Posterolateral Corner Reconstruction in the Multiligament Injured Knee: State of the Art

Yuen Wen Loong Paul, Lee Yee Han Dave

Volume 5 | Issue 1 | Jan – April 2020 | Page 27-35

Author: Yuen Wen Loong Paul [1], Lee Yee Han Dave [1]

[1] Department of Orthopaedics, Changi General Hospital,2 Simei Street 3, Singapore 5298892

Address of Correspondence

Dr. Lee Yee Han Dave,
Department of Orthopaedics, Changi General Hospital,2 Simei Street 3, Singapore 5298892
E-mail: dave.lee.y.h@singhealth.com.sg

Abstract

Posterolateral corner injuries were labelled as the “dark side” of the knee due to the paucity of knowledge on the subject. This has been increasingly studied and we now have a better understanding of this injury. Posterolateral corner(PLC) injuries are a significant cause of knee instability and cruciate reconstruction failures. This paper aims to review the literature over the last 10 years; on PLC epidemiology, anatomy, biomechanics, clinical and radiographic assessment, management and outcomes.
Keywords: Posterolateral corner, Knee Repair, Reconstruction.

References

1. LaPrade RF, Wentorf FA, Fritts H, Gundry C, Hightower CD. 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 Dec;23(12):1341-7.
2. 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 Jul-Aug;25(4):433-8.
3. Shaw KA, Dunoski BS, Mardis NJ, Pacicca DM. Combined posterolateral corner and acute anterior cruciate ligament injuries in an adolescent cohort: a magnetic resonance imaging analysis. Int Orthop. 2016 Mar;40(3):555-60.
4. 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 Jul-Aug;27(4):469-75.
5. 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 Nov-Dec;31(6):854-60.
6. Chahla J, Moatshe G, Dean CS, LaPrade RF. Posterolateral Corner of the Knee: Current Concepts. Arch Bone Jt Surg. 2016 Apr;4(2):97-103.
7. 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 Feb;69(2):233-42.
8. Shon OJ, Park JW, Kim BJ. Current Concepts of Posterolateral Corner Injuries of the Knee. Knee Surg Relat Res. 2017 Dec 1;29(4):256-268.
9. Kang KT, Koh YG, Son J, Jung M, Oh S, Kim SJ, Kim SH. Biomechanical influence of deficient posterolateral corner structures on knee joint kinematics: A computational study. J Orthop Res. 2018 Feb 13.
10. Djian P. Posterolateral knee reconstruction. Orthop Traumatol Surg Res. 2015 Feb;101 (1 Suppl):S159-70.
11. Crespo B, James EW, Metsavaht L, LaPrade RF. Injuries to posterolateral corner of the knee: a comprehensive review from anatomy to surgical treatment. Rev Bras Ortop. 2015 Jul-Aug; 50(4): 363–370.
12. Kang KT, Koh YG, Nam JH, Jung M, Kim SJ, Kim SH. Biomechanical evaluation of the influence of posterolateral corner structures on cruciate ligaments forces during simulated gait and squatting. PLoS One. 2019 Apr 4;14(4):e0214496.
13. Lee DY, Park YJ, Kim DH, Kim HJ, Nam DC, Park JS, Hwang SC. The role of isolated posterior cruciate ligament reconstruction in knees with combined posterior cruciate ligament and posterolateral complex injury. Knee Surg Sports Traumatol Arthrosc. 2018 Sep;26(9):2669-2678.
14. Forsythe B, Saltzman BM, Cvetanovich GL, Collins MJ, Arns TA, Verma NN, Cole BJ, Bach BR Jr. Dial Test: Unrecognized Predictor of Anterior Cruciate Ligament Deficiency. Arthroscopy. 2017 Jul;33(7):1375-1381.
15. Chahla J, Murray IR, Robinson J, Lagae K, Margheritini F, Fritsch B. Posterolateral corner of the knee: an expert consensus statement on diagnosis, classification, treatment, and rehabilitation. Knee Surg Sports Traumatol Arthrosc. 2019 Aug;27(8):2520-2529.
16. 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 Oct;90(10):2069-76.
17. Kane PW, Cinque ME, Moatshe G, Chahla J, DePhillipo NN, Provencher MT, LaPrade RF. Fibular Collateral Ligament: Varus Stress Radiographic Analysis Using 3 Different Clinical Techniques. Orthop J Sports Med. 2018 May 2;6(5):2325967118770170.
18. wathmey FW Jr, Tompkins MA, Gaskin CM, Miller MD. Can stress radiography of the knee help characterize posterolateral corner injury? Clin Orthop Relat Res. 2012 Mar;470(3):768-73.
19. Jackman T, LaPrade RF, Pontinen T, Lender PA. Intraobserver and interobserver reliability of the kneeling technique of stress radiography for the evaluation of posterior knee laxity. Am J Sports Med. 2008 Aug;36(8):1571-6.
20. 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 Dec;38(12):2502-8.
21. Rosas, Humberto G. Unraveling the Posterolateral Corner of the Knee. RadioGraphics 2016. Vol. 36, No. 6.
22. LaPrade RF, Wentorf F. Diagnosis and treatment of posterolateral knee injuries. Clin Orthop Relat Res. 2002 Sep;(402):110-21.
23. Filli L, Rosskopf AB, Sutter R, Fucentese SF, Pfirrmann CWA. MRI Predictors of Posterolateral Corner Instability: A Decision Tree Analysis of Patients with Acute Anterior Cruciate Ligament Tear. Radiology. 2018 Oct;289(1):170-180.
24. Bonadio MB, Helito CP, Gury LA, Demange MK, Pécora JR, Angelini FJ. Correlation between magnetic resonance imaging and physical exam in assessment of injuries to posterolateral corner of the knee. Acta Ortop Bras. 2014;22(3):124-6.
25. LaPrade RF. Arthroscopic evaluation of the lateral compartment of knees with grade 3 posterolateral knee complex injuries. Am J Sports Med. 1997 Sep-Oct;25(5):596-602.
26. Feng H, Zhang H, Hong L, Wang XS, Zhang J. The lateral gutter drive-through sign: an arthroscopic indicator of acute femoral avulsion of the popliteus tendon in knee joints. Arthroscopy. 2009 Dec;25(12):1496-9.
27. Cooper JM, McAndrews PT, LaPrade RF. Posterolateral corner injuries of the knee: anatomy, diagnosis, and treatment. Sports Med Arthrosc Rev. 2006 Dec;14(4):213-20.
28. Feng H, Zhang H, Hong L, Wang XS, Cheng KB, Zhang J. Femoral peel-off lesions in acute posterolateral corner injuries: incidence, classification, and clinical characteristics. Arthroscopy. 2011 Jul;27(7):951-8.
29. Hughston JC, Andrews JR, Cross MJ, Moschi A. Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am. 1976 Mar;58(2):173-9.
30. Fanelli GC, Larson RV. Practical management of posterolateral instability of the knee. Arthroscopy. 2002 Feb;18(2 Suppl 1):1-8.
31. Kannus P, Järvinen M. Nonoperative treatment of acute knee ligament injuries. A review with special reference to indications and methods. Sports Med. 1990 Apr;9(4):244-60.
32. Krukhaug Y, Mølster A, Rodt A, Strand T. Lateral ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc. 1998;6(1):21-5.
33. Stannard JP1, Brown SL, Farris RC, McGwin G Jr, Volgas DA. The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med. 2005 Jun;33(6):881-8. Epub 2005 Apr 12.
34. 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 Apr;38(4):804-9.
35. McCarthy M, Ridley TJ, Bollier M, Cook S, Wolf B, Amendola A. Posterolateral Knee Reconstruction Versus Repair. Iowa Orthop J. 2015;35:20-5..
36. Westermann RW, Marx RG, Spindler KP, Huston LJ and Amendola A1, Andrish JT, Brophy RH, Dunn WR MOON Knee Group. No Difference Between Posterolateral Corner Repair and Reconstruction With Concurrent ACL Surgery: Results From a Prospective Multicenter Cohort. Orthop J Sports Med. 2019 Jul 30;7(7):2325967119861062.
37. Franciozi, C. E., Kubota, M. S., Abdalla, R. J., Cohen, M., Luzo, M. V. M., & Laprade, R. F. Posterolateral corner repair and reconstruction: overview of current techniques. Annals of Joint 2018. 3, 89–89.
38. Stannard JP, Stannard JT, Cook JL. Repair or Reconstruction in Acute Posterolateral Instability of the Knee: Decision Making and Surgical Technique Introduction. J Knee Surg. 2015 Dec;28(6):450-4.
39. Lerat JL, Dejour H, Trillat A. Treatment of recent and old injuries of the lateral ligament of the knee. Clin. Orthop. Traumatol 1978. Volume 64, Issue 3.
40. Ohnishi Y, Pascual-Garrido C, Kumagae H, Sakai A, Uchida S. Arthroscopic Technique for Isolated Posterolateral Rotational Instability of the Knee. Arthrosc Tech. 2017 Mar 6;6(2):e291-e295.
41. Rauh PB, Clancy WG Jr, Jasper LE, Curl LA, Belkoff S, Moorman CT 3rd. Biomechanical evaluation of two reconstruction techniques for posterolateral instability of the knee. J Bone Joint Surg Br. 2010 Oct;92(10):1460-5.
42. Plaweski S, Belvisi B, Moreau-Gaudry A. Reconstruction of the Posterolateral Corner After Sequential Sectioning Restores Knee Kinematics. Orthop J Sports Med. 2015 Feb 12;3(2):2325967115570560.
43. Yoon KH, Lee JH, Bae DK, Song SJ, Chung KY, Park YW. Comparison of clinical results of anatomic posterolateral corner reconstruction for posterolateral rotatory instability of the knee with or without popliteal tendon reconstruction. Am J Sports Med. 2011 Nov;39(11):2421-8.
44. Kim SJ, Kim TW, Kim SG, Kim HP, Chun YM. Clinical comparisons of the anatomical reconstruction and modified biceps rerouting technique for chronic posterolateral instability combined with posterior cruciate ligament reconstruction. J Bone Joint Surg Am. 2011 May 4;93(9):809-18.
45. Kang KT, Koh YG, Son J, Kim SJ, Choi S, Jung M, Kim SH. Finite Element Analysis of the Biomechanical Effects of 3 Posterolateral Corner Reconstruction Techniques for the Knee Joint. Arthroscopy. 2017 Aug;33(8):1537-1550.
46. Kim SJ, Shin SJ, Choi CH, Kim HC. Reconstruction by biceps tendon rerouting for posterolateral rotatory instability of the knee: Modification of the Clancy technique. Arthroscopy. 2001 Jul;17(6):664-7.
47. Kuzma SA, Chow RM, Engasser WM, Stuart MJ, Levy BA. Reconstruction of the posterolateral corner of the knee with achilles tendon allograft. Arthrosc Tech. 2014 Jun 16;3(3):e393-8.
48. RV, Larson. Isometry of the lateral collateral and popliteofibular ligaments and techniques for reconstruction using a free semitendinosus tendon graft. Operative Techniques in Sports Medicine. 2001 Vol 9, No 2 (April).
49. Borton ZM, Yasen SK, Britton EM, Heaton SR, Palmer HC, Wilson AJ. Combined All-Inside Anterior Cruciate Ligament Reconstruction and Minimally Invasive Posterolateral Corner Reconstruction Using Ipsilateral Semitendinosus and Gracilis Autograft. Arthrosc Tech. 2017 Mar 20;6(2):e331-e339.
50. Arciero RA. Anatomic posterolateral corner knee reconstruction. Arthroscopy. 2005 Sep;21(9):1147.
51. LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, 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 Sep;32(6):1405-14.
52. Frosch KH, Akoto R, Heitmann M4, Enderle E, Giannakos A, Preiss A. Arthroscopic reconstruction of the popliteus complex: accuracy and reproducibility of a new surgical technique. Knee Surg Sports Traumatol Arthrosc. 2015 Oct;23(10):3114-20.
53. Frosch KH, Akoto R, Drenck T, Heitmann M, Pahl C, Preiss A. Arthroscopic popliteus bypass graft for posterolateral instabilities of the knee : A new surgical technique. Oper Orthop Traumatol. 2016 Jun;28(3):193-203.
54. Treme GP, Salas C, Ortiz G, Gill GK, Johnson PJ, Menzer H, Richter DL, Qeadan F, Wascher DC, Schenck RC Jr. A Biomechanical Comparison of the Arciero and LaPrade Reconstruction for Posterolateral Corner Knee Injuries. Orthop J Sports Med. 2019 Apr 15;7(4):2325967119838251.
55. van Gennip S, van der Wal WA, Heesterbeek PJC, Wymenga AB, Busch VJJF. Posterolateral corner reconstruction in combined injuries of the knee: Improved stability with Larson’s fibular sling reconstruction and comparison with LaPrade anatomical reconstruction. Knee. 2020 Jan;27(1):124-131.
56. Kuzma SA, Chow RM, Engasser WM, Stuart MJ, Levy BA. Reconstruction of the posterolateral corner of the knee with achilles tendon allograft. Arthrosc Tech. 2014 Jun 16;3(3):e393-8.
57. Tapasvi SR, Shekhar A, Patil SS. Anatomic Posterolateral Corner Reconstruction With Autogenous Peroneus Longus Y Graft Construct. Arthrosc Tech. 2019 Nov 11;8(12):e1501-e1509.
58. NM, Selim. Combined Anterior Cruciate Ligament and Posterolateral Corner Reconstruction by Hamstring Tendon Autografts Through a Single Femoral Tunnel by Graft-to-Graft Suspension and Fixation. Arthrosc Tech. 2018 Apr 30;7(5):e557-e567.
59. Hermanowicz K, Malinowski K, Góralczyk A, Guszczyn T, LaPrade RF. Minimally Invasive, Arthroscopic-Assisted, Anatomic Posterolateral Corner Reconstruction. Arthrosc Tech. 2019 Feb 11;8(3):e251-e257.
60. Frings J, Kolb JP, Drenck TC, Krause M, Alm L, Akoto R, Frosch KH. Anatomic Reconstruction of the Posterolateral Corner: An All-Arthroscopic Technique. Arthrosc Tech. 2019 Jan 21;8(2):e153-e161..
61. Kolb JP, Frings J, Krause M, Hartel M, Frosch KH. An All-Arthroscopic Technique for Complex Posterolateral Corner Reconstruction. Arthrosc Tech. 2019 Sep 11;8(9):e999-e1006.
62. Ahn JH, Wang JH, Lee SY, Rhyu IJ, Suh DW, Jang KM. Arthroscopic-assisted anatomical reconstruction of the posterolateral corner of the knee joint. Knee. 2019 Oct;26(5):1136-1142.
63. Kim JG, Ha JG, Lee YS, Yang SJ, Jung JE, Oh SJ. Posterolateral corner anatomy and its anatomical reconstruction with single fibula and double femoral sling method: anatomical study and surgical technique. Arch Orthop Trauma Surg. 2009 Mar;129(3):381-5.
64. Bohm KC, Sikka RS, Boyd JL, Yonke B, Tompkins M. Part I: An anatomic-based tunnel in the fibular head for posterolateral corner reconstruction using magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc. 2015 Jul;23(7):1889-94..
65. Kamath GV, Redfern JC, Burks RT. Femoral radiographic landmarks for lateral collateral ligament reconstruction and repair: a new method of reference. Am J Sports Med. 2010 Mar;38(3):570-4.
66. Fok AW, Kuang GM, Yau WP. Femoral radiographic landmarks for popliteus tendon reconstruction and repair: a new method of reference. Am J Sports Med. 2014 Feb;42(2):394-8.
67. Kim SJ, Chang CB, Choi CH, Yoo YS, Kim SH, Ko JH, Park KK. Intertunnel relationships in combined anterior cruciate ligament and posterolateral corner reconstruction: an in vivo 3-dimensional anatomic study. Am J Sports Med. 2013 Apr;41(4):849-57.
68. Krause M, Akoto R, Drenck TC, Frosch KH, Preiss A. Posterolateral Rotatory Knee Instability-MRI Evaluation of Anatomic Landmarks for Tibial Drill Tunnel Placement in Open and Arthroscopic Popliteus Tendon Reconstruction. J Knee Surg 2019 Jul;32(7):667-672.
69. Moatshe G, Dean CS, Chahla J, Serra Cruz R, LaPrade RF. Anatomic Fibular Collateral Ligament Reconstruction. Arthrosc Tech. 2016 Mar 28;5(2):e309-14.
70. Coobs BR, LaPrade RF, Griffith CJ, Nelson BJ. Biomechanical analysis of an isolated fibular (lateral) collateral ligament reconstruction using an autogenous semitendinosus graft. Am J Sports Med. 2007 Sep;35(9):1521-7.
71. Geeslin AG, LaParde RF. Outcomes of treatment of acute grade III isolated and combined Posterolateral knee injuries. J Bone Joint Surg Am. 2011; 93: 1672-83.
72. Mouton SG, Geeslin AG, LaParde RF. A systematic review of outcomes of the posterolateral corner knee injuries Part 2. Surgical treatment of chronic injuries. Am J Sports Med. 2016 Jun;44(6):1616-23.
73. Tardy N, Boisrenoult P, Teissier P, Steltzlen C, Beaufils P, Pujol N. Clinical outcomes after multiligament injured knees: medial versus lateral reconstructions. Knee Surg Sports Traumatol Arthrosc. 2017 Feb;25(2):524-531.
74. Godin JA, Cinque ME, Pogorzelski J, Moatshe G, Chahla J, LaPrade RF. Multiligament Knee Injuries in Older Adolescents: A 2-Year Minimum Follow-up Study. Orthop J Sports Med. 2017 Sep 22;5(9):2325967117727717.
75. Wajsfisz A, Bajard X, Plaweski S, Djian P, Demey G, Limozin R, French Arthroscopy Society (SFA). Surgical management of combined anterior or posterior cruciate ligament and posterolateral corner tears: for what functional results? Orthop Traumatol Surg Res. 2014 Dec;100(8 Suppl):S379-83.
76. Li Y, Hong L, Wang XS, Zhang H, Li X, Zheng T, Feng H. Midterm Clinical Outcome of Combined Posterior Cruciate Ligament Reconstruction and Posterolateral Corner Surgery Using Second-Look Arthroscopic Lateral Gutter Drive-Through Test as an Adjunctive Evaluation. Orthop Surg. 2019 Jun;11(3):422-430.
77. Cartwright-Terry M, Yates J, Tan CK, Pengas IP, Banks JV, McNicholas MJ. Medium-term (5-year) comparison of the functional outcomes of combined anterior cruciate ligament and posterolateral corner reconstruction compared with isolated anterior cruciate ligament reconstruction. Arthroscopy. 2014 Jul;30(7):811-7.
78. Moulton SG, Matheny LM, James EW, LaPrade RF. Outcomes following anatomic fibular (lateral) collateral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2015 Oct;23(10):2960-6.
79. Gormeli G, Gormeli CA, Elmah N, Karakaplan M, Ertem K, Ersoy Y. Outcome of the treatment of chronic isolated and combined posterolateral corner knee injuries with 2-6 year follow-up. Arch Orthop Trauma Surg. 2015, 135, pages1363–1368.
80. Franciozi CE, Albertoni LJB, Kubota MS, Abdalla RJ, Luzo MVM, Cohen M, LaPrade RF. A Hamstring-Based Anatomic Posterolateral Knee Reconstruction With Autografts Improves Both Radiographic Instability and Functional Outcomes. Arthroscopy. 2019 Jun;35(6):1676-1685.e3.
81. Yoon KH, Lee SHo, Park SY, Park SE, Tak DH. Comparison of Anatomic Posterolateral Knee Reconstruction Using 2 Different Popliteofibular Ligament Techniques. Am J Sports Med. 2016 Apr;44(4):916-21.

(Abstract)      (Full Text HTML)      (Download PDF)