درمان ناپايداري قدامي -خارجي خلفي -خارجي زانو بدون بازسازي كمپلكس خلفي خارج

Treatment of combined anterolateral posterolateral rotary instability without PLC reconstruction

Background and Aim: Combined anterolateral and posterolateral rotary instability are treated by correcting knee alignment, Anterior Cruciate Ligament (ACL) reconstruction and repair or reconstruction of the Posterolateral Complex (PLC). Because of technical difficulties encountered in these operations and the need for more than tow stages, and considering the controversy among the importance of Posterolateral Complex (PLC) in valgue knee, this study was performed to treat this instability by ACL reconstruction alone, after correction of varus, without reconstruction of the posterolateral complex and further extra-articular manipulation. Methods: This clinical trial was performed on 29 patients (29 knees) with combined anterolateral and posterolateral rotary instability. Subjective and objective instability signs were recorded. Arthroscopy was then performed. To correct alignment, a valgus osteotomy was done and then an ACL reconstruction carried out. Results after a mean of 23 months follow-up, were compared to the ones of before surgery. Fisher Exact test, x2 and Wilcoxon tests were used to analyze data. Results: Pain was relieved in more than half and locking disappeared in all of the patients. giving way diminished from 79.3% to 6.9%. Special instability tests showed a significant improvement after surgery (P<0.001). Most of the patients returned to the preinjury level of work or sports. Conclusion: Based on the results of this study, after correcting varus, ACL-reconstruction alone, without further invasive procedures on extra-articular structures and posterolateral complex, is sufficient to cure this instability, avoiding unneeded complications and longer rehabilitation.