gms | German Medical Science

Objectives: Arthroscopic reconstruction techniques of the posterolateral corner (PLC) have been developed in recent years. Arthroscopic reconstruction techniques for higher-grade PLC injuries (Fanelli Type B) have not yet been validated in clinical studies. The procedure described by Arciero is well-established and showed good restoration of joint stability in former studies.

This study aimed to compare clinical outcomes of a newly developed arthroscopic technique vs. the established open surgery in a prospective clinical trial of patients undergoing these two different surgical procedures.

Methods: 26 Patients with a high-grade PLC injury (Fanelli Type B) were included in this study. Inclusion criteria were chronic injuries (> 3 weeks) with combined varus instability, PLRI and a ruptured PCL.

They were randomly assigned to arthroscopic (n = 14) or open reconstruction (n = 12). Surgeries were all performed according to an arthroscopic technique described by Frings et al. (Arciero’s arthroscopic technique - group A) or conventional technique described by Arciero et al. (open technique - group B) with additional PCL reconstruction.

Follow-up was conducted at 6 and 12 months. Clinical examination evaluated ROM, external rotational (ER) and varus instability and posterior drawer (PD) of both knees (side-to-side-difference- SSD). Subjective scores included the IKDC subjective score, Lysholm Score and Numeric Rating Scale for pain.

Results: All patients in both groups presented with Fanelli Type B injuries with varus instability, an increased external rotational instability in dial test and subjective instability.

No clinically relevant differences in patient-reported outcome scores differences (Lysholm Score: A 83.6 ± 7.1 vs. B 87.1 ± 14.2; IKDC subjective score: A 74.9 ± 10.7 vs. B 79.6 ±14.1) and ROM (Flexion SSD A 9.3 ± 4.5° vs. B 5.7 ± 6.1°) were shown in both groups at 6 and 12 months follow up.

Additionally no statistically significant differences were detected between groups with respect to external rotation (ER SSD: A -4.9 ± 3° vs. B -5.7 ± 7.3°) and instrumental stability testing (PD SSD: A -2.3 ± 0.9mm vs. B -2.8 ± 1.3mm). Arthroscopic reconstruction showed significant shorter operation time (A 121.9 ± 11.6min vs. B 156.6 ± 40.4 min p=0.0367).

There were no clinical failure or neurovascular complications of the surgical procedures at any follow-up examination.

Conclusion: This study indicates sufficient restoration of PLRI, varus instability and posterior drawer after arthroscopic or open PLC reconstruction without neurovascular complications or clinical failure. Both techniques were equivalent with respect to PROMS and instrumental stability testing.

A shorter and less invasive surgical procedure might favor the arthroscopic reconstruction over the open technique in future treatment considerations.

For final judgment of clinical patient outcomes, further follow-up examinations at 24 months postoperatively will have to be conducted.