The comparison of clinical outcomes of popliteal tendon recess and reconstruction technique

Objective To compare the objective and subjective clinical outcomes of recess procedure versus popliteal tendon reconstruction in patients with posterolateral corner injury. Methods From January 2012 to January 2017, patients who were eligible for inclusion in this study if they 1) had acute posterolateral rotational instability (PLRI) and were treated surgically in our institution, 2) were followed for a minimum of 2 years with examination under anesthesia results. The mean age was 34.5±7.4 years (range 20-45 years). According to Fanelli's classification, there were 31 type A, 17 type B and 6 type C cases. There were 26 patients in reconstruction group and 28 patients in recess group. Outcomes included subjective scoring systems (Lysholm score, Tegner score and International Knee Documentation Committee (IKDC) subjective score), knee stability examinations (the side-to-side difference (SSD) of tibial external rotation angle by dial test, posterior and varus stress radiograph) and second-look arthroscopic lateral gutter drive-through test during hardware removal operation. Results The mean follow-up duration was 30.2±4.9 months in reconstruction group and 32.2±9.9 months in recess group. At the final follow-up, there were no significant differences in Lysholm scores (reconstruction group: 70.1±15.5, recess group: 70.0±10.2; t=0.089, P=0.926), Tegner scores (reconstruction group: 3(2, 5), recess group: 2(1, 4); U=395.522, P=0.156), or IKDC subjective scores (reconstruction group: 74.8±19.3, recess group: 71.2±17.6; t=0.381, P=0.722) between the groups. No significant difference in SSD on posterior stress radiography (reconstruction group: 4.1±3.4 mm, recess group: 4.7±2.6 mm; t=0.918, P=0.345) or medial stress radiography (reconstruction group: 4.0±1.7 mm, recess group: 3.8±1.9 mm; t=0.208, P=0.820) was observed. There was no significant difference on SSD of dial test (reconstruction group: 1.5°±4.2°, recess group: 1.1°±4.0°, t=0.586, P=0.565). No positive lateral gutter drive-through test was observed in all groups. Conclusion Both recess procedure and popliteal tendon reconstructions significantly improve the knee stability and subjective outcomes of patients with PLRI. In a comparison with popliteal tendon reconstruction, the recess procedure has similar subjective and objective clinical outcomes. Key words: Collateral ligaments; Tendon injuries; Arthroscopy; Reconstructive surgical procedures