Anatomic Reconstruction of the Posterolateral Bundle of the Anterior Cruciate Ligament and Posterolateral Corner with Lateral Capsule, Biceps Femoris Tendon, and Lateral Meniscal Repairs.

Abstract

Background: Multiligament injuries can severely impair knee stability and function, leading to long-term complications if not managed. Injuries involving the posterolateral corner (PLC), especially when combined with anterior cruciate ligament (ACL) tears, require prompt anatomic reconstruction to restore normal knee function.

Indications: Unrecognized or inadequately treated PLC injuries can lead to persistent varus and rotational instability, increasing stress on cruciate ligament grafts and compromising reconstruction outcomes. Thus, timely surgical reconstruction of all 3 primary PLC stabilizers (the fibular collateral ligament [FCL], popliteus tendon, and popliteofibular ligament [PFL]) is critical to restoring native biomechanics and maintaining long-term knee function.

Technique description: This technique describes an anatomic reconstruction of the posterolateral (PL) bundle of the ACL, along with repairs of the lateral capsule, biceps femoris tendon, and lateral meniscus, in a patient presenting with complete foot drop. After careful neurolysis of the surrounding common peroneal nerve scar tissue, anatomic tunnels were drilled for reconstruction of the PLC-including the FCL, popliteus tendon, and PFL. Sutures were placed in the lateral capsule for a repair later in the case. Next, arthroscopy was performed to evaluate the ACL bundles, during which a PL bundle tear was identified. A semitendinosus tendon autograft was then harvested. The ACL PL bundle femoral tunnel was drilled, followed by an inside-out repair of the lateral meniscus. The ACL PL bundle tibial tunnel was then created. Grafts were passed and fixed sequentially, with the PLC grafts secured first, followed by fixation of the ACL graft in full extension. The procedure concluded with open repairs of the avulsed biceps femoris tendon and lateral capsule.

Results: Geeslin et al reported that acute PLC injuries treated surgically within 3 weeks had more favorable outcomes with reconstruction or hybrid techniques, while primary repair followed by staged cruciate reconstruction was associated with higher failure rates.

Discussion/conclusion: Timely anatomic reconstruction of the main PLC static stabilizers with a concurrent repair of the tendon and capsular structures effectively and reliably restores native knee stability in acute settings. Compared with delayed or staged procedures, early reconstruction often leads to improved outcomes and reduces the risk of graft failure.

Patient consent disclosure statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.