(Fig 3-B.38, 39, 42) Posterolateral Corner Reconstruction

https://youtu.be/_pQgDx_WxNM

https://youtu.be/6WOItzqJj1g

 

📌 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.

 

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✅ 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

1. Semin Musculoskelet Radiol. 2016 Feb;20(1):52-64.
2. Arthroscopy. 2004 Jul;20 Suppl 2:195-200.
3. Radiol Clin North Am. 2018 Nov;56(6):935-951.

 

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