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Review
. 2020 Feb;13(1):123-132.
doi: 10.1007/s12178-019-09581-3.

ACL and Posterolateral Corner Injuries

Robert S Dean  1 , Robert F LaPrade  2
Affiliations
Review

ACL and Posterolateral Corner Injuries

Robert S Dean et al. Curr Rev Musculoskelet Med. 2020 Feb.

Abstract

Purpose of review: The importance of the posterolateral corner (PLC) with respect to knee stability, particularly in the setting of anterior cruciate ligament (ACL) deficiency, has become more apparent in recent years. The purposes of this article are to review the current concepts of PLC injuries and to address their role in the ACL-deficient and ACL-reconstructed knee.

Recent findings: Recent literature demonstrates that a single staged, combined reconstruction is optimal. Studies further provide more thorough insight into avoidance of tunnel collision during the multiligament reconstruction. In total, reconstruction procedures have demonstrated successful outcomes in over 90% of patients. In summary, we report that in the setting of suspected concomitant PLC and ACL injury, it is essential to address both injuries; appreciating the local anatomy, diagnostic modalities, and surgical techniques are each crucial to achieving desirable clinical outcomes.

Keywords: Anterior cruciate ligament; Lateral (fibular) collateral ligament; Ligament reconstruction; Multiligament injury; Posterolateral corner.

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Conflict of interest statement

Robert Dean declares that he has no conflict of interest.

Robert LaPrade reports grants and personal fees from Arthrex, Inc., grants from Linvatec, grants and personal fees from Ossur, grants and personal fees from Smith & Nephew, outside the submitted work.

Figures

Fig. 1
Fig. 1
Dissection of the major structures of the PLC from a lateral perspective with the long head of the biceps femoris resected. PFL, patellofemoral ligament; FCL, fibular collateral ligament; LM, lateral meniscus
Fig. 2
Fig. 2
Dissection of the major structures of the PLC with the knee at 90° flexion. PLT, popliteus tendon; LG, lateral gastrocnemius; FCL, fibular collateral ligament; ALL, anterolateral ligament; LHB, long head of biceps
Fig. 3
Fig. 3
Dissection of a left lateral knee at 90° of flexion, identifying the common peroneal nerve (CPN). Important to identify and protect intraoperatively. ITB: Iliotibial band; LHB: long head of the biceps femoris
Fig. 4
Fig. 4
Demonstration of the dial test with the knee at 30°. a The patient at neutral tibial rotation on left and increased tibial external rotation on the right. b > 10° difference on side-to-side comparison, significant for a positive dial test and suggestive of PLC injury
Fig. 5
Fig. 5
Varus stress radiographs showing a likely FCL tear according to the accepted values by LaPrade et al. [26]. a The affected knee, while b the healthy knee. There is a side-to-side difference of 3.7 mm
Fig. 6
Fig. 6
This magnetic resonance image of a right knee shows a complete tear of the fibular collateral ligament (FCL). It further shows increased signal intensity at the femoral attachment site of the popliteus tendon (PLT) suggesting PLT injury as well
Fig. 7
Fig. 7
This magnetic resonance image of a right knee demonstrates the classical bone bruise pattern associated with PLC injuries. This image shows an anteromedial femoral condyle and tibial plateau bone bruising pattern
Fig. 8
Fig. 8
A right knee lateral view showing a hockey stick incision extending from the femoral shaft and lateral femoral condyle to the area between Gerdy’s tubercle and fibula head is performed to develop a posterior-based skin flap
Fig. 9
Fig. 9
Right knee posterior (a) and lateral (b) view demonstrating the anatomic reconstruction. One can see the restoration of the native anatomy in this reconstruction technique
See this image and copyright information in PMC

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