Diagnosis and Treatment of Injuries to the Posterolateral Ligament Complex

ABSTRACT

Posterolateral corner (PLC) injuries are an often unrecognized and disabling injury that frequently accompanies other ligamentous disruptions. The spectrum of injury severity and heterogeneity of treatment options have made comparison of outcomes difficult. Several clinical studies and reviews have focused on the outcomes and treatment algorithms of knee dislocations or multiligamentous knee injuries.[1] [2] [3] There is, however, a paucity of data in the literature analyzing the clinical outcomes and treatment recommendations of isolated PLC injuries or PLC injuries in combination with a single cruciate ligament tear. Furthermore, to our knowledge there is no review that analyzes the different repair or reconstructive techniques and assesses the clinical outcomes of these techniques.

KEYWORDS

Posterolateral corner - ligamentous - injury - knee

REFERENCES

• 1 Shelbourne K D, Haro M S, Gray T. Knee dislocation with lateral side injury: results of an en masse surgical repair technique of the lateral side.  Am J Sports Med. 2007;  35 (7) 1105-1116
• 2 Fanelli G C. Treatment of combined anterior cruciate ligament-posterior cruciate ligament-lateral side injuries of the knee.  Clin Sports Med. 2000;  19 (3) 493-502
• 3 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
• 4 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 (2) 173-179
• 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 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
• 7 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
• 8 Sanchez II A R, Sugalski M T, LaPrade R F. Anatomy and biomechanics of the lateral side of the knee.  Sports Med Arthrosc. 2006;  14 (1) 2-11
• 9 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 (2) 233-242
• 10 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 (1) 88-97
• 11 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
• 12 Stäubli H U, Birrer S. The popliteus tendon and its fascicles at the popliteal hiatus: gross anatomy and functional arthroscopic evaluation with and without anterior cruciate ligament deficiency.  Arthroscopy. 1990;  6 (3) 209-220
• 13 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 (4) 536-541
• 14 Terry G C, LaPrade R F. The biceps femoris muscle complex at the knee. Its anatomy and injury patterns associated with acute anterolateral-anteromedial rotatory instability.  Am J Sports Med. 1996;  24 (1) 2-8
• 15 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
• 16 Hughston J C, Norwood Jr L A. The posterolateral drawer test and external rotational recurvatum test for posterolateral rotatory instability of the knee.  Clin Orthop Relat Res. 1980;  (147) 82-87
• 17 Juhng S K, Lee J K, Choi S S, Yoon K H, Roh B S, Won J J. MR evaluation of the “arcuate” sign of posterolateral knee instability.  AJR Am J Roentgenol. 2002;  178 (3) 583-588
• 18 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 (4) 433-438
• 19 Shindell R, Walsh W M, Connolly J F. Avulsion fracture of the fibula: the ‘arcuate sign’ of posterolateral knee instability.  Nebr Med J. 1984;  69 (11) 369-371
• 20 Weber W N, Neumann C H, Barakos J A, Petersen S A, Steinbach L S, Genant H K. Lateral tibial rim (Segond) fractures: MR imaging characteristics.  Radiology. 1991;  180 (3) 731-734
• 21 Woods G W, Stanley R F, Tullos H S. Lateral capsular sign: x-ray clue to a significant knee instability.  Am J Sports Med. 1979;  7 (1) 27-33
• 22 LaPrade R F, Gilbert T J, Bollom T S, Wentorf F, Chaljub G. The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries.  Am J Sports Med. 2000;  28 (2) 191-199
• 23 Fleming Jr R E, Blatz D J, McCarroll J R. Posterior problems in the knee. Posterior cruciate insufficiency and posterolateral rotatory insufficiency.  Am J Sports Med. 1981;  9 (2) 107-113
• 24 Fanelli G C, Giannotti B F, Edson C J. Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction.  Arthroscopy. 1996;  12 (5) 521-530
• 25 Harner C D, Waltrip R L, Bennett C H, Francis K A, Cole B, Irrgang J J. Surgical management of knee dislocations.  J Bone Joint Surg Am. 2004;  86-A (2) 262-273
• 26 Liow R Y, McNicholas M J, Keating J F, Nutton R W. Ligament repair and reconstruction in traumatic dislocation of the knee.  J Bone Joint Surg Br. 2003;  85 (6) 845-851
• 27 Tzurbakis M, Diamantopoulos A, Xenakis T, Georgoulis A. Surgical treatment of multiple knee ligament injuries in 44 patients: 2-8 years follow-up results.  Knee Surg Sports Traumatol Arthrosc. 2006;  14 (8) 739-749
• 28 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
• 29 Krukhaug Y, Mølster A, Rodt A, Strand T. Lateral ligament injuries of the knee.  Knee Surg Sports Traumatol Arthrosc. 1998;  6 (1) 21-25
• 30 Wascher D C, Dvirnak P C, DeCoster T A. Knee dislocation: initial assessment and implications for treatment.  J Orthop Trauma. 1997;  11 (7) 525-529
• 31 Veltri D M, Warren R F. Operative treatment of posterolateral instability of the knee.  Clin Sports Med. 1994;  13 (3) 615-627
• 32 Mariani P P, Santoriello P, Iannone S, Condello V, Adriani E. Comparison of surgical treatments for knee dislocation.  Am J Knee Surg. 1999;  12 (4) 214-221
• 33 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
• 34 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
• 35 Verma N N, Mithöfer K, Battaglia M, MacGillivray J. The docking technique for posterolateral corner reconstruction.  Arthroscopy. 2005;  21 (2) 238-242
• 36 Jung Y B, Jung H J, Kim S J et al.. Posterolateral corner reconstruction for posterolateral rotatory instability combined with posterior cruciate ligament injuries: comparison between fibular tunnel and tibial tunnel techniques.  Knee Surg Sports Traumatol Arthrosc. 2008;  16 (3) 239-248
• 37 Khanduja V, Somayaji H S, Harnett P, Utukuri M, Dowd G S. Combined reconstruction of chronic posterior cruciate ligament and posterolateral corner deficiency. A two- to nine-year follow-up study.  J Bone Joint Surg Br. 2006;  88 (9) 1169-1172
• 38 Strobel M J, Schulz M S, Petersen W J, Eichhorn H J. Combined anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner reconstruction with autogenous hamstring grafts in chronic instabilities.  Arthroscopy. 2006;  22 (2) 182-192
• 39 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
• 40 LaPrade R F. Posterolateral Knee Injuries: Anatomy, Evaluation, and Treatment. New York: Thieme; 2006
• 41 Fanelli G C, Edson C J. Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up.  Arthroscopy. 2004;  20 (4) 339-345