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📌 Posterolateral Corner (PLC) Injury Treatment
✅ Treatment Overview
- High-grade PLC injuries are best treated with reconstruction rather than repair.
- The lateral collateral ligament (LCL), popliteus tendon (PT), and popliteofibular ligament (PFL) are key reconstruction focus areas.
✅ Acute Injury Management
- Grade I and II: Use a knee brace in extension for 4-6 weeks, followed by physical therapy. Delayed ACL or PCL reconstruction may follow once knee mobility is restored.
- Grade III: Prompt reconstruction of cruciate ligaments and PLC structures. Avulsion injuries are repaired directly to bone, and primary repairs of LCL and PT avulsions without midsubstance tears are done within 2-3 weeks post-injury.
✅ Chronic Injury Management
- Chronic injuries often require ligamentous reconstruction and correction of varus deformity via high tibial medial open osteotomy.
✅ Nonanatomical: These techniques do not place tunnels at the native ligament footprints.
- Clancy Procedure: Tenodesis of the distal biceps tendon to mimic the LCL.
- Larson Procedure: Uses a vertical graft limb from the fibular head to the lateral femoral condyle and an oblique graft limb from the posterior fibular head to the femoral condyle.
- Modified Larson (Fanelli): Uses a washer lock and a figure-of-eight graft configuration.
- Modified Larson (Arciero): Involves two femoral drill holes to reconstruct the PT and LCL footprints.
- Stannard’s Technique: Uses anterior or posterior tibial allografts (minimum 2.4 cm) to reconstruct the LCL, PT, and PFL.
✅ Anatomical: These techniques place grafts in the native anatomical positions.
- LaPrade’s Technique: Reconstruction of the LCL, PT, and PFL with two femoral tunnels, one tibial tunnel, and one fibular tunnel. Preferred graft is a split Achilles allograft.
References
- Semin Musculoskelet Radiol. 2016 Feb;20(1):52-64.
- Arthroscopy. 2004 Jul;20 Suppl 2:195-200.
- Radiol Clin North Am. 2018 Nov;56(6):935-951.
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#PLCInjury, #KneeReconstruction, #OrthopedicSurgery, #LigamentReconstruction, #SportsMedicine, #KneeInjuryTreatment, #LCLReconstruction, #PopliteusTendon, #OrthopedicResearch, #KneeSurgery
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