Injuries and Treatment Strategies of Posterolateral Instability of the Knee

T. Nau; Y. Chevalier; V. Vécsei

doi:10.1055/s-2005-836331

Osteosynthesis and Trauma Care, Table of Contents

Osteosynthesis and Trauma Care 2005; 13(2): 98-104
DOI: 10.1055/s-2005-836331

Original Article

Injuries and Treatment Strategies of Posterolateral Instability of the Knee

T. Nau¹ , Y. Chevalier¹ , V. Vécsei¹

¹University of Vienna Medical School, Trauma Center, Vienna, Austria

Abstract

Posterolateral instability of the knee may result in significant functional disability. Isolated injury is rare; rather, this condition more often occurs in combination with associated ligament ruptures. During the last few years, numerous anatomical and biomechanical studies have contributed to a better understanding of this anatomical region. A number of therapeutic procedures, for acute as well as for chronic injuries have been reported; however, long-term functional results indicate that they have been only moderately successful. This article reviews current knowledge of the anatomy, biomechanics, injuries, and therapeutic strategies of this challenging region of the knee.

Key words

Posterolateral corner - knee ligament reconstruction

Full Text

References

1 Albert J P, Brown A W. Management of chronic posterolateral rotatory instability of the knee: Surgical technique for the posterolateral corner sling procedure. Instr Course Lect. 1998; 47 369-378
2 Baker C L, Norwood L A, Hughston J C. Acute posterolateral instability of the knee. J Bone Joint Surg [Am]. 1988; 65 614-618
3 Chen F S, Rokito A S, Pitman M I. Acute and chronic posterolateral rotatory instability of the knee. J Am Acad Orthop Surg. 2000; 8 97-110
4 Ching-Jen W, Han-Shiang C, Ting-Wen H, Li-Jen Y uan. Outcome of surgical reconstruction for posterior cruciate and posterolateral instabilities of the knee. Injury. 2002; 33 815-822
5 Clancy W G, Sutherland T B. Combined posterior cruciate ligament injuries. Clin Sports Med. 1994; 13 629-647
6 Clancy W G, Meister K, Craythorne C B. Posterolateral corner collateral ligament reconstruction. In: Jackson DW (ed). Reconstructive Knee Surgery. Raven Press, New York 1995; 143-159
7 Cooper D E. Tests for posterolateral instability of the knee in normal subjects: Results of examination under anesthesia. J Bone Joint Surg [Am]. 1991; 73 30-36
8 DeLee J C, Riley M B, Rockwood C A. Acute posterolateral rotatory instability of the knee. Am J Sports Med. 1983; 11 199-207
9 Fanelli G C, Edson C J. Posterior cruciate ligament injuries in trauma patients. Part II. Arthroscopy. 1995; 11 526-529
10 Fanelli G C, Roger V L. Practical management of posterolateral instability of the knee. Arthroscopy. 2002; 18 1-8
11 Gollehon D L, Torzilli P A, Warren R F. The role of the posterolateral and cruciate ligaments in the stability of the human knee: a biomechanical study. J Bone Joint Surg [Am]. 1987; 69 233-242
12 Grood E S, Stowers S F, Noyes F R. Limits of movement in the human knee: Effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg [Am]. 1988; 70 88-97
13 Hughston J C, Andrews J R, Cross M J, Moschi A. Classification of knee ligament instabilities: Part II. The lateral compartment. J Bone Joint Surg [Am]. 1976; 58 173-179
14 Hughston J C, Norwood L A. The posterolateral drawer test and external rotational recurvatum test for posterolateral rotatory instability of the knee. Clin Orthop. 1980; 147 82-87
15 Hughston J C, Jacobsen K E. Chronic posterolateral rotatory instability of the knee. J Bone Joint Surg [Am]. 1985; 67 351-359
16 Jakob R P, Warner J P. Lateral and posterolateral rotatory instability of the knee. In: DeLee JC, Drez D (eds). Orthopaedic sports medicine principles and practice. WB Saunders, Philadelphia 1974; 1275-1312
17 LaPrade R F, Terry G C. Injuries to the posterolateral aspect of the knee: association of anatomic injury patterns with clinical instability. Am J Sports Med. 1997; 25 433-438
18 Latimer H A, Tibone J E, AlAttrache N S, McMahon P J. Reconstruction of the collateral ligament of the knee with patellar tendon allograft: report of a new technique in combined ligament injuries. Am J Sports Med. 1998; 26 656-662
19 Maynard M J, Deng X, Wickiewicz T L, Warren R F. The popliteofibular ligament: Rediscovery of a key element in posterolateral stability. Am J Sports Med. 1996; 24 311-316
20 Nau T, Chevalier Y, Duval N, Vécsei V, DeGuise J A. Biomechanical analysis of different reconstruction techniques of posterolateral knee instability. European Surg (Proceedings). 2002; 34 (Suppl) 189
21 Noyes F R, Stowers S F, Grood E S, Cummings J, VanGinkel L A. Posterior subluxation of the medial and lateral tibiofemoral compartments: an in vitro ligament sectioning study in cadaveric knees. Am J Sports Med. 1993; 21 407-414
22 Noyes F R, Barber-Westin S D. Surgical reconstruction of severe chronic posterolateral complex injuries of the knee using allograft tissues. Am J Sports Med. 1995; 23 2-12
23 Noyes F R, Barber-Westin S D. Treatment of complex injuries involving the posterior cruciate and posterolateral ligaments of the knee. Am J Knee Surg. 1996; 9 200-214
24 Noyes F R, Barber-Westin S D. Surgical restoration to treat chronic deficiency of the posterolateral complex and cruciate ligaments of the knee joint. Am J Sports Med. 1996; 24 415-426
25 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; 73 278-286
26 Seebacher J R, Inglis A E, Marshall J L, Warren R F. The structure of the posterolateral aspect of the knee. J Bone Joint Surg [Am]. 1982; 64 536-541
27 Sidles J A, Larson R V, Garbini J L, Downey D J, Matsen F A. Ligament length relationships in the moving knee. J Orthop Res. 1988; 6 593-610
28 Suda Y, Seedhom B B, Matsumoto H, Otani T. Reconstructive treatment of posterolateral rotatory instability of the knee. Am J Knee Surg. 2000; 13 110-116
29 Terry G C, LaPrade R F. The posterolateral aspect of the knee: anatomy and surgical approach. Am J Sports Med. 1996; 24 732-739
30 Veltri D M, Warren R F. Anatomy, biomechanics, and physical findings in posterolateral knee instability. Clin Sports Med. 1994; 13 599-614
31 Veltri D M, Warren R F. Operative treatment of posterolateral instability of the knee. Clin Sports Med. 1994; 13 615-627
32 Veltri D M, Deng X H, Torzilli P H, Warren R F, Maynard M J. The role of cruciate and posterolateral ligaments in stability of the knee: a biomechanical study. Am J Sports Med. 1995; 23 436-443

Dr. T Nau

University of Vienna Medical School · Trauma Center

Währinger Gürtel 18-20

1090 Vienna

Austria

Phone: +43/1/4 04 00 59 02

Fax: +43/1/4 04 00 59 49

Email: thnau@hotmail.com