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Posterolateral Corner Reconstruction

 

synonyms: posterolateral corner reconstruction, PLC reconstruction, PLC repair, Posterolateral corner repair,

Posterolateral Corner Recon CPT

Posterolateral Corner Recon Anatomy

Posterolateral Corner Recon Indications

  • Grade III injury= direct repair withing 2weeks, the sooner the easier.
  • Chronic PLC injury (>3 weeks from injury)
  • Chronic PLC instability with varus knee alignment: requires concomitant valgus-producing HTO (medial opening wedge). Soft tissue reconstructions will eventually stretch out and fail if alignment is not corrected. (Naudie DD, AJSM 2004;32:60).
  • PCL / PLC injury
  • ACL /PLC injury
  • Acute Multiple ligament knee injury / Knee Dislocation

Posterolateral Corner Recon Contraindications

  • Grade I and Grade II injuries: may be treated non-operatively with early mobilization and expected good outcomes. (Kannus P, Am J Sports Med. 1989;17:83-8). 3-wks of immobilization in full extention followed by progessive ROM and strengthening exercises.

Posterolateral Corner Recon Alternatives

Posterolateral Corner Recon Planning / Special Considerations

  • Ensure any needed soft tissue allografts are available. Multiple options exist for PLC reconstruction.
  • For ACL/PLC injury repair PLC first.
  • For ACL/PCL/PCL injury: Pass all grafts and then fix grafts in the following order: 1-PLC, 2-PCL, 3-ACL.

Posterolateral Corner Recon Technique

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block.
  • Supine position. All bony prominences well padded.
  • General endotracheal anesthesia.
  • Prep and drape in standard sterile fashion.
  • Knee examination under anesthesia.
  • Knee Arthroscopy, evaluate lateral compartment for associated meniscal/chondral injury
  • Measure lateral joint opening with a calibrated nerve hook. Knees that have insufficient posterolateral structures will demonstrate 8mm of joint opeing at the intercondylar notch and >12mm of opening at the periphery of the lateral compartment. (Noyes FR, in Orthoppaedic Sports Medicine, 2003;1907)
  • ACL Reconstruction / PCL Reconstruction.
  • Evaluate iliotibial tract, biceps femoris, peroneal nerve, LCL, popliteus, popliteofibular ligament.
  • Repair injured structures by direct suture, sutures through drill-holes, or suture anchors in acute cases.
  • Expose fibular head. Create tunnel from anterior to posterior at the maximal diameter of the fibular head.
  • Determine isometric point on the lateral femoral epicondyle and drill femoral tunnel.
  • Pull semitendinosus graft through fibular tunnel. Both ends of graft are then pulled into the femoral tunnel the femoral tunnel and secured with an interference screw.
  • Graft is tensioned and fixed at 30° flexion and neutral rotation.
  • Alterative: Split Achilles tendon allograft. Bone block fixed in isometric point on lateral femoral condyle. First limb secured in fibular head. Second limb secured through a tunnel from posterior to anterior in lateral proximal tibia.
  • Irrigate.
  • Close in layers.

Posterolateral Corner Recon Complications

  • Peroneal Nerve Palsy
  • Infection
  • Hematoma
  • Stiffness / decreased ROM
  • Persistent laxity
  • Painful hardware

Posterolateral Corner Recon Follow-up care

  • Post-op: NWB, hinged knee brace locked in extention.
  • 7-10 Days: Wound check, NWB, Hinged brace open from 0-45°. Begin PT, avoid hamstring activity.
  • 6 Weeks: Advance to weight bearing as tolerated, Hinged brace 0-120°. Discontinue brace at 8weeks.
  • 3 Months: Advance to stregthening program
  • 6 Months: Sport specific rehab
  • 1Yr: Return to full activities

Posterolateral Corner Recon Outcomes

Posterolateral Corner Recon Review References

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