AANA Lab Course 902 - Foundations in Arthroscopy (Resident/Fellow)-Lecture & Demo_ Surgical Approach to Posterior Lateral Corner All Residents Should Perform Knee Dissection to Evaluate Meniscal Repair, Ligament Tunnel Placement, Collateral Ligament Anatomy, and Rele

Lecture & Demo_ Surgical Approach to Posterior Lateral Corner All Residents Should Perform Knee Dissection to Evaluate Meniscal Repair, Ligament Tunnel Placement, Collateral Ligament Anatomy, and Rele

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This presentation by Dr. Paul D. Fadale of Brown Medical School focuses on the posterolateral corner (PLC) of the knee, an anatomically complex region critical for knee stability. The lateral knee is composed of three anatomical layers: the superficial layer containing the iliotibial band (ITB) and biceps femoris; the middle includes quadriceps retinaculum and patellofemoral ligaments; and the deep layer houses the lateral joint capsule, lateral collateral ligament (LCL), and popliteus tendon.<br /><br />The PLC functions via static stabilizers (fibular collateral ligament, popliteofibular ligament, posterior capsule) and dynamic stabilizers (popliteus, biceps femoris, ITB). It controls knee motion in six degrees of freedom including rotations (abduction/adduction, flexion/extension, rotation) and translations (anterior/posterior, medial/lateral, distraction/compression). The LCL provides varus stability, while the popliteus complex resists posterolateral instability and supports the posterior cruciate ligament (PCL).<br /><br />Common injury mechanisms include falls on flexed knees with plantarflexion, dashboard impact in car accidents, and hyperflexion without direct trauma. Most PLC injuries are combined with PCL injuries (~90%). Physical examination involves tests for increased external rotation at 30° and 90° flexion; posterior tibial subluxation may mask PLC injury highlighting the need to reduce the tibia before testing. Collateral ligament testing at 0° and 30° flexion helps differentiate isolated injuries from cruciate ligament involvement.<br /><br />Imaging includes X-rays for fractures and stress views, and MRI (95% accuracy) for tear localization and associated soft tissue damage. Management varies; acute primary repairs are preferred within ~2-3 weeks, while chronic injuries require complex reconstructions using techniques such as biceps tenodesis, fibula-based grafts, or anatomic reconstructions targeting LCL, popliteus, and popliteofibular ligaments.<br /><br />Surgical approaches involve a three-window lateral incision exposing femoral and fibular attachments, with careful peroneal nerve identification and protection. This detailed anatomical and clinical overview emphasizes evolving treatment algorithms for accurate diagnosis and repair to restore knee stability and function.

Keywords

posterolateral corner

knee stability

lateral collateral ligament

popliteus tendon

fibular collateral ligament

posterior cruciate ligament

knee injury mechanisms

MRI knee imaging

posterolateral corner reconstruction

knee physical examination