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Injuries and Surgeries pertaining to Posterolateral Structures (includes LCL)
See also Biomechanics, Knee Alignment, and Component Interdependency and Knee Biomechanics, Functional Anatomy of ACL as well as Multiple Knee-Ligament Reconstructions
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Posterolateral Knee Reconstruction With an Anatomical Bone–Patellar Tendon–Bone Reconstruction of the Fibular Collateral Ligament, Frank R. Noyes and Sue D. Barber-Westin; American Journal of Sports Medicine, Baltimore; February 2007, Vol 35, p. 259-273. Comments: Noyes and Barber-Westin describe the benefits of anatomically-correct reconstruction of the posterolateral structures (also known as posterolateral corner). The lateral collateral ligament (also known as fibular collateral ligament) is best reconstructed with a formal graft, not patched up and sewn together haphazardly. An Analysis of the Causes of Failure in 57 Consecutive Posterolateral Operative Procedures, Frank Noyes, Sue Barber-Westin and Jay Albright; American Journal of Sports Medicine, Baltimore; September 2006, Vol 34, p. 1419-1430. Comments: This penetratingly insightful study highlights the importance of having a full complement of functionally intact tensile structures in the knee. The authors note that in a multi-ligament-injured knee, the cruciate ligaments need to be reconstructed, and any bony malalignments (in particular bowleggedness, also known as genu varum) must be corrected first. Otherwise, the posterolateral reconstruction can be guaranteed to fail. Comparison of 2 Surgical Techniques of Posterolateral Corner Reconstruction of the Knee, Thomas Nau et al.; The American Journal of Sports Medicine, Baltimore; December 2005, Vol 33, p. 1838-1845. Comments: Posterolateral corner (also known as posterolateral-structures or PLC) reconstruction makes considerable technical demands on the surgeon. This cadaver-based study looked at two different surgical methods. Method A entailed reconstructing the tibial and fibular attachments of the popliteus tendon, as well as the lateral collateral ligament (LCL). This method resulted in an abnormal internal tibial rotation during dynamic testing. Method B, which entailed reconstructing the LCL and the popliteofibular ligament, brought good results in dynamic testing. For a comprehensive overview of all the major considerations pertaining to treatment of ACL injuries (including discussions of the impact of concomitant injuries, including damage to other ligaments as well as to articular cartilage and menisci), please see the October 2005 article Clinical Sports Medicine Update: Treatment of Anterior Cruciate Ligament Injuries, Part I, by Bruce D. Beynnon et al., in the ACL Reconstructions via Patellar-Tendon Autografts (includes also Quadriceps Tendon Autografts) Subsection. For insight into the topic of combined PCL (posterior cruciate ligament) and PLC (posterolateral corner, also known as posterolateral structures) reconstruction, please see the March 2005 article Biomechanical Analysis of a Combined Double-Bundle Posterior Cruciate Ligament and Posterolateral Corner Reconstruction, by Jon Sekiya et al., in the PCL Injuries and Reconstructive Surgeries Subsection. For insight into the use of high tibial osteotomy in the context of treating PLC instability, see the January 2004 article Opening Wedge High Tibial Osteotomy for Symptomatic Hyperextension-Varus Thrust, by Naudie et al., in the Osteotomies and Complex Bone-Realignment Surgeries Subsection. For insight into the importance of intact posterolateral structures in the context of ACL-reconstruction success, please see the August 2001 article Revision Anterior Cruciate Surgery with Use of Bone-Patellar Tendon-Bone Autogenous Grafts, by Noyes and Barber-Westin, in the Revision Reconstructions: Factors behind ACL-Graft Failures, Outcomes Subsection. Posteralateral Instability Gary J. Calabrese and John A. Bergfeld; Knee Ligament Rehabilitation, edited by Todd S. Ellenbecker.
Philadelphia, Pennsylvania: Churchill Livingstone (Harcourt), 2000. Pages 160-165. Comments: The posterolateral complex (also known as the posterolateral structures [PLS], the posterolateral corner [PLC], or the arcuate complex) is very important to reliable knee functioning. Sadly, the PLC is often overlooked or forgotten, especially in cases where the doctor focuses only on the cruciate ligaments (ACL and PCL). The PLC includes the LCL (lateral collateral ligament, which is also known as the fibular collateral ligament) as well as several smaller ligaments (including the arcuate, popliteofibular and fabellofibular ligaments), as well as several other structures. This chapter explains the functional anatomy and biomechanics of these structures and how they work together. Given the numerous structures involved, careful diagnosis of PLC problems is essential. Surgical and nonsurgical rehabilitation options are discussed. Severe damage to the PLC is usually treated via careful reconstruction of each of the affected components. Due to the tremendous complexity of this area of the knee, such work requires a surgeon highly experienced specifically with this type of work.
Anatomy of the lateral collateral ligament of the knee, Brad R. Meister; The American Journal of Sports Medicine, Baltimore; Nov/Dec 2000, Vol 28/6, p. 869. Comments: Meister discusses in detail the motion of the LCL, and points out the imperative for kinematically-correct reconstructions of this ligament. He notes that in one study of entailing 500 injured knees, the distribution of torn ligaments was as follows: 63% ACL, 44% MCL, 7% PCL, and 4% LCL, with a considerable number of knees harbouring multiple ligamentous injuries. He points out that the comparatively low incidence of LCL injuries means relatively few surgeons are up-to-date on reconstruction techniques of said ligament. The effects of grade III posterolateral knee complex injuries on anterior-cruciate-ligament graft force: A biomechanical analysis, Robert F. LaPrade; The American Journal of Sports Medicine, Baltimore; Jul/Aug 1999, Vol 27/4, p. 469. Comments: This study shows that untreated grade III posterolateral-structure injuries contribute to anterior-cruciate-ligament graft failure by exposing the nascent ligament to higher forcing. (Note that the term "posterolateral structures" refers the LCL along with several other structures [popliteus tendon, arcuate ligament complex, and lateral capsular ligament], but not the PCL.) (This study is also listed under the Biomechanics, Knee Alignment, and Component Interdependency section.)
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