr. Yeatts, Hong, Dr. Moorman, Dr. Piasecki, Dr. Fleischli, and Dr. Saltzman), and the Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY (Dr. Trofa)
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Murgier J, Boisrenoult P, Steltzlen C, Beaufils P, Pujol N. Anatomical knee postero-lateral corner reconstruction: The "Versailles" technique. Orthop Traumatol Surg Res 2017; 103:1031-1034. [PMID: 28782698 DOI: 10.1016/j.otsr.2017.05.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/10/2017] [Accepted: 05/16/2017] [Indexed: 02/02/2023]
Abstract
Postero-lateral knee instability raises surgical challenges. Of the many available reconstruction techniques, few ensure anatomical reconstruction of the postero-lateral corner (PLC). The "Versailles" technique ensures the anatomical reconstruction of the three main PLC stabilisers (lateral collateral ligament, popliteus tendon, and popliteo-fibular ligament) by using either a hamstring autograft or a tendon allograft.
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Affiliation(s)
- J Murgier
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 78150 Le Chesnay, France; Service d'orthopédie-traumatologie, hôpital Pierre-Paul-Riquet, 308, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - P Boisrenoult
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 78150 Le Chesnay, France.
| | - C Steltzlen
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 78150 Le Chesnay, France
| | - P Beaufils
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 78150 Le Chesnay, France
| | - N Pujol
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 78150 Le Chesnay, France
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Manning WA, Ghosh K, Blain A, Longstaff L, Deehan DJ. Tibiofemoral forces for the native and post-arthroplasty knee: relationship to maximal laxity through a functional arc of motion. Knee Surg Sports Traumatol Arthrosc 2017; 25:1669-1677. [PMID: 27034084 DOI: 10.1007/s00167-016-4093-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Accurate soft tissue balance must be achieved to improve functional outcome after total knee arthroplasty (TKA). Sensor-integrated tibial trials have been introduced that allow real-time measurement of tibiofemoral kinematics during TKA. This study examined the interplay between tibiofemoral force and laxity, under defined intraoperative conditions, so as to quantify the kinematic behaviour of the CR femoral single-radius knee. METHODS TKA was undertaken in eight loaded cadaveric specimens. Computer navigation in combination with sensor data defined laxity and tibiofemoral contact force, respectively, during manual laxity testing. Fixed-effect linear modelling allowed quantification of the effect for flexion angle, direction of movement and TKA implantation upon the knee. RESULTS An inverse relationship between laxity and contact force was demonstrated. With flexion, laxity increased as contact force decreased under manual stress. Change in laxity was significant beyond 30° for coronal plane laxity and beyond 60° for rotatory laxity (p < 0.01). Rotational stress in mid-flexion demonstrated the greatest mismatch in inter-compartmental forces. Contact point position over the tibial sensor demonstrated paradoxical roll-forward with knee flexion. CONCLUSION Traditional balancing techniques may not reliably equate to uniform laxity or contact forces across the tibiofemoral joint through a range of flexion and argue for the role of per-operative sensor use to aid final balancing of the knee.
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Zaffagnini S, Signorelli C, Bonanzinga T, Roberti Di Sarsina T, Grassi A, Budeyri A, Marcheggiani Muccioli GM, Raggi F, Bragonzoni L, Lopomo N, Marcacci M. Technical variables of ACL surgical reconstruction: effect on post-operative static laxity and clinical implication. Knee Surg Sports Traumatol Arthrosc 2016; 24:3496-3506. [PMID: 27628740 DOI: 10.1007/s00167-016-4320-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/02/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE The hypothesis was that an alteration of different surgical variables of ACL reconstruction would produce significant changes in post-operative static laxity of knee joint. METHODS Joint laxity was acquired by a surgical navigation system for 17 patients just after graft fixation during single-bundle reconstruction with extra-articular lateral tenodesis. The analysed laxity parameters were: internal/external rotation at 30° (IE30) and 90° (IE90) of flexion, varus/valgus rotation at 0° (VV0) and 30° (VV30) of flexion and anterior/posterior displacement at 30° (AP30) and 90° (AP90) of flexion. As surgical variables, the angles between the tibial tunnel and the three planes were defined as well as the lengths of the tunnel and the relationship between native footprints and tunnels. The same analysis was performed for the femoral side. All surgical variables were combined in a multivariate analysis to assess for predictive factors between them and post-operative laxities values. To quantify the performance of each multivariate model, the correlation ratio (η 2) and the corresponding P value (*P < 0.050) have been evaluated. RESULTS Multivariate analysis underlined statistically significant models for the estimation of: AP30 (η 2 = 0.987; P = 0.014), IE30 (η 2 = 0.995; P = 0.005), IE90 (η 2 = 0.568; P = 0.010), VV0 (η 2 = 0.932; P = 0.003). The parameters that greatly affected the identified models were the orientation of the tibial tunnel with respect to the three anatomical planes. The estimation of AP30, IE30 and IE90 got lower value as the orientation of the tibial tunnel with respect to transverse plane decreases. Considering the orientation to sagittal ([Formula: see text]) and coronal ([Formula: see text]) plane, we found that their reduction provoked a decrease in the estimation of AP30, IE30 and IE90 (except [Formula: see text] that did not appear in the estimation of AP30). The estimation of VV0 got an increase of [Formula: see text], and [Formula: see text] which led to a laxity reduction. CONCLUSION The main finding of the present in vivo study was the possibility to determine significant effects on post-operative static laxity level of different surgical variables of ACL reconstruction. In particular, the present study defined the conditions that minimize the different aspects of post-operative laxity at time-zero after surgery.
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Affiliation(s)
- S Zaffagnini
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy. .,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy. .,Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria (PA), Italy. .,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna (BO), Italy.
| | - C Signorelli
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy
| | - T Bonanzinga
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy
| | - T Roberti Di Sarsina
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy
| | - A Grassi
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria (PA), Italy
| | - A Budeyri
- Orthopaedics and Traumatology, SANKO University, Gaziantep, Turkey
| | - G M Marcheggiani Muccioli
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy.,Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria (PA), Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna (BO), Italy
| | - F Raggi
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy
| | - L Bragonzoni
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna (BO), Italy
| | - N Lopomo
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Ingegneria dell'Informazione, Università degli Studi di Brescia, Brescia (BS), Italy
| | - M Marcacci
- Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy.,Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna (BO), Italy
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Mouton C, Theisen D, Seil R. Objective measurements of static anterior and rotational knee laxity. Curr Rev Musculoskelet Med 2016; 9:139-47. [PMID: 26970758 PMCID: PMC4896875 DOI: 10.1007/s12178-016-9332-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Several devices allow to measure anterior and rotational static knee laxity. To date, the use of rotational laxity measurements in the daily clinical practice however remains to be improved. These measurements may be systematically integrated to the follow-up of knee injuries. Physiologic laxity measurements may particularly be of interest for the identification of risk factors in athletes. Furthermore, knee laxity measurements help to improve the diagnosis of knee soft tissue injuries and to follow up reconstructions. Further prospective follow-ups of knee laxity in the injured/reconstructed knees are however required to conclude on the best treatment strategy for knee soft tissue injuries.
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Affiliation(s)
- Caroline Mouton
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg City, Luxembourg
| | - Daniel Theisen
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg City, Luxembourg
| | - Romain Seil
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg City, Luxembourg.
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, 76, rue d'Eich, L-1460, Luxembourg City, Luxembourg.
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Mouton C, Theisen D, Meyer T, Agostinis H, Nührenbörger C, Pape D, Seil R. Noninjured Knees of Patients With Noncontact ACL Injuries Display Higher Average Anterior and Internal Rotational Knee Laxity Compared With Healthy Knees of a Noninjured Population. Am J Sports Med 2015; 43:1918-23. [PMID: 26045620 DOI: 10.1177/0363546515587080] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Excessive physiological anterior and rotational knee laxity is thought to be a risk factor for noncontact anterior cruciate ligament (ACL) injuries and inferior reconstruction outcomes, but no thresholds have been established to identify patients with increased laxity. PURPOSE (1) To determine if the healthy contralateral knees of ACL-injured patients have greater anterior and rotational knee laxity, leading to different laxity profiles (combination of laxities), compared with healthy control knees and (2) to set a threshold to help discriminate anterior and rotational knee laxity between these groups. STUDY DESIGN Case-sectional study; Level of evidence, 3. METHODS A total of 171 healthy contralateral knees of noncontact ACL-injured patients (ACL-H group) and 104 healthy knees of control participants (CTL group) were tested for anterior and rotational laxity. Laxity scores (measurements corrected for sex and body mass) were used to classify knees as hypolax (score <-1), normolax (between -1 and 1), or hyperlax (>1). Proportions of patients in each group were compared using χ(2) tests. Receiver operating characteristic curves were computed to discriminate laxity between the groups. Odds ratios were calculated to determine the probability of being in the ACL-H group. RESULTS The ACL-H group displayed greater laxity scores for anterior displacement and internal rotation in their uninjured knee compared with the CTL group (P < .05). Laxity profiles were different between the groups for the following associations: normolax in anterior displacement/hypolax in internal rotation (6% [ACL-H] vs 15% [CTL]; P = .02) and hyperlax in anterior displacement/normolax in internal rotation (27% [ACL-H] vs 10% [CTL]; P < .01). The laxity score thresholds were 0.75 for anterior laxity and -0.55 for internal rotation. With both scores above these thresholds, a patient was 3.18-fold more likely to be in the ACL-H group (95% CI, 1.74-5.83). CONCLUSION The healthy contralateral knees of patients with noncontact ACL injuries display different laxity values both for internal rotation and anterior displacement compared with healthy control knees. The identification of knee laxity profiles may be of relevance for primary and secondary prevention programs of noncontact ACL injuries.
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Affiliation(s)
- Caroline Mouton
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg
| | - Daniel Theisen
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Hélène Agostinis
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg
| | | | - Dietrich Pape
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg
| | - Romain Seil
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg
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Combined anterior and rotational laxity measurements allow characterizing personal knee laxity profiles in healthy individuals. Knee Surg Sports Traumatol Arthrosc 2015; 23:3571-7. [PMID: 25155050 PMCID: PMC4661198 DOI: 10.1007/s00167-014-3244-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/13/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to quantify sagittal and rotational knee laxity profiles taking into account individual influencing factors. METHODS Linear regression models were used to determine which individual characteristics (age, height, body mass and sex) influenced the outcome in a group of 104 healthy subjects. The standardized residuals were used as individualized (corrected) laxity scores and were combined to determine knee laxity profiles. RESULTS Anterior knee laxity was not influenced by individual characteristics. Rotational knee laxity was higher in females and inversely related to body mass. The correlation between anterior laxity and internal rotation scores was weak (r = 0.24, p = 0.02). The proportion of knees concerned by increased laxity scores (scores >1) was similar for anterior displacement, internal and external rotation (15 %). Only 32 % of the tested subjects showed a normal profile (score >-1 and <1) for all three directions, 33 % were concerned by hyperlaxity, 40 % by hypolaxity and 5 % by both. CONCLUSIONS The diversity of laxity profiles found here highlights that the interpretation of multidirectional knee laxity is complex and suggests the necessity for individualized care of knee diseases and injuries. These results contribute to the understanding of knee laxity and throw the basis for prevention strategies and improvement of treatment outcomes in injuries and diseases. LEVEL OF EVIDENCE Case series with no comparison groups, Level IV.
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Wajsfisz A, Bajard X, Plaweski S, Djian P, Demey G, Limozin R, Bousquet V, Rocheconcar G, Louis ML, Arndt J, Azar M, Sonnery-Cottet B, Boisrenoult P. Surgical management of combined anterior or posterior cruciate ligament and posterolateral corner tears: for what functional results? Orthop Traumatol Surg Res 2014; 100:S379-83. [PMID: 25455185 DOI: 10.1016/j.otsr.2014.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/10/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Management of combined anterior or posterior cruciate ligament and posterolateral corner tears is still poorly codified. The aim of this study was to evaluate functional outcome after complete surgical treatment. MATERIALS AND METHODS This retrospective multicenter study included 53 patients. Mean age was 29.8 yrs. (15-49). The anterior and posterior cruciate ligaments were involved in respectively 48 and 5 cases. Mean time to surgery was 25.6 months (0-184), and in 10 cases less than 21 days. Nine patients were sedentary workers and 29 non-sedentary (13 laborers). All ligament injuries were treated surgically. Mean follow-up was 49 months (12-146). Last follow-up assessment used IKDC, Lysholm and KOOS scores. RESULTS At last follow-up, IKDC score graded 14 patients A, 25 B, 8 C and 6 D, versus 0 A, 4 B, 25 C, 22 D and 2 ungraded preoperatively. Mean subjective IKDC and Lysholm scores were respectively 72.8 (11.5-100) and 77.5 (37-100). Mean KOOS scores (pain, symptoms, daily life, sports, quality of life) were respectively 78 (3-100), 70 (25-100), 88 (47-100), 53 (0-100) and 50 (0-100). Posterolateral laxity was corrected in all but two cases. All sedentary workers and 86.7% of non-sedentary workers could return to work. The job had to be changed in 10% of cases overall, but in 25% of cases for laborers. DISCUSSION The present results are comparable with those of the literature. The strategy of combined surgical treatment showed functional efficacy, usually associated with return to work except for some laborers. There was a non-significant trend in favor of acute-phase ligament reconstruction. LEVEL OF EVIDENCE IV (retrospective series).
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Affiliation(s)
- A Wajsfisz
- Clinique Drouot, 20, rue Laffitte, 75009 Paris, France
| | - X Bajard
- Hôpital d'instruction des Armées-Begin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - S Plaweski
- Service d'orthopédie traumatologie, centre hospitalier universitaire de Grenoble, hôpital Sud, 38434 Échirolles cedex, France
| | - P Djian
- Cabinet Goethe, 23, avenue Niel, 75017 Paris, France
| | - G Demey
- Lyon-ortho-clinic, 29B, avenue des Sources-Bâtiment-Trait-d'Union, 69009 Lyon, France
| | - R Limozin
- Médipole Garonne, 45, rue de Gironis, 31100 Toulouse, France
| | - V Bousquet
- Clinique du sport de merignac, 4, rue Negrevergne, 33700 Mérignac, France
| | - G Rocheconcar
- Service d'orthopédie traumatologie, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - M-L Louis
- Cabinet médical ICOS, 118, rue Jean-Mermoz, 13008 Marseille, France
| | - J Arndt
- Service d'orthopédie traumatologie, hôpitaux universitaire de Strasbourg, 67091 Strasbourg, France
| | - M Azar
- Service d'orthopédie traumatologie, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | | | - P Boisrenoult
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 78150 le Chesnay, France.
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