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. 2025 May 23:S0749-8063(25)00352-4.
doi: 10.1016/j.arthro.2025.04.055. Online ahead of print.

A Contemporary International Expert Consensus Statement on the Evaluation, Diagnosis, Treatment, and Rehabilitation of Injuries to the Posterolateral Corner of the Knee

Robert F LaPrade  1 , Cameron Gerhold  2 , Kyle N Kunze  3 , Andrew G Geeslin  4 , Luke V Tollefson  1 , Udit Dave  2 , José Rafael Garcia  5 , Björn Barenius  6 , Charles Brown  7 , Túlio Vinícius de Oliveira Campos  8 , Moisés Cohen  9 , Lars Engebretsen  10 , Gonzalo Ferrer  11 , Carlos E Franciozi  12 , Brett A Fritsch  13 , Karl-Heinz Frosch  14 , Pablo E Gelber  15 , Alan Getgood  16 , Michael Hantes  17 , Michael Held  18 , Camilo P Helito  19 , Eivind Inderhaug  20 , Steinar Johansen  21 , Koen Carl Lagae  22 , Bruce A Levy  23 , Martin Lind  24 , Timothy Lording  25 , Rodrigo Maestu  26 , Fabrizio Margheritini  27 , Jacques Menetrey  28 , Gilbert Moatshe  10 , Joan C Monllau  29 , Iain R Murray  30 , Roberto Negrín  11 , David A Parker  31 , Nicolas Pujol  32 , James Robinson  33 , Kristian Samuelsson  34 , Ciara Stevenson  35 , Maria J Tuca  36 , Soshi Uchida  37 , Wybren A van der Wal  38 , Silvio Villascusa  39 , Richard P B Von Bormann  40 , Jorge Chahla  41
Affiliations

A Contemporary International Expert Consensus Statement on the Evaluation, Diagnosis, Treatment, and Rehabilitation of Injuries to the Posterolateral Corner of the Knee

Robert F LaPrade et al. Arthroscopy. .

Abstract

Purpose: To use a modified Delphi technique to generate an expert consensus statement on the evaluation, diagnosis, treatment, and rehabilitation of posterolateral corner (PLC) injuries of the knee.

Methods: A 5-individual working group developed a list of 62 statements regarding PLC injuries for use in a 3-round modified Delphi series. Ultimately, 40 statements were retained, and a 100% participation rate was observed in all rounds. Consensus for each statement was quantified.

Results: Overall, 82.5% of statements reached consensus. Consensus was reached regarding the following: (1) The dial, posterolateral drawer, and external rotation recurvatum tests, magnetic resonance imaging, varus-stress radiographs, and bilateral hip-to-ankle radiographs have diagnostic utility. (2) The presence of concomitant meniscal pathology or neuromuscular injury influences surgical timing. (3) Useful classification systems to guide treatment of PLC injuries currently do not exist. (4) Acute soft-tissue avulsions involving a single stabilizing structure can be repaired. (5) Isolated repair of grade III PLC tears should not be performed without augmentation or reconstruction, and complete grade III PLC injuries should undergo PLC reconstruction. (6) No universally accepted PLC reconstruction technique exists, although the LaPrade technique (anatomic reconstruction of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament using 2 grafts secured in 2 femoral tunnels, 1 fibular tunnel, and 1 tibial tunnel) may confer superior outcomes. (7) There is no consensus on the utility of routine postoperative varus stress radiographs as an objective measure of surgical success.

Conclusions: Statements that achieved unanimous consensus (all experts stating they "strongly agree") concerned routine use of physical and radiographic evaluations to confirm varus laxity due to PLC injuries and bilateral hip-to-ankle radiographs in the setting of chronic PLC injuries. Individualized treatment based on the presence of concomitant injuries and staged rehabilitation programs are essential. The significance of a grade III posterolateral drawer test in detecting external rotational laxity and whether common peroneal nerve neurolysis should be routinely performed remain in question. No single reconstruction technique confers optimal clinical outcomes. Postoperative varus stress radiographs are not reliable for determining residual laxity.

Level of evidence: Level V, consensus of expert opinion.

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Conflict of interest statement

Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: R.F.L. reports a relationship with Smith & Nephew that includes other professional activities; is on the board of directors or is a committee member of International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) (Deputy Chair); is on the traveling fellowship committee of ISAKOS (Scientific Committee); and serves on the editorial or governing board of American Journal of Sports Medicine (AJSM), Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA), Journal of Experimental Orthopaedics (JEO), International Journal of Sports Physical Therapy (IJSPT), Operative Techniques in Sports Medicine (OTSM), and Journal of Knee Surgery (JKS). K.N.K. performs consulting for AllaiHealth and owns stock in Best in Class MD (BICMD). A.G.G. reports a consulting or advisory relationship with Smith & Nephew; receives speaking and lecture fees from Smith & Nephew and Ossur Americas; receives travel reimbursement from Smith & Nephew and Ossur Americas; serves on the Arthroscopy Editorial Board; and is the Infographics Editor for Arthroscopy. B.B. is a paid consultant for Arthrex and ConMed Linvatec; owns stock or stock options in AstraZeneca; owns intellectual property (IP) royalties in ConMed Linvatec; and is a board or committee member of European Society of Sports Traumatology, Knee Surgery, & Arthroscopy (ESSKA) Arthroscopy Committee and ISAKOS. C.B. is a paid consultant and paid presenter or speaker for Smith & Nephew. L.E. is on the editorial or governing board of Acta Orthopaedica, Journal of Bone and Joint Surgery–American, Knee, and KSSTA; is a board or committee member of American Orthopaedic Society for Sports Medicine, ESSKA, and ISAKOS; receives IP royalties from Arthrex; is a paid consultant for Arthrex; receives research support from Arthrex, Biomet, and Smith & Nephew; receives publishing royalties and financial or material support from British Jounral of Sports Medicine (BJSM); and owns stock or stock options in iBalance. C.E.F. is a board or committee member of Sociedade Brasileira de Cirurgia do Joelho (SBCJ). B.A.F. owns stock or stock options in 360 Knee Systems, Personalised Surgery, and SDIP Innovations (SDIP); is a paid presenter or speaker for Arthrex and Corin U.S.A.; receives research support from Arthrex, Corin U.S.A., Smith & Nephew, and Zimmer; receives IP royalties from Corin U.S.A. and Exactech; is a paid consultant for Corin U.S.A.; and is a board or committee member of ISAKOS. K-H.F. receives IP royalties from Arthrex; is a paid presenter or speaker for Arthrex; and receives research support from Arthrex. P.E.G. receives IP royalties from ConMed Linvatec; is a paid consultant for ConMed Linvatec and Newclip; and is a paid presenter or speaker for ConMed Linvatec and Newclip. A.G. receives research support from Aesculap/B.Braun, Ossur, and Smith & Nephew; is on the editorial or governing board of AJSM and KSSTA; receives IP royalties from Graymont; is a board or committee member of ISAKOS; owns stock or stock options in LinkX Robotics, Ostesys Robotics, Precision OS, Smart HTO, Spring Loaded Technologies, and Surgical Health Innovations; is a paid consultant for Smith & Nephew; and is a paid presenter or speaker for Smith & Nephew. M. Hantes is on the editorial or governing board of KSSTA. M. Held is a member of the editorial or governing board of South African Orthopaedic Association (SAOA); is a paid presenter or speaker for Smith & Nephew; and receives research support from Smith & Nephew. E.I. is a member of the editorial or governing board of AJSM and KSSTA; is a paid consultant for Smith & Nephew; and is a paid presenter or speaker for Smith & Nephew. B.A.L. receives IP royalties from Arthrex; is a paid consultant for Arthrex; owns stock or stock options in COVR Medical; and is on the editorial or governing board of Journal of Knee Surgery, KSSTA, and Orthopedics Today. M.L. is a paid presenter or speaker for Arthrex and Smith & Nephew; is a board or committee member of ESSKA; and receives research support from Johnson & Johnson, Novartis, and Smith & Nephew. T.L. is a paid presenter or speaker for Arthrex, Medacta, and Smith & Nephew; is a board or committee member of ISAKOS; is a paid consultant for Medacta and Smith & Nephew; and receives research support from Smith & Nephew. R.M. is a board or committee member of Arthroscopy Argentine Association, ISAKOS, and Latin American Arthroscopy, Knee and Sports Society and is a paid consultant for Permedica and Smith & Nephew. J.M. is a paid consultant for DePuy (A Johnson & Johnson Company); is on the editorial or governing board of KSSTA; and receives royalties and financial or material support from Springer. J.C.M. is a paid presenter or speaker for Smith & Nephew and ConMed Linvatec; is on the editorial or governing board of Arthroscopy; and is a board or committee member of European Society for Sports Traumatology, Knee Surgery and Arthroscopy. I.R.M. is a paid consultant for Smith & Nephew, Stryker, and Arthrex and is a member of the editorial or governing board of Bone and Joint Research and Journal of Bone and Joint Surgery–British. R.N. is a paid presenter or speaker for Biomet and Smith & Nephew; receives research support from Smith & Nephew; and receives other financial or material support from Biomet. D.A.P. is a paid consultant for Smith & Nephew; is a paid presenter or speaker for Smith & Nephew; is on the editorial or governing board of SMARTT Journal, AJSM, Orthopaedic Journal of Sports Medicine (OJSM), and Journal of ISAKOS (JISAKOS); receives research support from Zimmer; owns stock or stock options in Personalised Surgery and Ganymed Robotics; is a board or committee member of ACL Study Group, Asia Pacific Knee Arthroscopy and Sports Medicine Society, Asia Pacific Knee Society, and ISAKOS; and is an unpaid consultant for Ganymed Robotics. J.R. is a paid consultant for Joint Operations and Smith & Nephew; is a paid presenter or speaker for Joint Operations, Newclip, ConMed Linvatec, and Smith & Nephew; receives research support from Newclip Technics, DePuy (A Johnson & Johnson Company), Smith & Nephew, and Stryker; receives other financial or material support from Corin U.S.A. and Smith & Nephew; and is a board or committee member of ESSKA Arthroscopy Committee and ISAKOS. C.S. is a paid presenter or speaker for Smith & Nephew and is a board or committee member of ISAKOS. M.J.T. is a paid presenter or speaker for Arthrex; receives research support from ConMed Linvatec; and is a board or committee member of ISAKOS. S.U. is a board or committee member of ISAKOS, Japan Hip Society, and Japanese Sports Orthopaedic Association; receives research support from Smith & Nephew; and is an unpaid consultant for Smith & Nephew. W.A.v.d.W. receives research support from Arthrex. R.P.B.V.B. reports a relationship with Smith & Nephew that includes other professional activities. J.C. is a board or committee member of American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and ISAKOS; is a paid consultant for Arthrex, ConMed Linvatec, Ossur, RTI Surgical, Smith & Nephew, and Vericel; receives hospitality payments from Breg, DePuy Synthes Sales, Joint Restoration Foundation, Medical Device Business, Pacira Pharmaceuticals, SI-Bone, and Vericel; receives educational support from Midwest Associates; and is a paid presenter or speaker for Smith & Nephew. All other authors (C.G., L.V.T., U.D., J.R.G., T.V.d.O.C., M.C., G.F., C.P.H., S.J., K.C.L., F.M., G.M., N.P., K.S., S.V.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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