The Posterolateral Corner: Surgical Approach and Technique Overview

ABSTRACT

Injuries to the posterolateral corner (PLC) of the knee can lead to profound knee instability, especially when combined with anterior cruciate or posterior cruciate ligament injury. With increased recognition of this injury, as well as improved understanding of the pathoanatomy, surgical treatment of these injuries has evolved in favor of acute treatment including reconstructive techniques to minimize recurrent laxity and allow for early rehabilitation. This article describes the approach to the PLC and the technique for figure of 8 reconstruction.

KEYWORDS

Posterolateral corner instability - posterolateral corner reconstruction

REFERENCES

• 1 O'Brien S J, Warren R F, Pavlov H, Panariello R, Wickiewicz T L. Reconstruction of the chronically insufficient anterior cruciate ligament with the central third of the patellar ligament.  J Bone Joint Surg Am. 1991;  73 (2) 278-286
• 2 Lunden J B, Bzdusek P J, Monson J K, Malcomson K W, Laprade R F. Current concepts in the recognition and treatment of posterolateral corner injuries of the knee.  J Orthop Sports Phys Ther. 2010;  40 (8) 502-516
• 3 Pacheco R J, Ayre C A, Bollen S R. Posterolateral corner injuries of the knee: a serious injury commonly missed.  J Bone Joint Surg Br. 2011;  93 (2) 194-197
• 4 Covey D C. Injuries of the posterolateral corner of the knee.  J Bone Joint Surg Am. 2001;  83-A (1) 106-118
• 5 DeLee J C, Riley M B, Rockwood Jr C A. Acute posterolateral rotatory instability of the knee.  Am J Sports Med. 1983;  11 (4) 199-207
• 6 Baker Jr C L, Norwood L A, Hughston J C. Acute posterolateral rotatory instability of the knee.  J Bone Joint Surg Am. 1983;  65 (5) 614-618
• 7 Hughston J C, Jacobson K E. Chronic posterolateral rotatory instability of the knee.  J Bone Joint Surg Am. 1985;  67 (3) 351-359
• 8 LaPrade R F, Wentorf F A, Fritts H, Gundry C, Hightower C D. A prospective magnetic resonance imaging study of the incidence of posterolateral and multiple ligament injuries in acute knee injuries presenting with a hemarthrosis.  Arthroscopy. 2007;  23 (12) 1341-1347
• 9 Kannus P. Nonoperative treatment of grade II and III sprains of the lateral ligament compartment of the knee.  Am J Sports Med. 1989;  17 (1) 83-88
• 10 Krukhaug Y, Mølster A, Rodt A, Strand T. Lateral ligament injuries of the knee.  Knee Surg Sports Traumatol Arthrosc. 1998;  6 (1) 21-25
• 11 Dedmond B T, Almekinders L C. Operative versus nonoperative treatment of knee dislocations: a meta-analysis.  Am J Knee Surg. 2001;  14 (1) 33-38
• 12 Richter M, Bosch U, Wippermann B, Hofmann A, Krettek C. Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations.  Am J Sports Med. 2002;  30 (5) 718-727
• 13 Ríos A, Villa A, Fahandezh H, de José C, Vaquero J. Results after treatment of traumatic knee dislocations: a report of 26 cases.  J Trauma. 2003;  55 (3) 489-494
• 14 Wong C H, Tan J L, Chang H C, Khin L W, Low C O. Knee dislocations-a retrospective study comparing operative versus closed immobilization treatment outcomes.  Knee Surg Sports Traumatol Arthrosc. 2004;  12 (6) 540-544
• 15 Camarda L, Condello V, Madonna V, Cortese F, D'Arienzo M, Zorzi C. Results of isolated posterolateral corner reconstruction.  J Orthop Traumatol. 2010;  11 (2) 73-79
• 16 Rios C G, Leger R R, Cote M P, Yang C, Arciero R A. Posterolateral corner reconstruction of the knee: evaluation of a technique with clinical outcomes and stress radiography.  Am J Sports Med. 2010;  38 (8) 1564-1574
• 17 Jakobsen B W, Lund B, Christiansen S E, Lind M C. Anatomic reconstruction of the posterolateral corner of the knee: a case series with isolated reconstructions in 27 patients.  Arthroscopy. 2010;  26 (7) 918-925
• 18 Veltri D M, Warren R F. Operative treatment of posterolateral instability of the knee.  Clin Sports Med. 1994;  13 (3) 615-627
• 19 Levy B A, Dajani K A, Whelan D B et al.. Decision making in the multiligament-injured knee: an evidence-based systematic review.  Arthroscopy. 2009;  25 (4) 430-438
• 20 Stannard J P, Brown S L, Farris R C, McGwin Jr G, Volgas D A. The posterolateral corner of the knee: repair versus reconstruction.  Am J Sports Med. 2005;  33 (6) 881-888
• 21 LaPrade R F, Johansen S, Agel J, Risberg M A, Moksnes H, Engebretsen L. Outcomes of an anatomic posterolateral knee reconstruction.  J Bone Joint Surg Am. 2010;  92 (1) 16-22
• 22 LaPrade R F, Kimber K A, Wentorf F A, Olson E J. Anatomy of the posterolateral aspect of the goat knee.  J Orthop Res. 2006;  24 (2) 141-148
• 23 LaPrade R F. Anatomic reconstruction of the posterolateral aspect of the knee.  J Knee Surg. 2005;  18 (2) 167-171
• 24 Markolf K L, Graves B R, Sigward S M, Jackson S R, McAllister D R. How well do anatomical reconstructions of the posterolateral corner restore varus stability to the posterior cruciate ligament-reconstructed knee?.  Am J Sports Med. 2007;  35 (7) 1117-1122
• 25 Arciero R A. Anatomic posterolateral corner knee reconstruction.  Arthroscopy. 2005;  21 (9) 1147
• 26 Feeley B T, Muller M S, Sherman S, Allen A A, Pearle A D. Comparison of posterolateral corner reconstructions using computer-assisted navigation.  Arthroscopy. 2010;  26 (8) 1088-1095
• 27 Terry G C, LaPrade R F. The posterolateral aspect of the knee. Anatomy and surgical approach.  Am J Sports Med. 1996;  24 (6) 732-739
• 28 LaPrade R F, Ly T V, Wentorf F A, Engebretsen L. The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon.  Am J Sports Med. 2003;  31 (6) 854-860
• 29 Levy B A, Dajani K A, Morgan J A, Shah J P, Dahm D L, Stuart M J. Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee.  Am J Sports Med. 2010;  38 (4) 804-809
• 30 LaPrade R F. Posterolateral Knee Injuries: Anatomy, Evaluation, and Treatment. New York: Thieme; 2006
• 31 LaPrade R F, Johansen S, Wentorf F A, Engebretsen L, Esterberg J L, Tso A. An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique.  Am J Sports Med. 2004;  32 (6) 1405-1414
• 32 Fanelli G C, Larson R V. Practical management of posterolateral instability of the knee.  Arthroscopy. 2002;  18 (2, Suppl 1) 1-8