Improving outcomes for posterolateral knee injuries

Abstract

Until recently, the posterolateral corner of the knee was noted both for its complex anatomy and diagnostic challenges. To improve the understanding of the posterolateral knee, we completed a comprehensive and stepwise research program with a focus on five primary areas: (1) surgical approach and relevant anatomy; (2) diagnosis; (3) clinically relevant biomechanics; (4) natural history; and (5) surgical treatment. Based on this comprehensive research program, the diagnosis and outcomes following treatment of posterolateral knee injuries have been significantly improved comparing the preoperative state to the state of the knee at a minimum 2 year follow-up in the cases series presented here. ß

Anatomic Posterolateral Corner Reconstruction

“…21,22 Grade III injuries to the PLC are best treated with surgical intervention, as symptomatic instability of the knee remains a significant risk when treated nonoperatively. 5,23 In 2004, LaPrade et al 21 described an anatomic reconstruction of the PLC using the native attachments of the FCL, PLT, and PFL. This was one of the earliest descriptions of a surgical option to recreate the anatomy of the 3 main static stabilizers of the PLC and is the basis for our current approach.…”

Surgical management of combined anterior or posterior cruciate ligament and posterolateral corner tears: For what functional results?

“…All patients operated on between 2001 and 2012 for PLC instability with associated ACL or PCL reconstruction were recruited. Inclusion criteria comprised: lesion of at least one PLC structure (lateral collateral ligament (LCL), popliteal tendon (PT), popliteal-fibular ligament (PFL), lateral posterior capsule (LPC)) associated with isolated lesion of one element of the central pivot (ACL or PCL) [14]; PLC lesion or lesions treated surgically (ligamentoplasty and/or suture and/or tibial valgization osteotomy); and minimum 12 months' follow-up. Surgery might be indicated in the acute-phase (< 21 days), or later in case of complaint of instability.…”

“…Clinical diagnosis of PLC lesion was founded on differential lateral laxity exceeding 10 • in forced varus in extension and 20 • in flexion and/or > 15 • differential external hyper-rotation on dialtest at 30 • and 90 • flexion in prone position [14]. ACL assessment comprised Lachman test at 20 • , and jerk test.…”

Clinically relevant biomechanics of the knee capsule and ligaments

“…Posterolateral knee injuries should not be ignored; chronic cases might even lead to reconstructions of the cruciate ligaments becoming overloaded and failing [37,25].…”