Posterolateral Corner of the Knee: An Update on Current Evaluation and Management Strategies

Abstract

Historically, the posterolateral corner (PLC) of the knee has been labelled as the “dark side” of the knee. The PLC is not a single structure but a confluence of multiple structures, including the lateral collateral ligament, popliteus muscle-tendon unit, and popliteofibular ligament. Understanding the individual components and their function is important to successfully identify these injuries. PLC injuries are commonly associated with cruciate injuries, and its early recognition is important to achieve successful outcomes. Injury to the PLC should be treated on a case-by-case basis, and an appropriate algorithm is required to manage them. Multiple surgical techniques ranging from primary repair to anatomic reconstruction have been reported in managing these injuries. We present the latest literature on the anatomy, biomechanics, clinical presentation, imaging, available techniques, and current management recommendations. There is a special focus on the pathoanatomy, which will help guide the treatment of these injuries.

Higher success rate observed in reconstruction techniques of acute posterolateral corner knee injuries as compared to repair: an updated systematic review

“…Over 400 articles on the topic of PLC injuries have been published since 2012, with greater than 100 articles published since the introduction of the PLC expert consensus [6]. Due to the complex anatomy and injury patterns inherent with the PLC, there exists considerable heterogeneity in the literature regarding surgical timing, surgical technique, the incidence and relevance of concomitant ligamentous injuries, and reported treatment outcomes [36,39].…”

“…Once considered the "dark side" of the knee, understanding of the anatomy and biomechanics of the posterolateral corner (PLC) was originally limited, resulting in poor diagnostic capabilities and limited treatment options in patients sustaining PLC injuries [5,6]. However, an advanced understanding of the biomechanical role of each anatomic structure comprising the PLC, along with recent investigations correlating physical examination findings with specific anatomic deficiencies, coupled with improvements in diagnostic imaging [22,44], have resulted in increased awareness and diagnosis of PLC injuries [23,36,40,41,48]. PLC injuries are commonly associated with injuries to the anterior cruciate ligament (ACL) and/or posterior cruciate ligament (PCL), with only 28% of PLC injuries reported to occur in isolation [5,11].…”