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Posterolateral Knee Reconstruction With an Anatomical Bone–Patellar Tendon–Bone Reconstruction of the Fibular Collateral Ligament

From the Cincinnati Sportsmedicine Research and Education Foundation, Cincinnati, Ohio

^* Address correspondence to Sue D. Barber-Westin, c/o Cincinnati Sportsmedicine Research and Education Foundation, 10663 Montgomery Road, Cincinnati, OH 45242 (e-mail: sbwestin{at}csmref.org).

Background: The authors have long advocated a graft reconstruction of the fibular collateral ligament, believing that direct suture repair or augmentation procedures do not provide a stable construct.

Purpose: To describe an operative technique and determine the clinical outcome of a bone–patellar tendon–bone graft anatomical replacement of the fibular collateral ligament in a consecutive series of knees.

Study Design: Case series; Level of evidence, 4.

Methods: A consecutive group of knees undergoing anatomical posterolateral reconstruction that included a fibular collateral ligament reconstruction with a bone–patellar tendon–bone graft was prospectively followed to determine the functional outcome and failure rate. Thirteen patients (14 posterolateral reconstructions) were observed 2 to 13.7 years postoperatively. All major posterolateral structures were surgically restored. The procedure represented a primary reconstruction in 7 patients and a revision in 6 patients. Anterior cruciate ligament ruptures were found in 7 patients and bicruciate ruptures in 5 patients, all of which were reconstructed. The rehabilitation protocol allowed immediate knee motion from 0° to 90° but included protection against lateral joint loads to prevent graft stretching and failure. The results were determined by a knee examination, stress radiography, KT-2000 arthrometer, the Cincinnati Knee Rating System, and the International Knee Documentation Committee Rating System.

Results: Significant improvements were found at follow-up for pain (P = .0001), swelling (P = .02), patient rating of the overall knee condition (P < .001), walking (P < .05), and stair climbing (P < .05). Thirteen of the 14 (93%) reconstructions restored normal or nearly normal lateral joint opening and external tibial rotation and 1 failed. The anterior cruciate ligament reconstructions were normal or nearly normal in 11 knees and abnormal in 1 knee.

Conclusions: The anatomical posterolateral procedure was effective in restoring normal limits to lateral joint opening and external tibial rotation, allowed immediate knee motion, and appeared to protect other soft tissue repairs.

Key Words: posterolateral • fibular collateral ligament • anatomical reconstruction

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