Technique Corner: Posterolateral Corner Reconstruction

Posterolateral corner injuries can be challenging to diagnose and require a thorough evaluation of relevant history, physical exam, and imaging. If left untreated, these injuries can result in chronic knee pain, instability, and inability to return to work or sports. This chapter will review basic posterolateral corner anatomy and biomechanics, operative indications, surgical techniques, postoperative rehabilitation, outcomes, and potential complications to provide surgeons a framework for managing patients with these complex injuries. The authors’ preferred technique is a fibula-based posterolateral corner reconstruction utilizing a single Achilles tendon allograft to reconstruct the lateral collateral ligament, popliteus tendon and popliteofibular ligament, which is performed in conjunction with a posterolateral capsular shift. The technique is based on anatomic sockets and graft placement. Furthermore, since posterolateral corner injuries are often part of a multiligamentous injury pattern, it is important to address concurrent anterior cruciate and posterior cruciate ligament injuries at the time of surgery, because anteroposterior instability has been shown to increase forces on the posterolateral corner reconstruction and may result in graft failure. Postoperative rehabilitation follows a staged approach progressing from restoring knee range of motion to building muscular endurance, strength, and power. Short- to mid-term follow-up studies show excellent clinical and functional outcomes, and low risk for subsequent revision surgery.