Posterolateral Corner of the Knee:Current Concepts

Document Type : CURRENT CONCEPTS REVIEW

Authors

1 Steadman Philippon Research Institute, The Steadman Clinic, Colorado, USA

2 Steadman Philippon Research Institute, The Steadman Clinic, Colorado, USA ------ Orthopedic Department, Oslo University Hospital, Oslo, Norway

Abstract

 
 
 
 Injuries to the posterolateral corner (PLC) comprise a significant portion of knee ligament injuries. A high index of suspicion is necessary when evaluating the injured knee to detect these sometimes occult injuries. Moreover, a thorough physical examination and a comprehensive review of radiographic studies are necessary to identify these injuries. In this sense, stress radiographs can help to objectively determine the extent of these lesions. Non-operative and operative treatment options have been reported depending on the extent of the injury. Complete PLC lesions rarely heal with non-operative treatment, and are therefore most often treated surgically. The purpose of this article was to review the anatomy and clinically relevant biomechanics, diagnosis algorithms, treatment and rehabilitation protocols for PLC injuries.
 

Keywords


  1. Geeslin AG, LaPrade RF. Location of bone bruises and other osseous injuries associated with acute grade III isolated and combined posterolateral knee injuries. Am J Sports Med. 2010; 38(12):2502-8.
  2. Harner CD, Vogrin TM, Hoher J, Ma CB, Woo SL. Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med. 2000; 28(1):32-9.
  3. LaPrade RF, Resig S, Wentorf F, Lewis JL. The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. A biomechanical analysis. Am J Sports Med. 1999; 27(4):469-75.
  4. 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(2):233-8.
  5. Scott WN. Insall & Scott Surgery of the Knee. Philadelphia: Elsevier Health Sciences; 2011.
  6. Griffith CJ, Wijdicks CA, Goerke U, Michaeli S, Ellermann J, LaPrade RF. Outcomes of untreated posterolateral knee injuries: an in vivo canine model. Knee Surg Sports Traumatol Arthrosc. 2011; 19(7):1192-7.
  7. LaPrade RF, Wentorf FA, Crum JA. Assessment of healing of grade III posterolateral corner injuries: an in vivo model. J Orthop Res. 2004; 22(5):970-5.
  8. Geeslin AG, LaPrade RF. Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries: a prospective case series and surgical technique. J Bone Joint Surg Am. 2011; 93(18):1672-83.
  9. LaPrade RF, Ly TV, Wentorf FA, Engebretsen L. The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med. 2003; 31(6):854-60.
  10. Gollehon DL, Torzilli PA, Warren RF. 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):233-42.
  11. Grood ES, Stowers SF, Noyes FR. 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.
  12. Gwathmey FW Jr, Tompkins MA, Gaskin CM, Miller MD. Can stress radiography of the knee help characterize posterolateral corner injury. Clin Orthop Relat Res. 2012; 470(3):768-73.
  13. Kawashima T, Takeishi H, Yoshitomi S, Ito M, Sasaki H. Anatomical study of the fabella, fabellar complex and its clinical implications. Surg Radiol Anat. 2007; 29(8):611-6.
  14. LaPrade RF, Tso A, Wentorf FA. Force measurements on the fibular collateral ligament, popliteofibular ligament, and popliteus tendon to applied loads. Am J Sports Med. 2004; 32(7):1695-701.
  15. LaPrade RF, Wozniczka JK, Stellmaker MP, Wijdicks CA. Analysis of the static function of the popliteus tendon and evaluation of an anatomic reconstruction: the “fifth ligament” of the knee. Am J Sports Med. 2010; 38(3):543-9.
  16. LaPrade RF. Arthroscopic evaluation of the lateral compartment of knees with grade 3 posterolateral knee complex injuries. Am J Sports Med. 1997; 25(5):596-602.
  17. Ranawat A, Baker CL 3rd, Henry S, Harner CD. Posterolateral corner injury of the knee: evaluation and management. J Am Acad Orthop Surg. 2008; 16(9):506-18.
  18. LaPrade RF. Posterolateral knee injuries: anatomy, evaluation, and treatment. Stuttgart: Thieme; 2011.
  19. Parsons EM, Gee AO, Spiekerman C, Cavanagh PR. The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med. 2015; 43(8):NP22.
  20. LaPrade RF, Terry GC. Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability. Am J Sports Med. 1997; 25(4):433-8.
  21. Cooper JM, McAndrews PT, LaPrade RF. Posterolateral corner injuries of the knee: anatomy, diagnosis, and treatment. Sports Med Arthrosc. 2006; 14(4):213-20.
  22. Veltri DM, Deng XH, Torzilli PA, Warren RF, Maynard MJ. The role of the cruciate and posterolateral ligaments in stability of the knee. A biomechanical study. Am J Sports Med. 1995; 23(4):436-43.
  23. Bae JH, Choi IC, Suh SW, Lim HC, Bae TS, Nha KW, et al. Evaluation of the reliability of the dial test for posterolateral rotatory instability: a cadaveric study using an isotonic rotation machine. Arthroscopy. 2008; 24(5):593-8.
  24. Cooper DE. Tests for posterolateral instability of the knee in normal subjects. Results of examination under anesthesia. J Bone Joint Surg Am. 1991; 73(1):30-6.
  25. LaPrade RF, Ly TV, Griffith C. The external rotation recurvatum test revisited: reevaluation of the sagittal plane tibiofemoral relationship. Am J Sports Med. 2008; 36(4):709-12.
  26. LaPrade RF, Heikes C, Bakker AJ, Jakobsen RB. The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. An in vitro biomechanical study. J Bone Joint Surg Am. 2008; 90(10):2069-76.
  27. LaPrade RF, Gilbert TJ, Bollom TS, 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):191-9.
  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):83-8.
  29. Krukhaug Y, Molster A, Rodt A, Strand T. Lateral ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc. 1998; 6(1):21-5.
  30. LaPrade RF, Hamilton CD, Engebretsen L. Treatment or acute and chronic combined anterior cruciate ligament and posterolateral knee ligament injuries. Sports Med Arthrosc. 1997; 5(2):91-9.
  31. Stannard JP, Brown SL, Farris RC, McGwin G Jr, Volgas DA. The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med. 2005; 33(6):881-8.
  32. Levy BA, Dajani KA, Morgan JA, Shah JP, Dahm DL, Stuart MJ. Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med. 2010; 38(4):804-9.
  33. Clancy WG Jr, Sutherland TB. Combined posterior cruciate ligament injuries. Clin Sports Med. 1994; 13(3):629-47.
  34. McCarthy M, Camarda L, Wijdicks CA, Johansen S, Engebretsen L, Laprade RF. Anatomic posterolateral knee reconstructions require a popliteofibular ligament reconstruction through a tibial tunnel. Am J Sports Med. 2010; 38(8):1674-81.
  35. LaPrade RF, Johansen S, Agel J, Risberg MA, Moksnes H, Engebretsen L. Outcomes of an anatomic posterolateral knee reconstruction. J Bone Joint Surg Am. 2010; 92(1):16-22.
  36. LaPrade RF, Hamilton CD. The fibular collateral ligament-biceps femoris bursa. An anatomic study. Am J Sports Med. 1997; 25(4):439-43.
  37. Black BS, Stannard JP. Repair versus reconstruction in acute posterolateral instability of the knee. Sports Med Arthrosc. 2015; 23(1):22-6.
  38. Geeslin AG, Moulton SG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, part 1: surgical treatment of acute injuries. Am J Sports Med. 2015; 44(2):1-7.