Skip to main content

Satisfactory knee function after single-stage posterolateral corner reconstruction in the multi-ligament injured/dislocated knee using the anatomic single-graft technique



Increasing importance has been placed on the posterolateral corner (PLC) in maintaining varus and rotational stability of the knee. The goal of this study was to evaluate knee function and clinical stability following a single-graft PLC reconstruction technique and identify factors associated with poor knee function.


This study identified patients with a multi-ligament knee injury between 2006 and 2013. Patients who received a single-graft fibular collateral ligament and PLC reconstruction with a single-stage surgery during the study period and had a minimum follow-up of 2 years after surgery were included. Functional outcomes were assessed using Lysholm and IKDC scores. Varus and rotational knee laxity and range of motion were assessed using physical examination.


The final study cohort included 61 patients who underwent PLC reconstruction using a single-graft technique. The mean IKDC score was 74.1 (± 22.3) and the mean Lysholm score was 80.3 (± 21.8) at mean follow-up of 3.8 years (range 2–9 years). Mean range of motion at final follow-up measured from 0° to 126° [range flexion: 95–145, range extension: 0–5]. Fifty-eight patients (95%) had grade 0 varus laxity in full knee extension, and 54 patients (88.5%) had grade 0 varus laxity at 30° of knee flexion. Female gender was associated with a lower postoperative IKDC score (p = 0.04).


Surgical treatment of the PLC using a single-graft technique can result in satisfactory knee function and stable physical examination findings at minimum 2 years after surgery. Female gender was predictive of poor knee function after PLC reconstruction. Surgical treatment of PLC injuries should be individualized based on the timing of surgery, specific injured knee structures, and physical examination findings. This study helps validate the use of a single-graft technique for PLC reconstruction and can be used to help counsel patients about expected knee function after surgical treatment of PLC injuries.

Level of evidence IV.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. Anderson A, Irrgang J, Kocher M, Mann B, Harrast J, International Knee Documentation Committee (2006) The international knee documentation committee subjective knee evaluation form: normative data. Am J Sports Med 34:128–135

    Article  PubMed  Google Scholar 

  2. Blackman A, Engasser W, Krych A, Stuart M, Levy B (2015) Fibular head and tibial-based (2-tailed) posterolateral corner reconstruction. Sports Med Arthrosc 23:44–50

    Article  PubMed  Google Scholar 

  3. Briggs K, Steadman J, Hay C, Hines S (2009) Lysholm score and Tegner activity level in individuals with normal knees. Am J Sports Med 37:898–901

    Article  PubMed  Google Scholar 

  4. Chahal J, Whelan D, Jaglal S, Smith P, MacDonald P, Levy B, Davis A (2014) The multiligament quality of life questionnaire: development and evaluation of test-retest reliability and validity in patients with multiligament knee injuries. Am J Sports Med 42:2906–2916

    Article  PubMed  Google Scholar 

  5. Collins M, Bond J, Crush A, Stuart M, King A, Levy B (2015) MRI injury patterns in surgically confirmed and reconstructed posterolateral corner knee injuries. Knee Surg Sports Traumatol Arthrosc 23:2943–2949

    Article  PubMed  Google Scholar 

  6. Demirdjian A, Petrie S, Guanche C, Thomas K (1998) The outcomes of two knee scoring questionnaires in a normal population. Am J Sports Med 26:46–51

    CAS  Article  PubMed  Google Scholar 

  7. Edson C (2001) Postoperative rehabilitation of the multiligament-reconstructed knee. Sports Med Arthrosc Rev 9:247–254

    Article  Google Scholar 

  8. Fanelli G, Edson C (2012) Surgical treatment of combined PCL–ACL medial and lateral side injuries (global laxity): surgical technique and 2 to 18 year results. J Knee Surg 25:307–316

    Article  PubMed  Google Scholar 

  9. Fanelli G, Orcutt D, Edson C (2005) The multiple-ligament injured knee: evaluation, treatment, and results. Arthroscopy 21:471–486

    Article  PubMed  Google Scholar 

  10. Fanelli G, Stannard J, Stuart M, MacDonald P, Marx R, Whelan D, Boyd J, Levy B (2010) Management of complex knee ligament injuries. J Bone Joint Surg Am 92:2235–2246

    PubMed  Google Scholar 

  11. Geeslin A, LaPrade R (2011) Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries: a prospective case series and surgical technique. J Bone Joint Surg Am 93:1672–1683

    Article  PubMed  Google Scholar 

  12. Geeslin A, Moulton S, LaPrade R (2016) A systematic review of the outcomes of posterolateral corner knee injuries, part 1: surgical treatment of acute injuries. Am J Sports Med 44:1336–1342

    Article  PubMed  Google Scholar 

  13. Jakobson B, Lund B, Christiansen S, Lind M (2010) Anatomic reconstruction of the posterolateral corner of the knee: a case series with isolated reconstruction in 27 patients. Arthroscopy 26:918–925

    Article  Google Scholar 

  14. Jiang W, Yao J, He Y, Sun W, Huang Y, Kong D (2015) The timing of surgical treatment of knee dislocations: a systematic review. Knee Surg Sports Traumatol Arthrosc 23:3108–3113

    Article  PubMed  Google Scholar 

  15. King A, Krych A, Prince M, Pareek A, Stuart M, Levy B (2016) Surgical outcomes of medial versus lateral multiligament-injured, dislocated knees. Arthroscopy 32:1814–1819

    Article  PubMed  Google Scholar 

  16. Krych A, Giuseffi S, Kuzma S, Stuart M, Levy B (2014) Is peroneal nerve injury associated with worse function after knee dislocation? Clin Orthop Relat Res 472:2630–2636

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kuzma S, Chow R, Engasser W, Stuart M, Levy B (2014) Reconstruction of the posterolateral corner of the knee with Achilles tendon allograft. Arthrosc Tech 3:e393–e398

    Article  PubMed  PubMed Central  Google Scholar 

  18. LaPrade R, Heikes C, Bakker A, Jakobsen R (2008) The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. An in vitro biomechanical study. J Bone Joint Surg Am 90:2069–2076

    Article  PubMed  Google Scholar 

  19. LaPrade R, Johansen S, Agel J, Risberg M, Moksnes H, Engebretsen L (2010) Outcomes of an anatomic posterolateral knee reconstruction. J Bone Joint Surg Am 92:16–22

    Article  PubMed  Google Scholar 

  20. LaPrade R, Johansen S, Wentorf F, Engebretsen L, Esterberg J, 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

    Article  PubMed  Google Scholar 

  21. Levy B, Dajani K, Morgan J, Shah J, Dahm D, Stuart M (2010) Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med 38:804–809

    Article  PubMed  Google Scholar 

  22. McCarthy M, Carmarda L, Wijkicks C, Johansen S, Engebretsen L, LaPrade R (2010) Anatomic posterolateral knee reconstructions require a popliteofibular ligament reconstruction through a tibial tunnel. Am J Sports Med 38:1674–1681

    Article  PubMed  Google Scholar 

  23. Moulton S, Geeslin A, LaPrade R (2016) A systematic review of the outcomes of posterolateral corner knee injuries, part 2: surgical treatment of chronic injuries. Am J Sports Med 44:1616–1623

    Article  PubMed  Google Scholar 

  24. Nau T, Chevalier Y, Hagemeister N, Deguise J, Duval N (2005) Comparison of 2 surgical techniques of posterolateral corner reconstruction of the knee. Am J Sports Med 33:1838–1845

    Article  PubMed  Google Scholar 

  25. Pestka J, Bode G, Salzmann G, Steinwachs M, Schmal H, Sudkamp N, Neimeyer P (2014) Clinical outcomes after cell-seeded autologous chondrocyte implantation of the knee: when can success or failure be predicts? Am J Sports Med 42:208–225

    Article  PubMed  Google Scholar 

  26. Prince M, Stuart M, King A, Sousa P, Levy B (2015) Posterolateral reconstruction of the knee: two-tailed surgical techniques. J Knee Surg 28:464–470

    Article  PubMed  Google Scholar 

  27. Ranawat A, Baker C, Henry S, Harner C (2008) Posterolateral corner injury of the knee: evaluation and management. J Am Acad Orthop Surg 16:506–518

    Article  PubMed  Google Scholar 

  28. Rios C, Leger R, Cote M, Yang C, Arciero R (2010) Posterolateral corner reconstruction of the knee: evaluation of a technique with clinical outcomes and stress radiography. Am J Sports Med 38:1564–1574

    Article  PubMed  Google Scholar 

  29. Schechinger S, Levy B, Dajani K, Shah J, Herrera D, Marx R (2009) Achilles tendon allograft reconstruction of the fibular collateral ligament and posterolateral corner. Arthroscopy 25:232–242

    Article  PubMed  Google Scholar 

  30. Stannard J, Brown S, Farris R, McGwin G, Volgas D (2005) The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med 33:881–888

    Article  PubMed  Google Scholar 

  31. Stannard J, Brown S, Robinson J, McGwin G, Volgas D (2005) Reconstruction of the posterolateral corner of the knee. Arthroscopy 21:1051–1059

    Article  PubMed  Google Scholar 

  32. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    Google Scholar 

  33. Werner B, Hadeed M, Gwarthmey F, Gaskin C, Hart J, Miller M (2014) Medial injury in knee dislocations: what are the common injury patterns and surgical outcomes? Clin Orthop Relat Res 472:2658–2666

    Article  PubMed  PubMed Central  Google Scholar 

  34. Yang B, Bae W, Ha J, Lee D, Jang H, Kim J (2013) Posterolateral corner reconstruction using the single fibular sling method for posterolateral rotatory instability of the knee. Am J Sports Med 41:1605–1612

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Bruce A. Levy.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.


No external source of funding.

Ethical Approval

Institutional Review Board approval was granted by Mayo Clinic (07-004018).

Informed consent

Informed consent was obtained for all patients in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sanders, T.L., Johnson, N.R., Pareek, A. et al. 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, 1258–1265 (2018).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Multi-ligament knee injury
  • Posterolateral corner
  • Knee
  • Knee dislocation