Weightbearing Protocols After Posterolateral Corner Reconstruction: A Systematic Review.

BACKGROUND

Multiligamentous knee injuries with a posterolateral corner injury represent a devastating insult to the knee.

PURPOSE

To evaluate multiligamentous knee reconstruction rehabilitation programs and recommend a rehabilitation program based on a review of published outcomes studies.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

A MEDLINE (PubMed), OVID, and Embase database search was conducted using the terms "posterolateral corner" and "rehabilitation." All articles obtained were examined to confirm their rehabilitation programs for multiligamentous knee injuries. These injuries included a posterolateral corner injury plus an isolated anterior or posterior cruciate ligament injury or a combined cruciate injury.

RESULTS

Ten publications representing 245 patients with multiligamentous knee reconstruction were analyzed. Rehabilitation protocols were divided by weightbearing (WB) status: in 2 studies, patients were non-WB until postoperative 4 weeks (delayed WB; n = 61); 5 studies permitted progressive WB until postoperative 6 weeks (progressive WB; n = 123); and 3 studies allowed WB immediately after surgery (immediate WB; n = 61). No significant difference in outcome scores among the 3 WB groups was found. Arthrofibrosis requiring manipulation under anesthesia was the most common complication (11%) in the delayed WB group, followed by the immediate WB group (3%) and the progressive WB group (0%;

CONCLUSION

This review revealed no significant difference in outcome scores when comparing immediate, progressive, and delayed WB protocols. Time to permitted return to sport was not significantly different among the groups, but there existed a trend toward earlier return in the progressive WB group. Patients in the delayed and immediate WB groups experienced a higher overall complication rate. Progressive WB postoperative protocols may decrease the risk of complications without compromising outcomes; however, more research is needed to identify the optimal postoperative rehabilitation protocol, given the significant data heterogeneity currently available in the literature.

Informations de copyright

© The Author(s) 2021.

Déclaration de conflit d'intérêts

One or more of the authors has declared the following potential conflict of interest or source of funding: B.L.M. has received educational support from Zimmer Biomet. B.B. has received educational support from Titan Surgical. P.S. has received educational support from Arthrex and Titan Surgical and hospitality payments from Arthrex. S.M. has received grant support from DePuy, educational support from Arthrex, and hospitality payments from Stryker and Zimmer Biomet. B.G.V. has received grant support from DePuy and educational support from Smith & Nephew and Titan Surgical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.