Posterolateral Knee Reconstruction

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The posterolateral corner of the knee is a complex area of the knee. The diagnosis of acute and chronic posterolateral knee injuries is also complex and requires various examination tests and imaging studies. Dr. LaPrade recommends to all patients with a complete, or Grade III injury, to undergo posterolateral reconstruction. The timing of this surgery is crucial and ideally, acute injuries should be treated within the first three weeks with either a repair or an anatomic reconstruction of the injured structures.

Description of Posterolateral Reconstruction

Dr. LaPrade will assess the patient’s knee alignment with a long leg x-ray. Dr. LaPrade usually recommends a combined hybrid approach of repair for those repairable structures and a reconstruction of midsubstance tears of the posterolateral corner for acute injuries; while in chronic injuries he generally performs a posterolateral reconstruction.

Dr. LaPrade has developed and validated multiple surgical techniques to treat these injuries to include:

Lateral collateral ligament reconstructions
• Popliteus tendon reconstructions
• Proximal tibiofibular joint reconstructions
• Complete posterolateral corner reconstructions

Dr. LaPrade has validated these objectively with stress radiographs and subjectively with patient outcome scores and demonstrated these results are much better than historical treatments for these injuries.

In chronic injuries, there is a very high risk of having any soft tissue posterolateral reconstruction stretch out in the face of varus alignment. Thus, for chronic posterolateral knee injuries, it is recommended to perform a proximal tibial opening wedge osteotomy, first, and to have the osteotomy heal, then assess if they still have functional limitations after the osteotomy heals.

Post-Op

The postoperative rehabilitation for these injuries includes immediate range of motion within the “safe zone” decided by the surgeon at the time of surgery, to be nonweight bearing for six weeks postoperatively and to avoid isolated active hamstring exercises for the first four months postoperatively to avoid significant stress to the healing posterolateral corner repair and reconstruction procedures.

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