Combined Posterior Cruciate Ligament and Posteromedial Reconstruction
Injuries to the posteromedial corner (PMC) have received relatively less attention in the literature than those to the posterolateral corner and as a consequence are often not considered when addressing the posterior cruciate ligament (PCL)-injured knee. Unrecognized or inadequately treated associated injuries are reported to have an incidence of 50–90 % in the PCL-injured knee and this may explain why some studies have shown unfavorable outcomes at midterm follow-up.
Part of the reason why injuries to the PMC may go unrecognized is due to the fact that the phrase “medial sided injury” has become synonymous with medial collateral ligament (MCL) sprains or tears and therefore it is often assumed that the medial-sided injuries will heal with nonoperative management. However, unlike low-grade MCL tears, injuries to the PMC are a significantly different clinical entity biomechanically and are unlikely to heal particularly in the setting of a multiligament-injured knee. In addition, persistent valgus or posteromedial instability can place additional strain on a reconstructed cruciate ligament and potentially cause late graft failure. Therefore, it is essential to have an appropriate index of suspicion and identify these injuries before cruciate reconstruction so that repair and/or reconstruction of the PMC and MCL can be undertaken at the same time.
This chapter seeks to highlight the key features of the anatomy, biomechanics, and surgical management of combined PCL and PMC injuries.
KeywordsPosterior cruciate ligament Posteromedial corner Posterior oblique ligament Medial collateral ligament
- 11.Brantigan OC, Voshell AF. The tibial collateral ligament: its function, its bursae, and its relation to the medial meniscus. J Bone Joint Surg. 1943;25:121–31.Google Scholar
- 19.Bauer KL, Stannard JP. Surgical approach to the posteromedial corner: indications, technique, outcomes. Curr Rev Musculoskelet Med. 2013;6(2):124–31.Google Scholar