Anatomic Posterolateral Reconstruction

Posterolateral corner of the knee is an anatomically complex region with variable formation of tendons and ligaments which provide important posterolateral stability of the knee. Injury of this region is often a high-energy multi-ligament injury that rarely happens in isolation. The three posterolateral structures that are biomechanically and surgically most important are fibular collateral ligament, popliteus tendon muscle, and popliteofibular ligament. A thorough physical examination combined with stress radiographs and magnetic resonance imaging is critical to accurately define the injured structures. Diagnostic arthroscopy further enhances our surgical decision-making in choosing the proper reconstruction technique. The most appropriate posterolateral corner surgical reconstruction should be used based on the careful grading of each injury. The aim of different surgical reconstructions is to restore the normal knee biomechanics. Surgical techniques have progressed and range from the classical wide-open approach, to minimally invasive approach with two mini-open incisions and percutaneous posterolateral corner reconstruction to arthroscopic popliteus bypass reconstruction. Posterolateral reconstruction is usually involved in complex knee reconstruction and mostly combined with posterior or anterior cruciate ligament reconstruction. High tibial osteotomy is used in chronic cases of varus malalignment in knees with posterolateral injury. Posterolateral corner reconstructions are technically demanding procedures. Complications after such procedure can arise in large part due to the complex anatomy and injury pattern of this region combined with a surgeon’s lack of experience and thus require a highly skilled and experienced surgeon to perform them.