Cutting edge Orthopedics

Knee Dislocations • 45  Repair Versus Reconstruction Reconstruction of the ACL and PCL using allograft is a proven method of treating mid-sub- stance cruciate ligament injuries and may also be used when the ligaments are avulsed off of bone. Wascher and associates published a series of 13 patients who underwent reconstruction of both the ACL and PCL after sustaining a knee dislocation [29]. The mean Lysholm score in these patients treated with reconstruction of both ACL and PCL was 88, demonstrating acceptable outcomes utilizing reconstruction. Mariani and associates retrospectively compared techniques using reconstruction and repair for ACL and PCL injuries in knee dislocations [18]. They report- ed 23 patients with knee dislocations, divided into three groups: one group undergoing primary repair of both ACL and PCL, another group undergoing ACL reconstruction with PCL repair, and a third group undergoing reconstruction of both ACL and PCL. They found similar outcomes in Lysholm knee scores in all three groups (84 in repair group, 86 in ACL reconstruction/PCL repair, and 85 in the reconstruction group). However, they did find a higher rate of flexion loss greater than 6° in groups undergoing primary repair (82% in repair group, 67% in ACL reconstruction/ PCL repair group, and 33% in reconstruction group). Arthroscopic repair of PCL “sleeve avul- sions” has also been recently reported [30]. Early repair of the posterolateral corner (PLC) historically has been recommended by Shelbourne and Klootwyk [31]. Due to risk of late loosening, reconstruction has been recom- mended in two studies and in a JAAOS review article [19, 32, 33]. One study showing higher failure rates in primary repair of the PLC was published by Stannard and associates in 2005 [19]. This study was a prospective cohort study that included 57 PLC injuries in 56 patients. Forty-four (77%) of these injuries were multiligamentous knee injuries. Patients were not randomized but were treated with either primary repair of the PLC ( n = 35) or reconstruction using allograft ( n = 22). This study found higher failure rates in primary repair than reconstruction (37% versus 9%). Lysholm scores were similar in the repair and reconstruction cohorts of the patients who did not fail (88.2 versus 89.6). Levy and associates have also reported similar results in a study [32] comparing primary repair versus reconstruction of the posterolateral corner. Reconstruction was found to have a significantly lower failure rate than primary repair. This retrospective review involved 28 knees treated in a single-stage procedure. Failure rate of primary repair was found to be approximately 40%, and failure rate of reconstruction was found to be approximately 6%. Both IKDC scores and Lysholm scores were found to be equivocal: 79 and 85 in the repair group versus 77 and 88 in the reconstruction group, respectively. Both of these studies staged the repair of the collateral repair and the arthroscopic cruciate reconstruction. In the Levy study the procedures were staged an average of greater than 4 months. The results of early repair of collaterals combined with acute repair or reconstruction of cruciates are not known. On the other hand, a retrospective study conducted by McCarthy and associates comparing repair versus reconstruction following posterolateral knee injuries suggests an alternative recom- mendation. The study evaluated a total of 26 knees, 17 reconstructions, and 9 repairs, to deter- mine if a significant difference existed between those knees reconstructed versus those repaired. Reconstructions were evaluated at a mean postoperative time of 38 months and repairs at a mean