AANA Middle East Arthroscopy Master Course (International)-Surgical Approach & Technique to Posterolateral Corner & Posterior Cruciate Ligament

Surgical Approach & Technique to Posterolateral Corner & Posterior Cruciate Ligament

Pdf Summary

This presentation by Mark R. Hutchinson, MD, Professor of Orthopaedics & Sports Medicine at the University of Illinois at Chicago, provides a comprehensive overview of the anatomy, injury mechanisms, diagnostic evaluation, and surgical reconstruction techniques of the Posterolateral Corner (PLC) and Posterior Cruciate Ligament (PCL) of the knee.<br /><br />Anatomically, the lateral knee consists of three layers: Layer 1 includes the iliotibial band (ITB) and biceps femoris with the peroneal nerve running deep; Layer 2 comprises the quadriceps retinaculum and patellofemoral ligaments; Layer 3 encompasses the lateral joint capsule, lateral collateral ligament (LCL), and popliteus tendon. The PLC complex includes key structures such as the LCL, popliteus tendon, and popliteofibular ligament (PFL), with precise femoral and fibular attachment sites detailed for surgical reference.<br /><br />Injury incidence ranges from 1-3% of knee injuries but is noted in 37-44% of traumatic knees with hemarthrosis, commonly due to motor vehicle accidents and athletic trauma. Mechanisms include dashboard impacts and falls on a flexed knee. The PCL injuries may be isolated or combined with PLC injuries.<br /><br />Diagnosis involves physical examination (posterior drawer test with 90% sensitivity and 99% specificity), radiographs, stress views, and MRI. Treatment decision depends on injury grade and chronicity, with grade III acute injuries often requiring surgical reconstruction.<br /><br />Surgical goals focus on precise anatomic tunnel placement, identifying and addressing all injury components, strong graft selection, secure fixation, and tailored rehabilitation. Reconstruction can be single- or double-bundle, the latter better replicating native PCL biomechanics though without definitive superior clinical outcomes.<br /><br />Two main surgical techniques are described: transtibial, which is more familiar but risks graft abrasion and neurovascular injury, and tibial inlay, which avoids the "killer turn" of graft passage and allows direct bone block healing.<br /><br />Graft choices vary: autografts like patellar tendon or hamstring preferred for isolated PCL, and allografts for multiligamentous cases. The stepwise surgical process includes arthroscopic evaluation, safety incisions to protect neurovascular structures, precise femoral and tibial tunnel formation, graft passage, fixation, and tensioning.<br /><br />In summary, effective management of PLC and PCL injuries demands detailed anatomical knowledge, accurate diagnosis, and meticulous surgical technique to restore knee stability and function.

Keywords

Posterolateral Corner

Posterior Cruciate Ligament

knee anatomy

knee injury mechanisms

diagnostic evaluation

surgical reconstruction

lateral knee layers

PLC injury incidence

PCL injury diagnosis

graft selection