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Cartilage Damage Determines Intermediate Outcome in the Late Multiple Ligament and Posterolateral Corner–Reconstructed Knee

A 5- to 10-Year Follow-up Study

From the Catholic University Hospitals, Leuven, Belgium

^* Address correspondence to Kristoff Corten, MD, Weligerveld 1, 3212 Lubbeek, Belgium (e-mail: kristoff.corten{at}uz.kuleuven.ac.be).

Background: Patients with chronic ruptures of 1 or both cruciate ligaments in combination with posterolateral rotatory instability of the knee often have some degree of cartilage damage at the time of surgery.

Hypothesis: Chondrosis at the time of reconstruction does not influence early and intermediate functional outcome of the multiple ligament reconstructed knee.

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

Methods: Twenty-one patients were available from an original 27 treated between 1995 and 2000. All patients were assessed preoperatively and postoperatively by physical examination and by applying 4 different knee rating scores. All patients were assessed at a mean follow-up of 39 months (range, 14–75 months) and 87 months (range, 62–123 months).

Results: At the first follow-up, all knee rating scores had improved significantly (P < .0003) compared with preoperatively; 84% of the reconstructed knees had normal to nearly normal laxities according to the International Knee Documentation Committee 2000 score. At the second follow-up, the functional scores remained significantly (P < .0089) better than preoperatively. Patients with chondrosis at the time of surgery did not have significantly different knee rating scores at the first follow-up compared with patients without cartilage damage. Four years later, the results in the chondrosis group were significantly worse (P < .05) for all knee rating scores compared with the patients without chondrosis. The results in 3 of 4 knee rating scores declined significantly in the chondrosis group over the 48-month interval between follow-up sessions. In the Tegner and Lysholm score, the results deteriorated to the preoperative level. Patients with different cruciate ligament reconstructions did not have significantly different knee rating scores.

Conclusion: The posterolateral sling procedure is a stable and reliable technique for posterolateral corner reconstruction. The presence of chondrosis at the time of surgery is an important prognosticator of functional outcome at intermediate follow-up.

Key Words: posterolateral corner injury • posterolateral sling procedure • chondrosis • multiple ligament reconstructed knee