Purpose: Posterolateral corner (PLC) injuries are complex injuries that account for 7% to 16% of ligamentous knee injuries. PLC injuries are sustained via direct force to the anterolateral knee in hyperextension or with varus load applied or via noncontact twisting or hyperextension. Isolated PLC injuries are rare. Typically PLC injuries occur in combination with posterior cruciate ligament or anterior cruciate ligament tears. PLC injuries are associated with the best outcomes if they are repaired within 2 to 3 weeks postinjury. This video demonstrates the surgical technique for open PLC repair and reviews the indications for, imaging modalities for, and clinical outcomes of PLC repair.

Methods: This video discusses the case presentation of a 36-year-old man with a history of a partial lateral meniscectomy of the left leg who was struck by an automobile. The video reviews the special clinical tests used to evaluate for PLC injury, such as the Lachman test, dial test, varus stress test, external rotation recurvatum test, posterolateral drawer test, and reverse pivot shift test. Radiographs of the left leg confirmed an avulsed fibular head fracture and a Segond fracture of the lateral tibial plateau. MRI confirmed a torn anterior cruciate ligament and disruption of the lateral collateral complex. A staged procedure was indicated, with management of the PLC first followed by anterior cruciate ligament reconstruction after the patient regained full knee range of motion. An incision was made from the Gerdy tubercle to the iliotibial band to visualize the traumatized area. The biceps complex was observed separate from the fibular head. The video shows proximal dissection to identify and protect the peroneal nerve with the use of a loop. The video then shows identification of the sagittal region at which the lateral collateral ligament was avulsed. After curetting the region, a 4.5-mm anchor was inserted into the fibular head with the use of double-loaded, No. 2 multigrade sutures. The peak suture anchor was inserted and pulled to assess stability because the fibular head is cancellous. An additional anchor was then placed on the anterolateral aspect of tibia to allow for capsular repair of the anterolateral ligament and the Segond fracture. The biceps femoris complex and the anterolateral complex were sutured in a in sequential mattress fashion. The sutures were tied with valgus stress on the ankle to shift stress of tissue laterally. Then, 4.75-mm swivel lock sutures were passed adjacent to the Gerdy tubercle to achieve a double-row repair.

Results: Excellent fixation stability was noted on stability testing, and gapping that was noted preoperatively was eliminated. Postoperative rehabilitation included toe-touch weight bearing with the use of crutches for 6 weeks postoperatively. At 6 weeks postoperatively, active and active-assisted range of motion from 0° to 90° range was permitted. From 6 to 12 weeks postoperatively, unrestricted active and active-assisted range of motion and weight bearing were permitted. Collateral ligament reconstruction can be considered at 3 months postoperatively if full range of motion can be obtained. Running can be resumed at 4 months postoperatively, and sports activity can be resumed at 9 to 12 months postoperatively.

Conclusion: In general, studies have shown that PLC reconstruction is superior to PLC repair. However, these studies do not include avulsion-type PLC injuries, which often have intact ligament integrity or partially damaged popliteal and lateral collateral ligaments. In patients with an avulsion-type PLC injury, knee stability can be restored by reattaching avulsed bone or avulsed capsular ligamentous complex. Repair in this subset of patients may be worthwhile and may be associated with a higher success rate than that reported in the literature. Complications of open posterolateral corner repair of the knee include complications typically associated with reconstruction, such as peroneal nerve injury, hematoma, arthrofibrosis, residual laxity on varus stress, and posttraumatic osteoarthritis.