Agenda for ISAKOS 2011 Posterolateral Knee Symposium May 19, 2011 (one hour) 

 

The posterolateral knee symposium agenda will cover current topics related to global diagnosis and 

recognition and cutting edge treatment of this difficult pathology.  Each faculty will be allotted seven (7) 

minutes to cover their topic. Please be respectful of other faculty and adhere to this time frame because 

we cannot exceed this time frame for our symposium.   

Symposium Goals: 

It is anticipated that participants will have an improved ability to understand the complex anatomy, 

clinically relevant biomechanics, diagnostic techniques, and operative treatment of both acute and 

chronic posterolateral knee injuries from attending this course. 

Chair: Robert F. LaPrade MD, PhD 

Agenda: 

1‐Clinically Relevant Anatomy and Diagnostic Techniques‐Rob LaPrade MD, PhD 

2‐Clinically Relevant Biomechanics‐Coen Wijdicks, PhD 

3‐Treatment of Acute Posterolateral Knee Injuries‐Andrew Geeslin, MD 

4‐Varus Thrust and Osteotomies to Treat Posterolateral Knee Injuries‐Markus Arnold MD, PhD 

5‐Indications for Surgery and Presence/Treatment of Concurrent Injuries‐Roland Becker MD, PhD 

6‐Techniques for Treatment of Chronic Posterolateral Knee Injuries‐Anatomic Allograft‐Steinar 

Johansen, MD 

7‐Techniques for Treatment of Chronic Posterolateral Knee Injuries‐Anatomic Autograft‐Rene Abdalla 

MD, PhD 

8‐Questions from Audience‐All Panelists 

 

E‐mail: drlaprade@sprivail.org 

 

 

2/22/2011

1

Clinically Relevant Anatomy and Diagnostic Techniques for

Posterolateral Knee InjuriesISAKOS Symposium

Rio de Janeiro, BrazilMay 19, 2011

Robert F. LaPrade, M.D., Ph.D.Director, Biomechanics Research Department,

Steadman Philippon Research Institute;The Steadman Clinic - Vail, Colorado, USA

Applied Anatomy of the Posterolateral Knee

* 28 different individual components

Fibular Collateral Ligament(LaPrade, AJSM, 2003)

• 1° varus stabilizer• Attachment sites:

─Proximal / posterior to lateral epicondyleepicondyle

─Midway along fibular head

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Popliteus Tendon• Important stabilizer to posterolateral

rotation• Popliteus attachment on femur

─18.5 mm from FCL attachmenton femur

─attaches to anterior fifth of popliteal sulcus

Popliteofibular Ligament

• Originates at musculotendinousjunction

• Anterior / Posterior divisions• Static stabilizer of ER

Arcuate (“Arched”) Ligament

• Does not exist• Misnamed in literature• PFL vs. “fibular” structures

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History• Usually due to varus or hyperextension

twisting injuries

• Majority (72%) are combined ligamentousi j iinjuries(LaPrade, AJSM, 1997; Geeslin, AJSM, 2011)

Diagnosis of PosterolateralKnee Injuries

• Acute vs chronic; isolated vs combined injuries• Multiple tests needed to assess PLC injury• Remember to test for peroneal nerve function

– Injured in 15% of posterolateral knee injuries (LaPrade,1997)

External Rotation Recurvatum Test

(Hughston, 1980)

• Lift big toe• Assess recurvatum

I di ti f bi d lig t i j • Indicative of combined ligament injury (usually ACL tear) LaPrade, AJSM 2008

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Varus stress test at 30°(Hughston, 1966)

• Put fingers over joint line• Apply stress through foot/ankle, not

the legthe leg• Check contralateral knee

Posterolateral Drawer Test(Hughston, 1980)

• Knee flexed to 90°• Foot 15° ER (sit on foot)• Assess posterolateral rotation

Ch k l l l k• Check contralateral normal knee

Dial Test at 30°and 90°

• External rotation of tibial tubercle 10°-15°increase at 30° (Grood, 1988; Fanelli,1998)

• If increases at 90°, PCL (Grood, 1988) and/or ACL (Wroble, 1993) also injuredACL (Wroble, 1993) also injured

* beware of disguised medial knee injuries

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Reverse Pivot Shift Test(Jakob, 1981)

• “Opposite” of pivot shift– Knee flexed, foot ER– Extend knee to reduce

subluxed tibia

* Dynamic Posterolateral Drawer Test

– Popliteus tendon main stabilizer– Large variability

◦ 35% in normal knees (Cooper, 1991)

Anterior Translation at 30°• Sectioning PLC - no increase in

primary anterior translation• In ACLD knees, absent PLC results in

increased translation 0°-30°( d 3 ) (grade 3+) (Nielsen 1986; Wroble 1993)

* think combined PLC for 3+ Lachman

Posterior Translation at 90°

• PCL - main restraint: 8 mm PT (grade 2)

• Combined PCL/PLT: >12 mm PT (grade 3)(g )

* think combined PLC for 3+ posterior drawer

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Varus Thrust Gait

• Usually underlying varus alignment

• May adapt with flexed knee gait

Avulsion Fractures

•Arcuate avulsion

•Segond avulsion

R d f h d b h * MRI defines attached structures better than Xrays

Varus Stress Xrays(LaPrade, JBJS, 2008)

• Side – to – side difference• >2.7 mm – complete FCL tear• >4 mm – complete PLC tear

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Kneeling PCL Stress Xrays(LaPrade, AJSM, 2008)

• 0 – 7 mm partial PCL• 8-11 mm isolated PCL• ≥ 12 mm – combined PCL injuryj y

*Pearl: posterior drawer test may underestimate ↑↑PT

Use of MRI to Diagnose PLC Injuries

(LaPrade, 2000)

• Thin slice (2 mm)• Entire fibular head / styloid

C l bli 1 5 3 • Coronal obliques 1.5 or 3 tesla magnet

• Understand complex anatomy

• Utilize clinical examination | varus / PCL stress radiographs | MRI to arrive

Summary

g p |at DX

2/22/2011

8

THANK YOU

Steadman Philippon Research InstituteBiomechanics Research Department

CURRENT CONCEPTS IN POSTEROLATERAL KNEE INJURY Rene J Abdalla, MD PhD

Federal University of São Paulo, Brazil

The postero-lateral compartment (PLC) structures are: lateral collateral ligament

(LCL), popliteous muscle-tendon (PMT), the popliteofibular ligament (PFL) and the

posterolateral capsule (PLC). The PLC restricts posterior tibial dislocation, provides

the primary restrain to external tibial rotation at low knee flexion angles and also is

the primary restrain to a knee varus movement, specially the LCL.

Injury to the PLC can cause an important functional incapacity due to a knee varus

instability associated to posterior and lateral knee rotation. PLC injuries can be

classified according to their etiology:

- Type 1: traumatic. The main mechanisms of injury are a direct blow to the

antero-medial region of the tibia with the knee in near extension and the knee is

forced into a hyperextension, external rotation and varus position. This injury can or

cannot be associated to a cruciate ligament injury. A PLC isolated injury only occurs

in 1.6% of the times.

- Type 2: physiological instability. This can happen in people that have an

excessive knee external rotation and have repetitive small traumas to the joint. In this

case, a postero-lateral instability, without LCL or cruciate ligament injury, will occur.

- Type 3: this is a combination of types 1 and 2. In this case, there is an

isolated injury to the ACL or PCL in a patient with a prior excessive knee external

rotation. The isolated cruciate ligament reconstruction will not correct the rotational

instability.

Diagnosis

Injury to the PLC is often missed and under-diagnosed. Clinical diagnosis is given by

the presence of a positive varus stress test, postero-lateral draw, positive dial test and

the presence of the reverse pivot shift.

Treatment

Our group follows the subsequent guidelines of treatment:

- All injuries associated to ACL or PCL injury should be treated surgically

- Isolated grades 1 or 2 PLC injuries: will depend on patient’s symptoms

- Isolated grade 3 PLC injuries: surgical treatment (described bellow).

- Surgical technique

Our group has established a new surgical technique for the PLC repair and is as

follows:

Autologous grafts are used for all reconstructions. The semi-tendinosus, the

gracilis and the hemi-tendon of the biceps are used to replace the LCL, the popliteus

tendon and the PFL.

For the replacement of the popliteus tendon, a doubled semitendinous graft is

used from anterior to posterior at the Gerdy tubercle towards a more proximal and

lateral region of the tibial metaphysis. For this to be carried out correctly we use a

PCL tibial guide that was devised by our group (Figure 1).

Figure 1 – PCL Tibial Guide

The lateral collateral ligament is reproduced by a biceps hemi-tendon that is

dissected from its insertion at the fibular head together with a section of the gracilis

tendon. A tunnel is drilled in the head of the fibula at the LCL insertion site point and

taking care to avoid the fibular nerve. The gracilis tendon is passed through this

tunnel and one portion is joined to the biceps hemi-tendon to form the new LCL while

the other portion is joined to the semi-tendinosous tendon to reproduce the popliteo-

fibular ligament. Both groups are inserted at the lateral epicondyle at the anatomical

position of the insertion site of the popliteous tendon and LCL (Figure 2).

Figure 2 – Graft landmarks

We have used this surgical technique since 1999 and, at the moment, have 18 patients

with a 45-month follow-up. Of these, 10 also had an ACL injury and 8 had a PCL

injury. At 3 years, the IKDC results showed that 13 subjects had a near-normal IKDC

whereas 5 had abnormal results.

Conclusion

Although PLC injuries are becoming more frequent, diagnosis is still difficult and

many times it is under-diagnosed. There are few high quality papers in the literature

that can aid us in deciding the best treatment for our patients; in addition to this, many

times our results are hard to evaluate because of the ACL and/or PCL simultaneous

injury. There are many surgical techniques described but we still do not have the

answer as to which is the best one. We believe that reconstruction should be

anatomical, that patients should be followed so we can learn from our results and that

more prospective studies should be performed.

REFERENCES

1. Abdalla RJ, Pacagnan AV, Loyola HA, Cohen M, Camanho GL, Forgas A. A proposal for a new tibial guide system for posterior cruciate ligament reconstruction. Arthroscopy. 2007 Jul;23(7):793 e791-794.

2. Baker CL Jr, Norwood LA, Hughston JC. Acute posterolateral rotatory instability of the knee. J Bone Joint Surg Am. 1983; 65:614-618.

3. Clifford GR, Robin RL, Mark PC, Clifford Y, and Robert AA, Posterolateral Corner Reconstruction of the Knee, Evaluation of a Technique With Clinical Outcomes and Stress Radiography, AJSM PreView, published on May 5, 2010 as doi: 10.1177/0363546510363462

4. Cooper DE, Warren RF, Warner JP. The posterior cruciate ligament and posterolateral structures of the knee: anatomy, function, and patterns of injury. Instr Course Lect. 1991; 40:249-270.

5. Covey D. Injuries to the posterolateral corner of the knee. J Bone Joint Surg Am. 2001; 83:106-118.

6. DeLee JC, Riley MB, Rockwood CA Jr. Acute posterolateral rotator instability of the knee. Am J Sports Med. 1983; 11:199-207.

7. Gollehon DL, Torzilli P, Warren RF. Th e role of the posterolateral and cruciate ligaments in the stability of the human knee: a biomechanical study. J Bone Joint Surg Am. 1987; 69:232-242.

8. Hughston JC, Andrews JR, Cross MJ, Moschi A. Classification of knee ligament injuries: part II, the lateral compartment. J Bone Joint Surg Am. 1976; 58:173-179.

9. LaPrade RF, Muench C, Wentorf F, Lewis JL. The effect of injury to the posterolateral structures of the knee on force in a posterior cruciate ligament graft: a biomechanical study. Am J Sports Med. 2002; 30:233-238.

10. Latimer HA, Tibone JE, ElAttrache NS, McMahon PJ. Reconstruction of the lateral 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.

11. Nielsen S, Helmig P. Posterior instability of the knee joint. Arch Orthop Trauma Surg. 1986; 105:121-125.

12. Nielsen S, Helmig P. The static stabilizing function of the popliteal tendon in the knee: an experimental study. Arch Orthop TraumaSurg. 1986; 104:357-362.

13. Nielsen S, Ovesen J, Rasmussen O. The posterior cruciate ligamentand rotatory knee instability: an experimental study. Arch Orthop Trauma Surg. 1985; 104:53-56.

14. Noyes FR, Barber-Westin SD. Posterior cruciate ligament revision reconstruction: I, causes of surgical failure in 52 consecutive operations. Am J Sports Med. 2005;33:646-654.

15. Veltri DM, Deng XH, Torzilli PA, Maynard MJ, Warren RF. The role of the popliteofibular ligament in stability of the human knee: a biomechanical study. Am J Sports Med. 1996; 24:19-27.

Varus Thrust and High Tibial Osteotomies to Treat Posterolateral Knee Injuries Markus P. ARNOLD, MD, PhD Senior Consultant, Knee Surgery Orthobiology & Cartilage Repair Dept. of Orthopaedic Surgery and Traumatology Kantonsspital Bruderholz CH-4101 Bruderholz, Switzerland

Varus leg alignment itself is a normal variant of human anatomy regularly seen in active

sportsmen. The biologic balance or joint homoeostasis may be guaranteed for decades, until

one of the structures fails. In the varus aligned leg the forces are not ideally balanced: there

is more tension stress and strain on the active and passive stabilizers on the lateral side than

the structures are meant to sustain, and there is more axial pressure in the medial knee

compartment. Clinical experience shows that a varus alignment itself may be no problem, but

varus thrust may be the beginning of the end [3].

What is varus thrust? Varus thrust of the knee is a clinical observation of an abrupt,

excessive varus moment of the knee, or in other words: a dynamic increase of a preexisting

varus angle (Fig. 1). A thrust occurs due to the opening of the lateral tibio-femoral

compartment upon initiation of load-bearing during normal gait [1]. Several anatomical

structures stabilize the knee actively and passively against the varus thrust motion: the

popliteal muscle-tendon, posterior joint capsule, iliotibial band and lateral collateral ligament

(LCL). It has been suggested that these posterolateral structures of the knee act as a unit to

balance a varus moment [2; 4]. The LCL is the most important passive stabilizer against a

straight lateral thrust force. Insufficiency of this ligament will cause increased lateral

compartment opening when external varus forces are applied.

It has been shown, that that even an intact lateral collateral ligament cannot prevent the

development of a varus thrust [5] (Fig. 2). Changing the weight bearing line from 0% to 50%

and from 50% to 100% varus increased the lateral joint opening significantly (Fig. 3).

An isolated lateral or posterolateral ligamentous reconstruction would therefore have a hard

time to survive the forces it had to face in the situation where a varus alignment has led to a

varus thrust.

A well-balanced valgus osteotomy with the goal to eliminate the dynamic phenomenon called

varus thrust, mostly in order to reduce the tensile forces on the posterolateral active and

passive stabilizers. Whether this mechanical leg correction should be performed before an

eventual ligamentous reconstruction or as a combined procedure remains a topic for debate.

[5]

References: 1 Chang A, Hayes K, Dunlop D, et al. (2004) Thrust during ambulation and the

progression of knee osteoarthritis. Arthritis Rheum, 50(12):3897-3903 2 Grood ES, Stowers SF, Noyes FR (1988) Limits of movement in the human knee.

Effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am, 70(1):88-97

3 Noyes FR, Barber-Westin SD, Hewett TE (2000) High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med, 28(3):282-296

4 Noyes FR, Stowers SF, Grood ES, Cummings J, VanGinkel LA (1993) Posterior subluxations of the medial and lateral tibiofemoral compartments. An in vitro ligament sectioning study in cadaveric knees. Am J Sports Med, 21(3):407-414

5 van de Pol GJ, Arnold MP, Verdonschot N, van Kampen A (2009) Varus alignment leads to increased forces in the anterior cruciate ligament. Am J Sports Med, 37(3):481-487

Figures:

Fig. 1:

a) b)

Varus thrust explained: a discrete varus alignment a) is dynamically increased at the moment

of varus thrust b). There is a lateral joint opening, the weight bearing line shifts to the medial

side, the tension forces on the lateral active and passive stabilizers increases.

Fig. 2

Photograph of a leg in the compression machine. The ACL tensiometer and lateral extensiometer are mounted. The 100% varus weightbearing line (white line) passes through the medial edge of the tibial plateau. Fig 3:

An example of a few loading cycles of an extended leg with the weightbearing line at the medial edge of the tibial plateau (100% varus), resulting in a visual thrusting pattern. The lateral joint opening curve is shown. The lateral joint opening occurred by axially loading an ACL intact knee, the test was started with a 25N preload and increased to 100N, 200N and 300N before returning to 25N

3/9/2011

1

Current Concepts of Posterolateral Knee Injury;

Clinically Relevant Biomechanics

Coen A. Wijdicks, Ph.D.Deputy Director

Senior Staff Scientist

Steadman Philippon Research InstituteBiomechanics Research Department

P• Purpose– To measure the force in intact FCL, PLT, and PFL during in vitro loading.

o Identify clinical relevance of these structures

o Identify structures for anatomical surgical reconstruction in grade III posterolateral injuries

LaPrade RF et al. AJSM 32, 2004

• Purpose• Purpose– To measure lateral compartment opening secondary to applied varus

stresses following posterolateral corner structure sectioning 

– To develop radiographic guidelines to quantify the amount of lateral compartment gapping seen with these injuries.

LaPrade RF et al. JBJS 90, 2008 Sugita T and Amis AA. AJSM 29, 2001

• Ligamentous Structural Properties– Measured the strength of the lateral collateral and popliteofibular ligaments

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• Purpose– To assist with the selection of reconstruction graft choices 

for anatomical posterolateral knee reconstruction techniques

LaPrade RF et al. AJSM 33, 2005

Rabbit Anatomy (JOR, 2003)y ( , )

• Purpose– Perform a detailed analysis of the anatomy of the posterolateral aspect of 

the rabbit knee, similar to previous studies of the human knee

Crum et al. JOR 21, 2003

Rabbit Surgical Instability (JOR, 2004)Rabbit Surgical Instability (JOR, 2004)

• Purpose– Purpose was to develop an in vivo model for knee instability following 

a posterolateral corner injury.

o Does the PLC heal?

LaPrade et al. JOR 22, 2004

Rabbit Surgical Instability (AJSM, 2006)

• Purpose– Determine the natural history of untreated posterolateral knee injuries at 

6 months postoperatively

o Long‐term outcome

LaPrade et al. AJSM 34, 2006

3/9/2011

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Canine Anatomy and Biomechanics (JOR 2007)Canine Anatomy and Biomechanics (JOR, 2007)

• Purpose– To describe the anatomy and characterize the biomechanics of the 

posterolateral aspect of the canine knee.

Griffith et al. J Orthop Res 25, 2007

Canine Surgical Instability (AJSM 2010)Canine Surgical Instability (AJSM, 2010)

• Purpose– Evaluate articular cartilage cross‐sectional area and maximum thickness using 

7.0‐T magnetic resonance images.

– Compare to corresponding histologic sections.

Pepin et al. Am J Sports Med 37, 2010

• Reconstruction Techniques– Findings show that the popliteus muscle‐

tendonligament complex, fibular collateral ligament, and posterolateralcapsular structures function as a unit.

– Operative reconstruction should address all of the posterolateral structures, since restoration of only a portion may result in residual instability.

Pasque et al. J Bone Joint Surg Br 85, 2003

• Purpose– Restore varus and external rotary static stability to grade III PLC injured knees.

– Biomechanical testing 

o Intact (native)

o Sectioned (injured)

o reconstructed 

LaPrade et al. Am J Sports Med 32, 2004

3/9/2011

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• Purpose– Determine potential motion differences between anatomic knee 

reconstruction both with and without a PFL graft placed through a tibialtunnel. 

– Biomechanical testing 

o Intact (native)

o Sectioned (injured)

o reconstructed 

McCarthy et al. Am J Sports Med 33, 2010

• Anatomic Reconstruction Technique

– 64 patients, 4.3 year follow‐up

– The posterolateral knee reconstruction technique significantly improved objective stability in patients.

LaPrade et al. J Bone Joint Surg Am 92, 2010

• Purpose– To determine if untreated posterolateral knee injuries would result in 

measureable evidence of early onset arthritis on ultra‐high field MRI.

Griffith et al. ORS, 2009

Summary

• FCL is primary restraint to varus. • FCL and popliteus complex have complimentary or

synergistic roles as stabilizers. • Varus stress radiographs provide reliable

measurements between clinicians. • The posterolateral corner in the rabbit knee does

not heal when injured. Even at 6 months.• 7.0T MRI provides an alternative method to

h l l l h h histology to evaluate early osteoarthritic changes. • Operative reconstruction should address all of the

posterolateral structures.• Inclusion of the PFL through a tibial tunnel does not

overconstrain the knee, and restored normal internal rotation.

3/17/2011

1

Treatment of Acute Grade III

Posterolateral Corner Injuries

Andrew G. Geeslin, MD

Posterolateral Knee Symposium

ISAKOS 2011, Rio de Janeiro, Brazil

Disclosures

• No potential conflicts of interest with the

topic of this presentation.

Indications

• Combined varus and

posterolateral rotatory

instability and/or a

varus thrust gait

• Patient reported

functional instability

or pain

Evaluation - Examination

• Note: PE may be

limited by pain

in acute injuries

PE should include:

• Gait (if symptoms permit)

• Varus opening at 20°

• Posterolateral drawer

• Dial at 30° & 90°

• Reverse pivot shift

Evaluation: Imaging Clinically Relevant Anatomy

• FCL

• Popliteus tendon

• PFL

• Lateral Capsule

• Biceps Femoris

• Iliotibial Band

LaPrade et al., AJSM 2003

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PLC Injury Assessment

Stepwise search

for injuries to

structures with

attachments to:

1. Fibula

2. Femur

3. Tibia

4. Lateral Meniscus

LaPrade et al., AJSM 2003

PLC Injury: Approach & Neurolysis

Geeslin and LaPrade., TKS 2011

PLC Assessment: Fibular Head

Structures attached

to fibular head:

– Biceps femoris

tendon

– FCL

– PFL

PLC Assessment: Lateral Femur

Perform ITB

splitting incision

to visualize:

–FCL

–PLT

PLC Assessment: Tibia, Lateral Meniscus

• Mid-Third Lateral

Capsular Ligament

– Meniscotibial

– Meniscofemoral

Arthroscopic Assessment

• Performed after open

PLC dissection

• Reconstruct ACL and

PCL as indicated

– Only secure femoral

grafts at this time

• Treat meniscus,

debride cartilage as

indicated

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Technique:

Repair vs. Reconstruction

• Repairable: Avulsion off bone

• Non-repairable: Midsubstance

tear, stretch injury

• Order of treatment:

1. Femur

2. Lateral Meniscus

3. Tibia

4. Fibular head/styloid

Technique:

Popliteus Recess Procedure

• Performed when

popliteus tendon is

avulsed from its

femoral attachment

without intra-

substance stretch,

musculotendinous

avulsion

Technique:

Popliteus Recess Procedure

• Vertical incision through

capsular ligament to

identify the PLT

anatomic attachment

• Dissect under VMO; use

aiming guide, eyelet pin

• Ream 5 mm tunnel, 1

cm deep

• Advance tendon, tie

sutures over medial

button

Technique: FCL Reconstruction

• Performed when PLT

does not require

reconstruction and PFL

is intact

• Semitendinosus

autograft

• Biomechanically

Validated (Coobs et al.,

AJSM 2007)

• Clinically Validated(LaPrade et al. AJSM 2010)

Coobs et al., AJSM 2007

Technique: PLC Reconstruction

• Anatomic PLCR

performed when FCL

and PLT are torn and

non-repairable

• Biomechanically

validated (LaPrade et al.,

AJSM 2004)

• Clinically validated (LaPrade et al., JBJS 2010)

LaPrade et al., AJSM 2004

Technique: Repairs

• Lateral capsule

– suture anchors

• Popliteomeniscal

fascicles

– mattress sutures

• Coronary ligament

– mattress sutures

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Technique:

Biceps Femoris Tendon Avulsion

• May require

proximal release

due to retraction

• Repaired with suture

anchors with the

knee in full

extension

Technique:

PFL Repair or Reconstruction

• PFL suture anchor repair

if FCL or PLT intact

• FCL/PFL Reconstruction

when PFL non-repairable

and FCL tear

Outcomes:

Acute Grade III PLC Injury

• Demographics

– 29 Patients, 30 Knees

– Average age 27 (16-63)

• Mechanism of Injury

– 7 high, 23 low velocity

– 19 due to sporting activities

• Associated Injuries

– 8 isolated, 10 w/ACL,

4 w/PCL, 8 w/ACL + PCL

• Final study group

– 25 pts (26 knees) with ≥2

yrs (avg 2.4) follow-up

• Subjective Eval

– Cincinnati Symptoms, Fn

– IKDC Subjective

• Objective Eval

– IKDC

– Varus Stress

Outcomes: Subjective

Comparison of average subscores at final follow-up

Outcomes: IKDC Objective Stability

Posterolateral stability and single-leg-hop scores

(A=normal, B=nearly normal, C=abnormal, D=severely abnormal)

Conclusions

• FCL, popliteus tendon, PFL

– Anatomic repair of avulsions, reconstruction of mid-

substance tears and intra-substance stretch injuries

• Anatomic repair of other posterolateral

structures with knee in full extension

• Single stage cruciate ligament reconstruction

recommended