Posterolateral Corner Reconstruction: A Systematic Review and Meta-analysis of Biomechanical Studies

Abstract

Background:Surgical reconstruction is the standard treatment for injuries to the posterolateral corner (PLC) of the knee and can be performed using either a fibular-based or combined tibiofibular-based technique. Although some comparative studies have been performed, there is no consensus regarding the reconstructive approach that confers optimal biomechanical properties of the PLC.Purpose:To perform a systematic review and meta-analysis to evaluate the biomechanical properties of the knee after PLC reconstruction with fibular-based and tibiofibular-based techniques.Study Design:Meta-analysis; Level of evidence, 4.Methods:A systematic review was performed by searching the PubMed, Cochrane Library, and Embase databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify studies that analyzed the biomechanical properties of PLC reconstruction techniques. Evaluated outcomes included varus laxity and external rotation laxity. The pooled biomechanical data were analyzed by random-effects models and heterogeneity was assessed using the I2 statistic.Results:Eleven studies met the inclusion criteria; 74 cadaveric specimens were included. Seven studies (54 specimens) evaluated the fibular-based Larson reconstruction technique, 3 studies (22 specimens) evaluated a modified fibular-based Larson reconstruction, and 1 study (7 specimens) evaluated the fibular-based Arciero reconstruction. Five studies (45 specimens) evaluated the tibiofibular-based LaPrade reconstruction technique and 2 studies (20 specimens) evaluated a modified LaPrade reconstruction. Data were pooled for fibular-based reconstructions (Larson, modified Larson, and Arciero) and tibiofibular-based reconstructions (LaPrade, modified LaPrade). Pooled analysis revealed no significant difference in varus laxity and external rotation laxity between fibular and tibiofibular reconstructions at 0°, 30°, 60°, and 90° of flexion (all P > .05).Conclusion:No difference in varus laxity and external rotation laxity was observed between fibular-based and tibiofibular-based techniques for PLC reconstruction. Moreover, there was no difference in varus laxity and external rotation laxity observed between the Larson, modified Larson, and LaPrade reconstructions. These results suggest that biomechanical stability after fibular- and tibiofibular-based PLC reconstructions is similar. Further clinical investigation is warranted to validate these cadaveric findings.