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.
- Close in layers.
Posterolateral Corner Recon Complications
- Peroneal Nerve Palsy
- 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
- Hunter R, AANA Advanced Arthroscopy: The Knee, 2010
- McKeon B, Knee Arthroscopy, 2011
- Insall & Scott Surgery of the Knee: Expert Consult - Online and Print, 5e, 2011
- Leiberman J, Advanced Reconstruction: Knee; 2010
- DeLee & Drez's, Orthopaedic Sports Medicine: 3e; 2009
- Noyes' Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes; 2009
- Ross G JBJS 2004;86A supplement 2:2
- Covey DC, JBJS 2001;83A:106°