Is PLC repair of a peel-off femoral lesion an effective option in a multiligament setting?

Purpose: Treatment of posterolateral corner (PLC) injury in the multiligament-injured knee is still controversial. The aim of this study was to investigate the clinical outcome of acute or sub-acute surgical repair of Type 1 and 2 PLC peel-off lesions in a multiligament setting.
Methods: Mini-open direct repair of the PLC was performed in 13 patients. Combined PCL, ACL and MCL injuries were simultaneously managed. Telos valgus and varus stress radiographs at 30° of flexion with 150 N load were used to investigate medial and lateral joint opening. Posterior stress radiograph with 150 N load was used to investigate the function of the PCL. External rotational laxity was assessed with a dial test at 30° of knee flexion, and photographs were taken to measure angles. Anterior displacement was examined using the manual maximum test performed with a KT-1000 arthrometer.
Results: A statistically significant reduction between pre- and postoperative laxity values was achieved for every test. Particularly, lateral joint opening side-to-side difference reduced from 10.3 ± 4.0 to 1.0 ± 3.2 mm and external rotation reduced from 15 ± 8° to 0° ± 6° more than that of the contralateral uninjured knee. The medial joint opening side-to-side difference reduced from 11.5 ± 5.6 to 2.6 ± 2.7 mm in the 7 patients surgically managed for MCL lesion. The anterior tibial displacement side-to-side difference reduced from 14.0 ± 5.0 to 3.0 ± 5.0 mm in the 9 patients surgically managed for ACL lesion. The posterior tibial translation side-to-side difference reduced from 11.1 ± 5.1 to 4.4 ± 3.9 mm in the 11 patients treated for PCL lesion.
Conclusion: The main finding of the current study is that acute repair of Type 1 and 2 PLC peel-off injury proved to be an effective procedure to restore PLC function in a multiligament-injured knee. These data enabled the current literature with an effective treatment option to face such a complex and various scenarios such as multiligament-injured knee.
Level of Evidence: IV.