Research Article| Volume 33, ISSUE 9, P815-821, November 2002

Download started.


Outcome of surgical reconstruction for posterior cruciate and posterolateral instabilities of the knee


      Purpose: To evaluate the clinical outcome and the incidence of degenerative changes in 25 patients with 25 knees undergoing surgical reconstruction for combined posterior cruciate ligament (PCL) and posterolateral instabilities of the knee with 2–5-year follow-up.
      Materials and methods: This series included 16 men and 9 women with an average age of 28 years. The average time from injury to surgery was 10 (range 2–24) months, and the average follow-up time was 40 (range 32–60) months. The mechanisms of injury were 88% due to trauma, and 12% sports related. Arthroscopic single bundle posterior cruciate reconstruction and reconstruction of the posterolateral structures were performed in all cases. Clinical evaluations included functional assessment, ligament laxity and radiograph of the knee. The results were correlated with the duration of injury, the severity of ligament laxity and the follow-up time.
      Results: The overall results were 68% satisfactory (28% excellent and 40% good) and 32% unsatisfactory (20% fair and 12% poor). Despite functional improvement, complete restoration of ligament stability was observed in only 44% of the knees, while 36% of the knees showed mild (<5 mm), and 20% moderate (5–10 mm) ligament laxity. There was no correlation of the clinical outcome with the duration from injury to surgery. The incidence of degenerative changes of the affected knee was 44%, and the rate correlated with the severity of ligament laxity, the duration from injury to surgery and the length of follow-up time.
      Conclusion: Despite the functional improvement, the currently devised surgical techniques only have modest success in restoration of ligament stability in knees with combined PCL and posterolateral instabilities. Further improvement in surgical technique including a dynamic reconstruction of the popliteus tendon complex seems necessary. The rate of degenerative changes of the affected knee appeared proportional to the duration of injury, the severity of ligament laxity and the length of follow-up time. The results of this study led us to recommend early surgical reconstruction for knees with combined posterior cruciate and posterolateral instabilities.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Ahlbäck S. Osteoarthritis of the knee. A radiographic investigation. Acta Radiol 1968;(Suppl 277):7–72.

        • Baker Jr., C.L
        • Norwood L.A
        • Hughston J.C
        Acute combined posterior cruciate and posterolateral instabilities of the knee.
        Am. J. Sports Med. 1984; 12: 204-208
        • Becker R
        • Ropke M
        • Nebelung W
        Clinical outcome of arthroscopic posterior cruciate ligament-plasty.
        Unfallchirurg. 1999; 102: 54-358
        • DeCampos J
        • Vangsness Jr., C.T
        • Merritt P.O
        • Sher J
        Ipsilateral knee injury with femoral fracture. Examination under anesthesia and arthroscopic evaluation.
        Clin. Orthop. 1994; 300: 178-182
        • Dejoura H
        • Walch G
        • Peyrot J
        • Eberhard P
        The natural history of rupture of the posterior cruciate ligament.
        Rev. Chir. Orthop. Reparatrice. Appar. Mot. 1988; 74: 35-43
        • Finely G.C
        • Giannotti B.F
        • Edson C.J
        Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction.
        Arthroscopy. 1996; 12: 521-530
      2. Fleming Jr RE, Blatz DJ, McCarroll JR. Posterior problems in the knee; posterior cruciate insufficiency and posterolateral rotatory insufficiency. Am J Sports Med 1981;9(2):107–13.

        • Gollehon D.L
        • Torzilli P.A
        • Warren R.F
        The role of the posterolateral and cruciate ligament in the stability of the knee.
        J. Bone Joint Surg. 1987; 69: 233-242
        • Grood E.S
        • Stowers S.F
        • Noyes F.R
        Limits of movement in the human knee.
        J. Bone Joint Surg. 1988; 70: 88-97
        • Hughston J.C
        • Jacobson K.E
        Chronic posterolateral rotatory instability of the knee.
        J. Bone Joint Surg. 1985; 67: 351-359
        • Hughston J.C
        • Norwood Jr., L.A
        The posterolateral drawer test and external rotational recurvatum test for posterolateral rotatory instability of the knee.
        Clin. Orthop. 1980; 147: 82-87
        • Kim S.J
        • Kim H.K
        • Kim H.J
        Arthroscopic posterior cruciate ligament reconstruction using a one-incision technique.
        Clin. Orthop. 1999; 359: 156-166
        • Lobenhoffer P
        Chronic instability after posterior cruciate ligament injury. Tactics, techniques, and results.
        Unfallchirurg. 1999; 102: 824-838
        • Nielsen S
        • Ovesen J
        • Rasmussen O
        The posterior cruciate ligament.
        Arch. Orthop. Trauma Surg. 1985; 104: 53-56
        • Noyes F.R
        • Barber-Westin S.D
        Surgical reconstruction of severe chronic posterolateral complex injuries of the knee using allograft tissues.
        Am. J. Sports Med. 1995; 23: 2-12
        • Noyes F.R
        • Barber-Westin S.D
        Surgical restoration to treat chronic deficiency of the posterolateral complex and cruciate ligament of the knee joint.
        Am. J. Sports Med. 1996; 24: 415-426
        • Ogata K
        • McCarthy J.A
        • Dunlap J
        • Manske O.R
        Pathomechanics of posterior sag of the tibia in posterior cruciate ligament deficient knees. An experimental study.
        Am. J. Sports Med. 1988; 16: 630-636
        • Pap G
        • Machner A
        • Nebulung W
        • Awiszus F
        Detailed analysis of proprioception in normal and ACL-deficient knees.
        J. Bone Joint. Surg. (Br). 1999; 81-B: 764-768
        • Rong G.W
        • Wang Y.C
        The role of cruciate ligaments in maintaining knee joint stability.
        Clin. Orthop. 1987; 215: 65-71
        • Trickey E.L
        Injuries to the posterior cruciate ligament: diagnosis and treatment of early injuries and reconstruction of late instability.
        Clin. Orthop. 1980; 147: 76-81
        • Veltri D.M
        • Warren R.F
        Anatomy, biomechanics and physical findings in posterolateral knee instability.
        Clin. Sports Med. 1994; 13: 599-614
        • Veltri D.M
        • Warren R.F
        Operative treatment of posterolateral instability of the knee.
        Clin. Sports Med. 1994; 13: 615-627
        • Veltri D.M
        • Deng X.H
        • Torzilli P.A
        The role of the cruciate and posterolateral ligaments in stability of the knee.
        Am. J. Sports Med. 1995; 23: 436-441
        • Wang C.J
        • Chen C.Y.C
        • Chen L.M
        • Yeh W.L
        Posterior cruciate ligament.
        Arch. Orthop. Trauma. Surg. 2000; 120: 525-528
        • Wang C.J
        • Chen H.H
        • Chen C.Y
        • Huang T.W
        Effects of knee position, graft tension and mode of fixation in posterior cruciate ligament reconstruction.
        Arthroscopy. 2002; 18: 496-500