Skip to main content
SpringerLink
Log in

Management of Lateral-Sided Ligamentous Laxity and Posterolateral Corner

  • Chapter
  • First Online:
Revision Anterior Cruciate Ligament Reconstruction

  • 435 Accesses

Abstract

Combined anterior cruciate ligament and posterolateral injury of the knee can result in significant functional instability for the affected individual. Both components of the instability must be treated to maximize the probability of success for the surgical procedure. Higher failure rates of anterior cruciate ligament reconstruction have been reported when the posterolateral instability has been left untreated. There are varying degrees of posterolateral instability with respect to pathologic external tibial rotation and varus laxity. Surgical treatment of posterolateral instability (PLI) must address all components of the PLI (popliteus tendon, popliteofibular ligament, lateral collateral ligament, and the lateral-posterolateral capsule), the abnormal planes of motion, as well as other structural injuries. Successful anterior cruciate ligament surgery depends upon recognition and treatment of posterolateral corner injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Fanelli GC, Desai B, Cummings PD, Hanks G, Kalenak A. Divergent alignment of the femoral interference screw in single incision endoscopic reconstruction of the ACL. Contemp Orthop. 1994;28(1):21–5.

    Google Scholar 

  2. Fanelli GC, Edson CJ, Maish DR. Revision ACL reconstruction. Associated patholaxity, tibiofemoral malalignment, rehabilitation, and results. Am J Knee Surg. 2001;14(3):1–4.

    Google Scholar 

  3. Bleday RM, Fanelli GC, Giannotti BF, Edson CJ, Barrett TA. Instrumented measurement of the posterolateral corner. Arthroscopy. 1998;14(5):489–94.

    Article  CAS  PubMed  Google Scholar 

  4. Fanelli GC, Feldman DD. Management of combined anterior cruciate ligament/posterior cruciate ligament/posterolateral complex injuries of the knee. Oper Tech Sports Med. 1999;7(3):143–9.

    Article  Google Scholar 

  5. Fanelli GC, Larson RV. Practical management of posterolateral instability of the knee. Arthroscopy. 2002;18(2) {February, Supplement 1}:1–8.

    Article  PubMed  Google Scholar 

  6. Fanelli GC, Fanelli DG, Edson CJ, Fanelli MG. Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries. J Knee Surg. 2014;27(5):353–8.

    Article  PubMed  Google Scholar 

  7. Fanelli GC, Fanelli DG. Fibular head based posterolateral reconstruction of the knee combined with capsular shift procedure. Sports Med Arthrosc Rev. 2015;23(1):33–43.

    Article  PubMed  Google Scholar 

  8. Fanelli GC. Fibular head based posterolateral reconstruction of the knee: surgical technique and outcomes. J Knee Surg. 2015;28(6):455–63.

    Article  PubMed  Google Scholar 

  9. Muller W, editor. The knee: form, function, and ligamentous reconstruction. New York: Springer; 1983.

    Google Scholar 

  10. Skyhar MJ, Warren RF, Oritz GJ, et al. The effects of sectioning the posterior cruciate ligament and the posterolateral complex on the articular contact pressure within the knee. J Bone Joint Surg Am. 1993;75:694–9.

    Article  CAS  PubMed  Google Scholar 

  11. Veltri DM, Warren RF. Posterolateral instability of the knee. J Bone Joint Surg. 1994;76-A:460–72.

    Article  Google Scholar 

  12. Fanelli GC. PCL injuries in trauma patients. Arthroscopy. 1993;9:291–4.

    Article  CAS  PubMed  Google Scholar 

  13. Fanelli GC, Edson CJ. PCL injuries in trauma patients: Part II. Arthroscopy. 1995;11(5):526–9.

    Article  CAS  PubMed  Google Scholar 

  14. Fanelli GC, Giannotti BF, Edson CJ. Current concepts review. The posterior cruciate ligament arthroscopic evaluation and treatment. Arthroscopy. 1994;10(6):673–88.

    Article  CAS  PubMed  Google Scholar 

  15. Fanelli GC, Orcutt DR, Edson CJ. Current concepts: the multiple ligament injured knee. Arthroscopy. 2005;21(4):471–86.

    Article  PubMed  Google Scholar 

  16. Fanelli GC. The multiple ligament injured knee: what I have learned. In: Fanelli GC, editor. The multiple ligament injured knee. A practical guide to management. Third ed. Springer Nature Switzerland AG. Cham: Switzerland; 2019. p. 3–21.

    Google Scholar 

  17. Fanelli GC. Rationale and surgical technique for PCL and multiple knee ligament reconstruction. Third ed. Warsaw: Biomet Sports Medicine; 2012.

    Google Scholar 

  18. Fanelli GC. Surgical treatment of combined PCL ACL medial and lateral side injuries (global laxity): acute and chronic. In: Fanelli GC, editor. The multiple ligament injured knee. A practical guide to management. Third ed. Springer Nature Switzerland AG. Cham: Switzerland; 2019. p. 295–316.

    Google Scholar 

  19. Fanelli GC. Combined PCL, ACL, posteromedial, and posterolateral reconstruction. In: Fanelli GC, editor. Posterior cruciate ligament injuries. A practical guide to management. Second ed. New York: Springer; 2015. p. 173–88.

    Chapter  Google Scholar 

  20. Arciero RA. Anatomic posterolateral corner knee reconstruction. Arthroscopy. 2005;21:1147.

    Article  PubMed  Google Scholar 

  21. Bicos J, Arciero RA. Novel approach for reconstruction of the posterolateral corner using a free tendon graft technique. Sports Med Arthrosc Rev. 2006;14:28–36.

    Article  PubMed  Google Scholar 

  22. Shi SY, Ying XZ, Zheng Q, Cao GP. Isometric reconstruction of the posterolateral corner of the knee. Acta Orthop Belg. 2009;75:504–11.

    PubMed  Google Scholar 

  23. Niki Y, Matsumoto H, Otani T, Enomoto H, Toyama Y, Suda Y. A modified Larson’s method of posterolateral corner reconstruction of the knee reproducing the physiological tensioning pattern of the lateral collateral and popliteofibular ligaments. Sports Med Arthrosc Rehabil Ther Technol. 2012;4:21.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Veltri DM, Warren RF. Operative treatment of posterolateral instability of the knee. Clin Sports Med. 1994;13(3):615–27.

    Article  CAS  PubMed  Google Scholar 

  25. Baker CL Jr, Norwood LA, Hughston JC. Acute combined posterior cruciate and posterolateral instability of the knee. Am J Sports Med. 1984;12(3):204–8.

    Article  PubMed  Google Scholar 

  26. Yoon KH, Bae DK, Ha JH, Park SW. Anatomic reconstructive surgery for posterolateral instability of the knee. Arthroscopy. 2006;22(2):159–65.

    Article  PubMed  Google Scholar 

  27. Stannard JP, Brown SL, Farris RC, McGwin G, Volgas DA. The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med. 2005;33:881–8.

    Article  PubMed  Google Scholar 

  28. Levy BA, Dajani KA, Morgan JA, Shah JP, Dahm DL, Stuart MJ. Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med. 2010;38:804–9.

    Article  PubMed  Google Scholar 

  29. Leiter JRS, Levy BA, Stannard JP, Fanelli GC, Whelan DB, Marx RG, Stuart MJ, Boyd JL, McDonald PB. Accuracy and reliability of determining the isometric point of the knee for multiligament knee reconstruction. Knee Surg Sports Traumatol Arthrosc. 2014;22:2187–93.

    Article  PubMed  Google Scholar 

  30. Sidles JA, Larson RV, Garbini JL, et al. Ligament length relationships in the moving knee. J Orthop Res. 1988;6:593–610.

    Article  CAS  PubMed  Google Scholar 

  31. Wascher DC, Grauer JD, Markoff KL. Biceps tendon tenodesis for posterolateral instability of the knee. An in vitro study. Am J Sports Med. 1993;21(3):400–6.

    Article  CAS  PubMed  Google Scholar 

  32. Fanelli GC. Surgical reconstruction for acute posterolateral injury of the knee. J Knee Surg. 2005;28(2):157–62.

    Article  Google Scholar 

  33. Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction. Arthroscopy. 1996;12(1):5–14.

    Article  CAS  PubMed  Google Scholar 

  34. Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction. Arthroscopy. 1996;12(5):521–30.

    Article  CAS  PubMed  Google Scholar 

  35. Fanelli GC, Edson CJ. Arthroscopically assisted combined ACL/PCL reconstruction. 2-10 year follow-up. Arthroscopy. 2002;18(7):703–14.

    Article  PubMed  Google Scholar 

  36. Fanelli GC, Edson CJ. Combined posterior cruciate ligament –posterolateral reconstruction with Achilles tendon allograft and biceps femoris tendon tenodesis: 2-10 year follow-up. Arthroscopy. 2004;20(4):339–45.

    Article  PubMed  Google Scholar 

  37. Levy B, Fanelli GC, Whalen D, Stannard J, MacDonald P, Boyd J, Marx R, Stuart M. Modern perspectives for the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg. 2009;17(4):197–206.

    Article  PubMed  Google Scholar 

  38. Levy B, Dajani KA, Whalen DB, Stannard JP, Fanelli GC, Stuart MJ, Boyd JL, MacDonald PA, Marx RG. Decision making in the multiple ligament injured knee: an evidence based systematic review. Arthroscopy. 2009;25(4):430–8.

    Article  PubMed  Google Scholar 

  39. Fanelli GC, Stannard JP, Stuart MJ, MacDonald PB, Marx RG, Whelan DB, Boyd JL, Levy BA. Management of complex knee ligament injuries. J Bone Joint Surg. 2010;92-A(12):2235–46.

    Google Scholar 

  40. Fanelli GC. Surgical treatment of lateral posterolateral instability of the knee using biceps femoris tendon procedures. Sports Med Arthrosc Rev. 2006;14(1):37–43.

    Article  PubMed  Google Scholar 

  41. Noyes FR, Barber-Westin SD, Hewett TE. High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees. Am J Sports Med. 2000;28:282–96.

    Article  CAS  PubMed  Google Scholar 

  42. Clancy WG Jr. Repair and reconstruction of the posterior cruciate ligament. In: Chapman MW, editor. Operative orthopaedics. Philadelphia: JB Lippincott; 1998. p. 1651–65.

    Google Scholar 

  43. Fanelli GC, Edson CJ, Orcutt DR, Harris JD, Zijerdi D. Treatment of combined ACL-PCL-MCL-PLC injuries of the knee. J Knee Surg. 2005;18(3):240–8.

    Article  PubMed  Google Scholar 

  44. Fanelli GC, Edson CJ. Surgical treatment of combined PCL, ACL, medial, and lateral side injuries (global laxity): surgical technique and 2 to 18 year results. J Knee Surg. 2012;25(4):307–16.

    Article  PubMed  Google Scholar 

  45. Fanelli GC, Sousa P, Edson CJ. Long term follow-up of surgically treated knee dislocations: stability restored, but arthritis is common. Clin Orthop Relat Res. 2014;472(9):2712–7.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Fanelli GC. Surgical treatment of posterolateral instability of the knee with biceps tendon transfer procedures. In: 32nd Annual Herodicus Society Meeting, Hershey, 25–28 June 2006.

    Google Scholar 

  47. Fanelli GC, Fanelli DG. Multiple ligament injured knee in patients eighteen years of age and younger. In: Fanelli GC, editor. The multiple ligament injured knee. A practical guide to management. Third ed. Springer Nature Switzerland AG. Cham: Switzerland; 2019. p. 507–21.

    Google Scholar 

  48. Fanelli GC, Fanelli DG. Knee dislocations in patients 18 years of age and younger. Surgical technique and outcomes. J Knee Surg. 2016;29(4):269–77.

    Article  PubMed  Google Scholar 

  49. Fanelli GC, Fanelli DG. Multiple ligament knee injuries in the pediatric population. J Knee Surg. 2018;31(5):399–409.

    Article  PubMed  Google Scholar 

  50. Fanelli GC, Tomaschewski D. Allograft use in the treatment of the multiple ligament injured knee. Sports Med Arthrosc Rev. 2007;15(3):139–48.

    Article  PubMed  Google Scholar 

  51. Fanelli GC, Beck JD, Edson CJ. Postoperative rehabilitation of the posterior cruciate ligament. Sports Med Arthrosc Rev. 2010;18(4):275–9.

    Article  PubMed  Google Scholar 

  52. Edson CJ, Fanelli GC, Beck JD. Rehabilitation after multiple ligament reconstruction of the knee. Sports Med Arthrosc Rev. 2011;19(2):162–6.

    Article  PubMed  Google Scholar 

  53. Edson CJ. Rehabilitation following PCL reconstruction: scientific and theoretical basis. In: Fanelli GC, editor. Posterior cruciate ligament injuries. A practical guide to management. Second ed. New York: Springer; 2015. p. 311–20.

    Google Scholar 

  54. Edson CJ, Fanelli GC. Postoperative rehabilitation of the multiple ligament injured knee. In: Fanelli GC, editor. The multiple ligament injured knee. A practical guide to management. Third ed. Springer Nature Switzerland AG. Cham: Switzerland; 2019. p. 551–8.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA

    Gregory C. Fanelli

  2. Department of Orthopaedic Surgery and Sports Medicine, Danville, PA, USA

    Gregory C. Fanelli

  3. Department of Orthopaedic Surgery and Sports Medicine, Geisinger Medical Center, Danville, PA, USA

    Matthew G. Fanelli & David G. Fanelli

  4. NYU Langone Department of Orthopedic Surgery, New York, NY, USA

    Michael G. Doran

Authors
  1. Gregory C. Fanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew G. Fanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David G. Fanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael G. Doran
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Division of Sports Medicine, New York University Langone Health, New York, NY, USA

    Michael J. Alaia

  2. Department of Orthopaedic Surgery, Division of Sports Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Kristofer J. Jones

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Fanelli, G.C., Fanelli, M.G., Fanelli, D.G., Doran, M.G. (2022). Management of Lateral-Sided Ligamentous Laxity and Posterolateral Corner. In: Alaia, M.J., Jones, K.J. (eds) Revision Anterior Cruciate Ligament Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-030-96996-7_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-96996-7_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-96995-0

  • Online ISBN: 978-3-030-96996-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation