Novel approach for reconstruction of the posterolateral corner using a free tendon graft technique

Abstract

Injuries to the lateral collateral ligament (LCL) and posterolateral corner of the knee, particularly when combined with anterior cruciate or posterior cruciate ligament injuries, can result in profound symptomatic knee instability. Although many surgical improvements have been made in the reconstruction of anterior and posterior cruciate ligament injuries, reconstruction of the posterolateral corner has had less predictable results, with residual pathologic laxity especially in the chronic situation. This has stimulated many surgeons to recommend acute repair of posterolateral knee injuries. This article will briefly review the relevant surgical anatomy, present a summary of current reconstructive techniques for the posterolateral corner, and describe our preferred method for anatomic reconstruction of the posterolateral corner for chronic instability of the knee by recreating the LCL and popliteofibular ligament using either autogenous or allograft soft tissue and an interference screw technique. We do not use a transtibial tunnel but re-orientate the transfibular tunnel and utilize 2 femoral tunnels an the attempt to recreate the LCL and popliteus tendon. In a small clinical series, this has proven to restore varus rotation and external rotation patholaxities with a high degree of predictability.