Posterolateral corner knee injuries: a narrative review

Figueroa, Francisco; Figueroa, David; Putnis, Sven; Guiloff, Rodrigo; Caro, Patricio; Espregueira-Mendes, João

doi:10.1302/2058-5241.6.200096

Cited by 19 publications

(24 citation statements)

References 65 publications

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“…The pattern of associated pathology in varus hyperextension PLC injuries has been reported before, and our findings were similar to those of previous reports. 1,6,10,19,23 However, in the present study, we were able to identify the entire flow of the injury pattern, including FCL, biceps femoris, and popliteus tendon injuries and peroneal nerve palsy with a varus hyperextension mechanism. In the ACL-PLC and ACL-PCL-PLC tear patterns, in patients without AM bone bruises, the FCL was torn off its femoral attachment, and the biceps femoris, popliteus tendon, and peroneal nerve were not injured.…”

Section: Discussionmentioning

confidence: 68%

Injury Patterns in Posterolateral Corner Knee Injury

Toyooka,

Persson,

LaPrade

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Posterolateral corner (PLC) knee injuries associated with different injury mechanisms are not well known. Purpose/Hypothesis: This study sought to assess the patterns of associated injuries in the setting of PLC injury. The hypothesis was that there are recognizable injury patterns in PLC injuries that may correlate with injury mechanism. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients who sustained a multiligament knee injury were retrospectively reviewed. Patients who sustained an acute grade 3 PLC injury and underwent surgery were enrolled in this study. A description of the PLC injury (location of the injury of the fibular collateral ligament [FCL], popliteus tendon, and/or popliteofibular ligament) and reported concomitant injuries (biceps femoris tendon or meniscal tears, cartilage pathology and/or peroneal nerve palsy, or bone bruises) were collected and classified based on intraoperative and magnetic resonance imaging (MRI) findings. Results: Of 135 patients reviewed, 83 did not have PLC involvement and 13 were excluded due to insufficient MRI scans available. Thus, 39 patients were included in this study. For both the anterior cruciate ligament (ACL)–PLC and ACL–posterior cruciate ligament–PLC injury patterns, the most frequent injury pattern entailed a bone bruise of the anteromedial (AM) femur and tibia, an FCL tear from the fibular head, the popliteus tendon avulsed off the femur, a biceps femoris tendon torn off the fibular head, and a common peroneal nerve palsy. Conversely, when no bone bruise occurred on the AM femur and tibia, the FCL was injured on the femoral side and the popliteus tendon, biceps femoris, and peroneal nerve were not injured. Conclusion: AM bone bruise was associated with a peroneal nerve injury in almost half of the patients, and peroneal nerve injury was not seen if there was no AM bone bruise.

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Section: Discussionmentioning

confidence: 68%

Injury Patterns in Posterolateral Corner Knee Injury

Toyooka,

Persson,

LaPrade

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…The complex anatomy and biomechanics of the structures of the posterolateral corner (PLC) of the knee, coupled with anatomical variability and the use of nonuniform nomenclature in the literature, led to this region once being labeled the "dark side of the knee." [1][2][3][4] PLC structures are pivotal to providing static and dynamic stability to the knee and resisting varus angulation and external tibial rotation. 1,2,[4][5][6][7] Several structures have been described in the PLC, but key components include the lateral (fibular) collateral ligament (LCL), the popliteofibular ligament (PFL), and the popliteus tendon (PT)/ popliteus myotendinous complex (PMTC).…”

mentioning

confidence: 99%

“…[1][2][3][4] PLC structures are pivotal to providing static and dynamic stability to the knee and resisting varus angulation and external tibial rotation. 1,2,[4][5][6][7] Several structures have been described in the PLC, but key components include the lateral (fibular) collateral ligament (LCL), the popliteofibular ligament (PFL), and the popliteus tendon (PT)/ popliteus myotendinous complex (PMTC). 1,2,[4][5][6][7][8] LCL is the major stabilizer against varus stress.…”

mentioning

confidence: 99%

“…1,2,[4][5][6][7] Several structures have been described in the PLC, but key components include the lateral (fibular) collateral ligament (LCL), the popliteofibular ligament (PFL), and the popliteus tendon (PT)/ popliteus myotendinous complex (PMTC). 1,2,[4][5][6][7][8] LCL is the major stabilizer against varus stress. The PFL and the PT stabilize against external rotation; if the LCL is torn and fails, they will act as secondary stabilizers against varus stress.…”

mentioning

confidence: 99%

“…10 As detailed later, menisci, medial ligamentous structures, and adjacent bone injuries are also often associated. 1,2,[4][5][6][7][8]12 Acute PLC injuries are commonly underdiagnosed clinically. 8 Recognizing these injuries on imaging, particularly on magnetic resonance imaging (MRI), is often crucial for proper diagnosis and effective treatment to prevent long-term complications, such as chronic posterolateral instability, cruciate ligament graft failure, and, ultimately, to prevent secondary osteoarthritis.…”

mentioning

confidence: 99%

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Demystifying the “Dark Side of the Knee”: An Update on Imaging of the Posterolateral Corner

Castro,

Baptista,

Afonso

2024

Semin Musculoskelet Radiol

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The posterolateral corner (PLC) of the knee is a complex anatomical-functional unit that includes ligamentous and tendinous structures that are crucial for joint stability. This review discusses the intricate anatomy, biomechanics, and imaging modalities, as well as the current challenges in diagnosing PLC injuries, with an emphasis on magnetic resonance imaging (MRI). Recognizing the normal MRI anatomy is critical in identifying abnormalities and guiding effective treatment strategies. Identification of the smaller structures of the PLC, traditionally difficult to depict on imaging, may not be necessary to diagnose a clinically significant PLC injury. Injuries to the PLC, often associated with cruciate ligament tears, should be promptly identified because failure to recognize them may result in persistent instability, secondary osteoarthritis, and cruciate graft failure.

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Posteromedial corner injuries result in the same posterior translation as posterolateral corner injuries in PCL ruptures

Bohe,

Greve,

Höger

et al. 2024

J. exp. orthop.

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PurposeRuptures of the posterior cruciate ligament (PCL) are often accompanied by posterolateral corner (PLC) and posteromedial corner (PMC) injuries. This study investigates the incidence and impact of PMC and PLC injuries on posterior tibial translation (PTT). It was hypothesized that PMC injuries are more common and impactful than previously reported.MethodsIn this retrospective study, all patients with a PCL injury between January 2016 and December 2023 and received magnetic resonance imaging (MRI) within 30 days of trauma were included. Patients with atraumatic PCL instability, missing MRI or additional anterior cruciate ligament (ACL) rupture were excluded. Posttraumatic MRI was analyzed for peripheral injuries. Preoperative stress radiographs for PTT were measured, and the side‐to‐side difference was calculated. The statistical significance level was set at p < 0.05.ResultsNinety‐two patients were included, predominantly male (71.7%) with a mean age of 35.8 ± 15.6 years at injury. The mean time from injury to MRI was 7.3 ± 7.9 days. There were 16 patients (27.4%) with isolated PCL injuries. The prevalence of medial injuries (37.0% superficial medial collateral ligament [sMCL], 66.3% deep medial collateral ligament and 51.1% posterior oblique ligament [POL]) was comparable to lateral injuries (22.8% LCL, 55.4% PLC and 13.0% popliteus tendon). Injuries of the PMC (sMCL ± POL) occurred in 53 patients (57.6%) and of the PLC (POP ± PLC ± LCL) in 59 (64.1%) patients. PTT was significantly increased in the presence of a peripheral‐associated injury compared to isolated PCL injury (p < 0.01). With a combined injury of PMC + PLC the PTT was significantly larger than in the case of a unilateral injury (p < 0.05 compared to PLC; p < 0.05 compared to PMC).ConclusionPCL injuries are commonly associated with PMC and/or PLC injuries. A PTT of >10 mm is equally caused by PLC and PMC‐associated injuries. Knowledge about the severity and localization of peripheral‐associated injuries is therefore essential for therapeutic decision‐making.Level of EvidenceLevel III retrospective cohort study.

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Posterolateral corner knee injuries: a narrative review

Cited by 19 publications

References 65 publications

Injury Patterns in Posterolateral Corner Knee Injury

Injury Patterns in Posterolateral Corner Knee Injury

Demystifying the “Dark Side of the Knee”: An Update on Imaging of the Posterolateral Corner

Posteromedial corner injuries result in the same posterior translation as posterolateral corner injuries in PCL ruptures

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