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

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The Multiple Ligament Injured Knee

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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.

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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

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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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  1. Banff Sport Medicine, Banff, AB, Canada

    Michaela Kopka & S. Mark Heard

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  1. Michaela Kopka
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  2. S. Mark Heard
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Correspondence to S. Mark Heard .

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Editors and Affiliations

  1. Department of Orthopedic Surgery, Geisinger Medical Center/Health System, Danville, PA, USA

    Gregory C. Fanelli

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Kopka, M., Heard, S.M. (2019). Surgical Treatment of Combined PCL/Lateral Side Injuries: Acute and Chronic. In: Fanelli, G. (eds) The Multiple Ligament Injured Knee. Springer, Cham. https://doi.org/10.1007/978-3-030-05396-3_15

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  • DOI: https://doi.org/10.1007/978-3-030-05396-3_15

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