AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Posterior Lateral Corner Reconstruction-Jeremy M. Burnham, M.D.

Posterior Lateral Corner Reconstruction-Jeremy M. Burnham, M.D.

Pdf Summary

This presentation by Dr. Jeremy M. Burnham focuses on Posterolateral Corner (PLC) reconstruction in the context of multiple ligament knee injuries (MLKIs), using a case study of a 17-year-old male outside linebacker who sustained a significant knee injury during a football game.<br /><br />The patient experienced a knee "buckle and pop" and was initially treated with RICE on-field but lost to follow-up until five weeks later. Physical examination revealed swelling, varus instability, quadriceps atrophy, absent motor function (0/5) in the extensor hallucis longus and tibialis anterior muscles, and loss of sensation, indicating possible nerve involvement. Imaging confirmed PLC and ACL injuries.<br /><br />The presentation reviews MLKI classification (Schenck classification), associated injuries including nerve, vascular, tendon, meniscal, and chondral damage, and highlights that operative treatment is generally superior to non-operative approaches for MLKIs, leading to better functional outcomes and lower rates of post-traumatic osteoarthritis.<br /><br />Timing of surgery remains controversial; early surgery (within 3-6 weeks) aids tissue handling and repair quality but carries risks of complications like compartment syndrome; delayed surgery (beyond 3 weeks) is recommended in some cases to reduce such risks and recover range of motion first. The Surgical Timing and Rehabilitation (STaR) trial is mentioned as a needed multicenter study to provide higher-level evidence on optimal timing and rehab protocols.<br /><br />Preferred graft choices and reconstruction techniques for ACL, PCL, PLC, and MCL/PMC are detailed. Surgical graft tensioning and fixation protocols involve specific knee flexion angles for different ligament reconstructions. Postoperative rehabilitation includes six weeks in a hinged knee brace with progressive weight-bearing and range of motion, followed by gradual return to sport activities over 6-12 months.<br /><br />The case progresses through surgical intervention with quad tendon autograft for ACL and PLC reconstruction, followed by postoperative imaging and clinical follow-up up to six months, demonstrating the recovery trajectory.<br /><br />In conclusion, the presentation underscores the complexity of MLKIs, advocating for operative treatment with properly timed surgery and structured rehabilitation to optimize outcomes in high-demand athletes.

Keywords

Posterolateral Corner reconstruction

Multiple ligament knee injuries

MLKI classification

Schenck classification

ACL injury

Operative treatment

Surgical timing

Rehabilitation protocols

Quad tendon autograft

High-demand athletes