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Surgical Treatment of Combined PCL/Lateral Side Injuries: Acute and Chronic

  • Michaela Kopka
  • S. Mark HeardEmail author
Chapter

Abstract

The management of combined posterior cruciate ligament (PCL) and posterolateral corner (PLC) injuries is a challenging, thought-provoking, and rewarding experience for the knee ligament surgeon. This chapter is intended to lay the foundation for understanding the evaluation and management of the acute and chronic PCL–PLC-injured knee. It reviews a brief history of the evolution of surgical management, followed by a detailed discussion of relevant anatomy and biomechanics, which is the critical starting point for surgical reconstruction and rehabilitation. The authors then present a novel technique for reconstructing the PCL and PLC, which employs the concept of graft tensioning and re-tensioning that is gaining popularity in knee reconstruction. Finally, the role of osteotomy in the management of this complex problem is explored. It is expected that both the veteran knee surgeon and one early in their career will gain valuable knowledge and technical pearls for performing combined PCL–PLC reconstruction.

Keywords

Posterior cruciate ligament Posterolateral corner Multi-ligament knee injury Surgical reconstruction Graft tensioning Popliteofibular ligament Fibular collateral ligament Popliteus Common peroneal nerve Osteotomy 

Abbreviations

ABI

Ankle–Brachial Index

ACL

Anterior Cruciate Ligament

AP

Anteroposterior

BF

Biceps Femoris

CPN

Common Peroneal Nerve

CT

Computed Tomography Scan

EUA

Examination Under Anesthesia

FCL

Fibular Collateral Ligament

GT

Gerdy’s Tubercle

HTO

High Tibial Osteotomy

IT

Iliotibial

LE

Lateral Epicondyle

LFC

Lateral Femoral Condyle

LHG

Lateral Head of Gastrocnemius

LM

Lateral Meniscus

MRI

Magnetic Resonance Imaging

MUA

Manipulation Under Anesthesia

NPV

Negative Predictive Value

PCL

Posterior Cruciate Ligament

PF

Patellofemoral

PFL

Popliteofibular Ligament

PLC

Posterolateral Corner

PLT

Popliteus

PPV

Positive Predictive Value

ROM

Range of Motion

Notes

Acknowledgements

We would like to acknowledge the following people who contributed to this chapter. Dr. Catherine Coady, Dalhousie University, for photo and text editing. Dr. Laurie Hiemstra and Dr. Greg Buchko, Banff Sport Medicine, and Sarah Kerslake, M.Sc., for text editing. Susan Heard for drawings and text editing.

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Banff Sport MedicineBanffCanada

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