gms | German Medical Science

Objectives: Purpose: The failure rate following posterolateral corner reconstruction (PLC) remains high. Previous research indicates that in posterior cruciate ligament (PCL) reconstruction the laxity is affected by the tibial slope (TS). This study aimed to determine how the TS influences the surgical outcome after Fanelli B injuries in combination with PCL injuries.

Hypothesis: We hypothesized that flattening of the tibial slope (TS) is associated with increased posterior laxity and poorer clinical outcomes after anatomic PLC reconstruction.

Methods: This study analyzed 47 patients who underwent anatomical PLC and PCL reconstruction according to techniques described by Arciero or LaPrade. TS and side-to-side difference (SSD) of posterior tibial translation (PTT) were measured before and after PCL reconstruction using instrumented stability testing performed by Rolimeter. After a minimum 12-month follow-up various patient-reported outcome measures (IKDC, Lysholm, VAS) were measured and compared.

Results: At a mean follow-up of 20.0 ± 8.9 months, a negative correlation between SSD of PTT and TS in the overall cohort (p=0.0037; r=-0.43; R2=0.18) was shown. Subgroup analysis (Group A: TS < 8°, n=16; Group B: TS > 8°, n=31) revealed Group A had higher PTT (3.9 mm ± 2.1 vs. Group B: 2.8 mm ± 1.5; p=0.0457) and increased PCL graft failure rates (p=0.0127). A negative association was found between SSD of PTT and Lysholm Score (r=-0.41; R2=0.17; p=0.0048). Subgroup analyses based on surgical technique (Arciero vs. LaPrade and open vs. arthroscopic), gender, or BMI did not reveal statistically significant distinctions in TS or SSD of PTT.

Conclusion: In combined PCL and anatomic PLC reconstruction, a flattened tibial slope is linked to higher remaining SSD of PTT, while lower SSD of PTT is associated with improved clinical outcomes. A TS < 8° correlates with elevated SSD of PTT and increased PCL graft failure rates.