Posterolateral corner of the knee ligament injuries: a systematic - - PowerPoint PPT Presentation

Posterolateral corner of the knee ligament injuries: a systematic review of functional and postoperative rehabilitation protocols

Brandon Morris, MD

Kansas University Medical Center Department of Orthopedic Surgery

December 9, 2017

Acknowledgements

• Research Team

Bryan G. Vopat, MD

• J. Paul Schroppel, MD

Scott Mullen, MD Brandon Barnds, MD Kenneth Kim, MD Armin Tarakemeh, BS

Disclosures

No conflicts of interest to disclose

• Posterolateral Corner of the Knee Injury
• Optimal function and rehabilitation protocol?
• Evidence or expert opinion based?
• Systematic literature review

Introduction

PLC Injury Epidemiology

PLC complex consists of:

• LCL(FCL) ligament
• Popliteofibular ligament
• Popliteus

PLC complex imparts dynamic and static knee stabilization Isolated PLC injury accounts for approximately 2%

• f all knee ligament injuries

Rehabilitation

• Rehabilitation Goals

– Protect ligament reconstruction – Preserve joint ROM – Promote active recovery

• Variations on Rehabilitation

– How much joint ROM to allow and when? – When to advance WB status?

Purpose

• To determine what type of rehabilitation

protocol (accelerated WB versus NWB) leads to better outcomes after isolated PLC injuries

Methods

• Systematic review of the literature

– PubMed search using terms:

• “Posterolateral corner” and “rehabilitation”
• Inclusion criteria: isolated PLC reconstruction with

description of postoperative protocol

• Exclusion criteria: isolated PLC repair, PLC

reconstruction concomitant with additional ligament reconstruction, concomitant meniscal repair, chondral repair, or osteochondral transplant

Results

Results

Description of Posteroperative Rehabilitation Protocols for Isolated PLC Reconstruction

Study ROM Weightbearing Running Sports Rehabilitation Details

Jakobsen et al 0°-90° at 1-2 wk; full ROM at ≥2 wk PWB with hinged brace at 1-2 wk; FWB with hinged brace ≥2wk; FWB at ≥6wk N/A Controlled sports ≥12 wk; contact sports at ≥24 wk 0°-90° ROM in hinged brace and partial weightbearing for 1-2 wk; unlimited degrees of range of motion and weight bearing during standing and walking starting in wk 2; unrestricted activity at 6 wk; controlled sports at 12 wk; contact sports at 24 wk Stannard et al Early motion at 1 d PWB with crutches at 1 wk; FWB at ≥1 wk if

• ther injuries permit

N/A N/A Early motion at 1 d; partial weight bearing using crutches for 1 wk with advancement to full weight bearing if patients’ other injuries permit; no aggressive motion work for 10 – 14 d Camarda et al Immobilized at 1-3 wk; passive ROM at ≥3 wk; 0°-110° at 4 wk NWB at 1-4 wk; PWB with crutches ≥4 wk; FWB ≥7 wk; At 20 wk Contact sports at 28 wk Immobilized with knee brace at 0° for 3 wk; passive ROM at at 3 wk; PWB as tolerated with crutches and 0°-110° at 4 wk; FWB at 7 wk; running at 20 wk; contact sports at 28 wk

FWB, full weightbearing; PWB, partial weightbearing; NWB, nonweightbearing; ROM, range of motion; N/A, not available

Discussion

• Isolated PLC Reconstruction
• Accelerated functional protocol may impart benefit,

however, not enough data to prove relationship

• PLC reconstruction restores rotational and varus

stability

• KOOS scores demonstrate reconstruction impacts

return to sports/activity and quality of life

• IDKC objective scores A or B in 84% of patients

Limitations

• Isolated PLC Reconstruction
• Small sample size
• Lack of control groups
• Variability of reported outcome measures

Conclusion

• Isolated PLC Reconstruction
• Accelerated functional rehab protocol with early

weightbearing – help or hindrance? We do not know yet and have concerns about long-term ligament stability

• More data needed; preferably Level I
• Difficult to study due to low injury incidence

Questions ???