Clinical and radiological long-term outcome after posterior cruciate ligament reconstruction and nonanatomical popliteus bypass

Purpose: The purpose of this study was to analyse the long-term outcome of patients treated for combined posterior cruciate ligament (PCL) and posterolateral corner injuries by combined PCL reconstruction and popliteus bypass according to Mueller or refixation of the popliteus tendon. Methods: Sixteen patients treated by combined PCL reconstruction and popliteus bypass according to Mueller (n = 7) or refixation of the popliteus tendon (n = 9) were included. A mean follow-up of 24 ± three years was performed using the International Knee Documentation Committee (IKDC) 2000, Lysholm, Tegner and the Knee Injury and Osteoarthritis Outcome (KOOS) scores. Bilateral stress radiographs were performed. The degree of osteoarthritis was assessed using Kellgren Lawrence score. Pearson correlations of predictive factors for worse outcome were performed (p < 0.05). Results: Categorically, total IKDC 2000 was B (nearly normal) in five (31%), C (abnormal) in seven (44%) and D (severely abnormal) in four (25%) patients. Lysholm score was 68 ± 22; KOOS symptom score was 40 ± 13, KOOS pain 26 ± 24, KOOS activity 18 ± 18, KOOS sport 51 ± 32 and KOOS LQ 44 ± 26. Median Tegner score decreased from pre-injury 7 (range 4-10) to 4 (range 2-10) at follow-up. Kellgren Lawrence score showed minimal osteoarthritis in seven (44%), moderate osteoarthritis in seven (44%) and severe osteoarthritis in one (12%) patient. Conclusions: The challenging group of patients treated by PCL reconstruction and popliteus bypass according to Mueller et al. or popliteus refixation showed only moderate clinical and radiological long-term outcome without statistical difference, even if patient age at surgery and the long-term follow-up is acknowledged. Anatomical posterolateral corner reconstruction techniques should be preferred