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The external rotation recurvatum test. With the patient supine, the examiner stabilizes the patient's distal femur with 1 hand and lifts the patient's great toe with the other hand, to observe the amount of genu recurvatum.
Source publication
Synopsis:
Injuries to the posterolateral corner of the knee pose a significant challenge to sports medicine team members due to their complex nature. Identifying posterolateral corner injuries is paramount to determining proper surgical management of the injured athlete, with the goal of preventing chronic pain, instability, and/or surgical failur...
Citations
... The area under the red circle shows sagittal proton-density fast-spin-echo (PDFSE) with fat sat: There is bone marrow contusion of the posterolateral tibial plateau, and there is also fluid posterior to the popliteus, indicative of PLC injury (Figures 1, 2). 2024 Table 3 shows phase-wise rehabilitation [11]. Figure 3 and Figure 4 show the vastus medialis oblique strengthening exercise. ...
This case report describes the rehabilitation of a 54-year-old female patient with a left knee dislocation and multiligament injury after surgery. The patient experienced persistent pain and difficulty with weight-bearing, leading to the need for surgical repair. The rehabilitation protocol included three phases: pain management, range-of-motion (ROM) restoration, muscle strength improvement, proprioception, and equilibrium promotion. Modalities like cryotherapy, compression, manual therapy, and a tailored exercise regimen were used. The patient's outcomes showed significant improvements post-rehabilitation, emphasizing the importance of structured physiotherapy interventions in recovery and functional restoration. The aim of the case report is to highlight the efficacy of a structured physiotherapy intervention protocol in facilitating recovery and functional restoration for patients with knee dislocation and multiligament injury post-surgery. Further research and evidence-based rehabilitation strategies are needed to improve outcomes in similar cases.
... There is a paucity of outcomes data regarding the nonoperative treatment of FCL injuries [40]. However, good outcomes have been reported in the literature regarding nonoperative treatment for grade I or II PLC injuries [37,41]. ...
... It is important to note that patients with a varus thrust gait may not have injury to the PLC, as the varus thrust pattern indicates increased medial condyle weight-bearing which is also seen in medial compartment arthrosis [36]. In addition, a patient with concurrent common peroneal nerve injury may present with a steppage gait [43]. ...
... Testing provides meaningful information, beyond strictly time from surgery, to guide decision-making regarding return to activities and sport. [5,13,61,62] OUTCOMES Geeslin et al. [63] and Moulton et al. [15] reported results of systematic reviews of acute and chronic PLC surgical management, respectively. In the acute setting, reconstruction of the PLC was associated with 81% success rate and 19% failure rate, as measured by a combination of post-operative Lysholm scores, International Knee Documentation Committee (IKDC) scores, and varus stress examination and radiography. ...
In this review, we examine the current understanding of posterolateral corner (PLC) injuries and treatment methods. We discuss the anatomy of the major structures of the PLC and the biomechanics of how these structures function together as a unit. The diagnosis using physical examination, radiographs, and magnetic resonance imaging is discussed. The development of an anatomic reconstruction technique is then described, along with the surgical technique and rehabilitation protocols. Anatomic-based reconstruction methods and a regimented rehabilitation protocol better restore the native biomechanics of the knee, and improve subjective and objective outcomes at follow-up.
... Other tests have been described as findings of PLC instability and may be added to the clinical examination. 10 Once suspicion of a PLC injury has been identified, appropriate imaging may include standard radiographs of the knee with adjunctive stress views when appropriate (Fig 1). Views of the contralateral extremity are important to get as a comparison of patient-specific normalcy, especially with stress radiographs. ...
The posterolateral corner (PLC) is an important stabilizer of the knee. This complex of ligaments and tendons functions as the primary restraint to varus and posterolateral rotation of the knee. Injury to the PLC can result in chronic instability, a varus-thrust gait, and early arthrosis of the medial compartment of the knee if left untreated. Several techniques have been designed to address injuries of the PLC. Over the last 30 years, our understanding of the posterolateral corner as well as its operative reconstruction evolved. This evolution has attempted to refine what is an “anatomic” reconstruction. With more improved techniques and new, innovative fixation devices, we hope to make a more favorable repair for recreating the native stability of the posterolateral corner.
... Association with fibular nerve injury can be found in 12-29% of the cases. Vascular injuries are rare [5], but the ABI (Ankle Brachial Index) should always be performed in case of vascular injury suspicion [28]. A prospective study evaluating patients who underwent Magnetic Resonance Imaging (MRI) for acute knee injury demonstrated an overall incidence of 9.1% of PLC injuries and 16% of cases associated with ACL or PCL rupture [17]. ...
Fibular head avulsion fractures are rare and are so-called the arcuate signal. Avulsion fracture of the iliotibial band and anterolateral ligament is known as a Segond fracture, and it is another rare entity. We describe the case of a 27-year-old woman who was hit by a car and suffered polytrauma, mainly suffering injuries to both knees. Radiographs of the knees showed a Segond fracture associated with the arched signal bilaterally. The aim of this study is to present a rare case report and literature review of a bilateral fibular head avulsion fracture associated with an anterolateral tibial avulsion fracture.
... [2][3][4][5][6] Our approach and perspective is based on a large body of anatomic, biomechanical, and clinical outcomes research that has collectively improved the treatment of these injures through better understanding of the anatomy and greater sensitivity and accuracy of diagnostic techniques, and ultimately validated this anatomic-based reconstruction technique. [6][7][8][9][10][11][12][13][14] This approach recreates the anatomy of the PLC using the anatomic attachments of the FCL, PFL, and PT. Biomechanically, this reconstruction technique described by LaPrade et al. 7 restores the native varus and rotational stability. ...
Historically described as the “dark side of the knee,” the posterolateral corner of the knee has been a significant focus of anatomic, biomechanical, and clinical outcomes research due to poor treatment outcomes for these injuries before improvements over the past 2 decades. These research efforts have resulted in significant improvements in the understanding, diagnosis, and surgical treatment of these injuries. Perhaps most importantly, improved understanding of the anatomy and biomechanics has led to the development of anatomic-based reconstructions, which have been subsequently validated with both biomechanical and clinical outcomes. Due to the complex anatomy and proximity of neurovascular structures, reconstructions have historically used large “hockey stick” incisions to provide adequate visualization to identify the anatomic insertions of the static stabilizers and ensure adequate protection of neurovascular structures. These anatomic-based techniques have significantly improved the clinical and objective outcomes of the surgical treatment of posterolateral knee injuries. However, as techniques have evolved and the clinical outcomes have improved, clinicians have attempted to develop and employ less-invasive and arthroscopically assisted techniques. Specifically, given the steep learning curve, paucity of clinical outcomes, increased operative time, and the limited view of the anatomy, which may increase the risk of nonanatomic tunnel placement, and injuries to surrounding structures, we cannot support an arthroscopic approach at this time.
... ITB: Iliotibial band; LHB: long head of the biceps femoris anteromedial tibia, knee hyperextension, and/or severe external rotation of the tibia while the knee is partially flexed. This most commonly occurs in the setting of athletic trauma, motor vehicle accident, and falls [20]. Only 28% of PLC injuries occur in isolation and are typically associated with ACL or posterior cruciate ligament (PCL) tears [5,6]. ...
Purpose of Review
The importance of the posterolateral corner (PLC) with respect to knee stability, particularly in the setting of anterior cruciate ligament (ACL) deficiency, has become more apparent in recent years. The purposes of this article are to review the current concepts of PLC injuries and to address their role in the ACL-deficient and ACL-reconstructed knee.
Recent Findings
Recent literature demonstrates that a single staged, combined reconstruction is optimal. Studies further provide more thorough insight into avoidance of tunnel collision during the multiligament reconstruction. In total, reconstruction procedures have demonstrated successful outcomes in over 90% of patients.
Summary
In summary, we report that in the setting of suspected concomitant PLC and ACL injury, it is essential to address both injuries; appreciating the local anatomy, diagnostic modalities, and surgical techniques are each crucial to achieving desirable clinical outcomes.
... The main femoral origin of PS muscle is from the lateral condyle, anteroinferior to the FCL and inserted into the superomedial part of the posterior tibial surface, which maintains the integrity of the knee joint and acts as a lateral rotator. [3,4] The PS is a triangular muscle covered by a thick fascia derived from the semimembranosus tendon, and it is innervated usually by two branches from the tibial nerve on its undersurface. [2,5] These branches ran between the periosteum of the tibia and the PS and entered the muscle 1 cm below its upper border. ...
... [6,27] The PS muscle acts as a medial rotator of the tibia or lateral rotator of the femur in a packed knee during flexion. [3,4] However, in contrast, the PS muscle is primarily an extensor and during flexion, its passive lengthening causes rotation of femur or tibia in a weight-bearing or free knee, respectively. [28,29] During the knee extension, the attachment of the PS tendon is positioned behind the FCL, but it moves anteriorly beneath the FCL in flexion. ...
... [35] A number of tests are applied to investigate the pathology of posterolateral knee structures. A specific test to rule out the damage to the PS muscle-tendon unit is the Dial test, which is positive at the earlier flexion of the knee and normal at 90°. [4,35,36] In PS tears, the site, its dimensions, presence of avulsed tendon with a bony fragment, the severity of the tendon retraction, and related menisco-ligamentous injury are essential to select the mode of surgery, if applicable. [20] The surgical sectioning of the PFL does not produce any significant change in the lateral rotation, varus rotation, and posterior translation of the tibia, but along with sectioning of the PS tendon, it results in abnormal external rotation of the tibia. ...
An extensive anatomical knowledge of the muscle popliteus and its tendon is indispensable to understand the posterolateral structures of the knee which is prone to injury compared to the medial knee structures. This study describes all the relevant anatomical details of the muscle and its clinical significance. Anatomical and clinical terms regarding the popliteus muscle are searched using databases and search engines for the collection of literature review. Abstracts and articles describing the posterolateral corner (PLC) structures apart from the muscle studied were excluded. Seventy-six articles were adopted using the inclusion and exclusion criteria, among which 62 articles had fulfilled the need. Original articles dealing with morphology and morphometric analysis of popliteus muscle are scarce. Hence, the finer details of the anatomy of the muscle in various populations are unavailable, which is considered as a deficiency of the study. This article deals with the morphology of the popliteus and its clinical and surgical implications pertaining to the PLC of the knee.
... Unrecognized or undertreated PLC injuries may compromise patient outcomes after reconstruction of other knee ligaments and may increase failure rates of these interventions. 2 Given this importance, the PLC has been the subject of study regarding its anatomy and biomechanical properties as well as imaging characteristics. 3,12,13,15,[17][18][19]23,26 This knowledge has influenced our recognition of and treatment strategies for these injuries. ...
Background
Injury to the posterolateral corner (PLC) of the knee requires reconstruction to restore coronal and rotary stability. Two commonly used procedures are the Arciero reconstruction technique (ART) and the LaPrade reconstruction technique (LRT). To the authors’ knowledge, these techniques have not been biomechanically compared against one another.
Purpose
To identify if one of these reconstruction techniques better restores stability to a PLC-deficient knee and if concomitant injury to the proximal tibiofibular joint or anterior cruciate ligament affects these results.
Study Design
Controlled laboratory study.
Methods
Eight matched-paired cadaveric specimens from the midfemur to toes were used. Each specimen was tested in 4 phases: intact PLC (phase 1), PLC sectioned (phase 2), PLC reconstructed (ART or LRT) (phase 3), and tibiofibular (phase 4A) or anterior cruciate ligament (phase 4B) sectioning with PLC reconstructed. Varus angulation and external rotation at 0º, 20º, 30º, 60º, and 90º of knee flexion were quantified at each phase.
Results
In phase 3, both reconstructions were effective at restoring laxity back to the intact state. However, in phase 4A, both reconstructions were ineffective at stabilizing the joint owing to tibiofibular instability. In phase 4B, both reconstructions had the potential to restrict varus angulation motion. There were no statistically significant differences found between reconstruction techniques for varus angulation or external rotation at any degree of flexion in phase 3 or 4.
Conclusion
The LRT and ART are equally effective at restoring stability to knees with PLC injuries. Neither reconstruction technique fully restores stability to knees with combined PLC and proximal tibiofibular joint injuries.
Clinical Relevance
Given these findings, surgeons may select their reconstruction technique based on their experience and training and the specific needs of their patients.
