Posterolateral corner (PLC) injuries commonly occur in the setting of a dislocated knee and often require multiple procedures due to concomitant vascular, nerve, and soft tissue involvement. Debate persists regarding single vs staged surgery. The purpose of this study was to compare knee function after single and staged surgery for PLC injury.
Patients who underwent surgery for a PLC injury (KD I, IIIL, IV) with minimum follow-up of 2 years were included. Patients treated with staged and single surgery were matched according to age, sex, and KD grade. Lysholm and International Knee Documentation Committee (IKDC) subjective scores were obtained. Risk factors for poor knee function were assessed, including age, nerve, vascular, meniscal and articular cartilage injuries.
Twenty single-surgery patients with a median age of 24 years (median follow-up 5.3 years, range 2–18.3) and 20 staged surgery patients with a median age of 26 years (median follow-up 4.3 years, range 2–19.8) were studied. The mean Lysholm score was 78.7 (± 20.3) in the single surgery and 84.2 (± 17.8) in the staged surgery cohort (n.s.). The mean IKDC score was 80.8 (± 21.1) in the single and 74.9 (± 18.9) in the staged surgery cohort (n.s.). Age at injury, peroneal, vascular, meniscal or cartilage injury were not associated with poor knee outcome.
This study demonstrates similar knee function among patients with PLC injuries treated with single or staged surgical procedures. The need for staged surgery for the dislocated knee with PLC involvement should be individualized based on specific knee and patient-related factors.
Level of evidence
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Acharya K, Pandey V, Rao P (2010) Knee dislocation with multi-ligament injury: evaluation, treatment and results. J Musculoskelet Res 13:119–126
Arciero RA (2005) Anatomic posterolateral corner knee reconstruction. Arthroscopy 21:1141–1147
Barfield WR, Holmes RE, Slone H, Walton ZJ, Hartsock LA (2015) Acute versus staged surgical intervention in multiligamentous knee injuries: a review of the literature since 2009. Curr Orthop Pract 26:530–535
Bin SI, Nam TS (2007) Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation. Arthroscopy 23:1066–1072
Collins MS, Bond JR, Crush AB, Stuart MJ, King AH, Levy BA (2015) MRI injury patterns in surgically confirmed and reconstructed posterolateral corner knee injuries. Knee Surg Sports Traumatol Arthrosc 23:2943–2949
Cooper JM, McAndrews PT, LaPrade RF (2006) Posterolateral corner injuries of the knee: anatomy, diagnosis, and treatment. Sports Med Arthrosc Rev 14:213–220
Cruz RS, Mitchell JJ, Dean CS, Chahla J, Moatshe G, LaPrade RF (2016) Anatomic posterolateral corner reconstruction. Arthrosc Tech 5:563–572
Darabos N, Gusic N, Vlahovic T, Darabos A, Popovic I, Vlahovic I (2013) Staged management of knee dislocation in polytrauma injured patients. Injury 44(3):40–45
Edson CJ (2001) Postoperative rehabilitation of the multiligament-reconstructed knee. Sports Med Arthrosc Rev 9:247–254
Fanelli GC, Giannotti BF, Edson CJ (1996) Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction. Arthroscopy 12:521–530
Fanelli GC, Stannard JP, Stuart MJ, MacDonald PB, Marx RG, Whelan DB et al (2010) Management of complex knee ligament injuries. J Bone Jt Surg Am 92:2235–2246
Geeslin AG, LaPrade RF (2010) Location of bone bruises and other osseous injuries associated with acute grade III isolated and combined posterolateral knee injuries. Am J Sports Med 38:2502–2508
Geeslin AG, LaPrade RF (2011) Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries: a prospective case series and surgical technique. J Bone Jt Surg Am 93:1672–1683
Griffith CJ, Wijdicks CA, Goerke U, Michaeli S, Ellermann J, LaPrade RF (2011) Outcomes of untreated posterolateral knee injuries: an in vivo canine model. Knee Surg Sports Traumatol Arthrosc. 19:1192–1197
Harner CD, Vogrin TM, Hoher J, Ma CB, Woo SL (2000) Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med 28:32–39
Ibrahim SAR, Ghafar S, Salah M, Alnas MA, Al Misfer A, Farouk H et al (2013) Surgical management of traumatic knee dislocation with posterolateral corner injury. Arthroscopy 29:733–741
King AH, Krych AJ, Prince MR, Pareek A, Stuart MJ, Levy BA (2016) Surgical outcomes of medial versus lateral multiligament-injured, dislocated knees. Arthroscopy 32:1814–1819
King AH, Krych AJ, Prince MR, Sousa PL, Stuart MJ, Levy BA (2015) Are meniscal tears and articular cartilage injury predictive of inferior patient outcome after surgical reconstruction for the dislocated knee? Knee Surg Sports Traumatol Arthrosc 23:3008–3011
LaPrade RF, Johansen S, Agel J, Risberg MA, Moksnes H, Engebretsen L (2010) Outcomes of an anatomic posterolateral knee reconstruction. J Bone Jt Surg Am 92:16–22
LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A (2004) An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med 32:1405–1414
LaPrade RF, Ly TV, Wentorf FA, Engebretsen L (2003) The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med 31:854–860
LaPrade RF, Resig S, Wentorf F, Lewis JL (1999) The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. A biomechanical analysis. Am J Sports Med 27:469–475
LaPrade RF, Terry GC (1997) Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability. Am J Sports Med 25:433–438
LaPrade RF, Wentorf FA, Crum JA (2004) Assessment of healing of grade III posterolateral corner injuries: an in vivo model. J Orthop Res 22:970–975
Levy BA, Dajani KA, Morgan JA, Shah JP, Dahm DL, Stuart MJ (2010) Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med 38:804–809
Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ et al (2009) Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy 25:430–438
Levy BA, Giuseffi SA, Bishop AT, Shin AY, Dahm DL, Stuart MJ (2010) Surgical treatment of peroneal nerve palsy after knee dislocation. Knee Surg Sports Traumatol Arthrosc 18:1583–1586
Mook WR, Miller MD, Diduch DR, Hertel J, Boachie-Adjei Y, Hart JM (2009) Multiple-ligament knee injuries: a systematic review of the timing of operative intervention and postoperative rehabilitation. J Bone Jt Surg Am 91:2946–2957
Ohkoshi Y, Nagasaki S, Shibata N, Yamamoto K, Hashimoto T, Yamane S (2002) Two-stage reconstruction with autografts for knee dislocations. Clin Orthop Relat Res. 398:169–175
Redmond JM, Levy BA, Dajani KA, Cass JR, Cole PA (2008) Detecting vascular injury in lower-extremity orthopedic trauma: the role of CT angiography. Orthopedics 31(8):761–767
Sanders TL, Johnson NR, Pareek A, Krych AJ, Marx RG, Stuart MJ et al (2017) Satisfactory knee function after single-stage posterolateral corner reconstruction in the multi-ligament injured/dislocated knee using the anatomic single-graft technique. Knee Surg Sports Traumatol Arthrosc 26(4):1258–1265
Schechinger SJ, Levy BA, Dajani KA, Shah JP, Herrera DA, Marx RG (2009) Achilles tendon allograft reconstruction of the fibular collateral ligament and posterolateral corner. Arthroscopy 25:232–242
Schenck RC (2004) Classification of knee dislocations. The multiple ligament injured knee. Springer, New York, NY, pp 37–49
Serra Cruz R, Mitchell JJ, Dean CS, Chahla J, Moatshe G, LaPrade RF (2016) Anatomic posterolateral corner reconstruction. Arthrosc Tech 5:563–572
Subbiah M, Pandey V, Rao SK, Rao S (2011) Staged arthroscopic reconstructive surgery for multiple ligament injuries of the knee. J Orthop Surg (Hong Kong) 19:297–302
Tay AK, MacDonald PB (2011) Complications associated with treatment of multiple ligament injured (dislocated) knee. Sports Med Arthrosc Rev 19:153–161
Wascher DC, Dvirnak PC, DeCoster TA (1997) Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma 11:525–529
Werner BC, Hadeed MM, Gwathmey FW, Gaskin CM, Hart JM, Miller MD (2014) Medial injury in knee dislocations: What are the common injury patterns and surgical outcomes? Clin Orthop Relat Res 472:2658–2666
Conflict of interest
The authors declare that they have no competing interests. Some individual authors do function as paid consultants for various orthopaedic device companies which did not affect the content or direction of this publication.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all participants.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Freychet, B., Kennedy, N.I., Sanders, T.L. et al. No difference between single and staged posterolateral corner surgical procedures in the multiligament injured/dislocated knee. Knee Surg Sports Traumatol Arthrosc (2020) doi:10.1007/s00167-019-05759-x
- Posterolateral corner
- Knee dislocation
- Staged surgery