Surgical restoration to treat chronic deficiency of the posterolateral complex and cruciate ligaments of the knee joint

We report the results of treatment of combined deficiency of the posterolateral complex and one or both cruciate ligaments. The posterolateral complex deficiencies were corrected by a proximal advancement procedure of the lateral collateral ligament and posterolateral complex tissues. The cruciate ligaments were reconstructed with either autogenous or allogenic tissue. Twenty-three consecutive patients were included in the study, 21 returned for followup at a mean of 42 months (range, 23 to 94) postoperatively, and one reconstruction failed before the 2-year evaluation. The results were evaluated using the Cincinnati Knee Rating System. Using another classification system that assesses lateral joint opening, external tibial rotation, and varus recurvatum tests, we found the posterolateral advancement was fully functional in 14 knees (64%) at followup; in 6 knees (27%) there was partial function; and in 2 knees (9%) the advancement had failed. The proximal advancement represents a simplified method to restore tension in the posterolateral complex. It allows early knee motion and is warranted in knees in which structurally intact but lax ligamentous structures are present. The procedure is not performed when inadequate, thinned, or scarred posterolateral structures exist (these require graft reconstruction) or in varus-aligned knees, Associated cruciate ligament deficiencies should be surgically corrected at the time of the posterolateral advancement procedure.