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Evaluation and Treatment of Posterolateral Instability of the Knee

Fanelli, Gregory C. MD

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Sports Medicine and Arthroscopy Review: March 2015 - Volume 23 - Issue 1 - p 1
doi: 10.1097/JSA.0000000000000059
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Posterolateral instability is a serious knee injury that is common with posterior cruciate ligament tears, less common with anterior cruciate ligament tears, and rarely occurs as an isolated injury. There are varying degrees of posterolateral instability with respect to pathologic external tibial rotation and varus laxity. Treatment of posterolateral instability must address all components of the posterolateral instability complex, which include the popliteus tendon, the popliteofibular ligament, the lateral collateral ligament, and the lateral and posterolateral capsule, as well as other structural knee injuries that are present. The successful treatment of posterior cruciate ligament and anterior cruciate ligament injuries depends upon recognition and treatment of the associated posterolateral corner injuries.

This issue of Sports Medicine and Arthroscopy Review is dedicated to the evaluation and treatment of posterolateral instability of the knee. It has been an honor to work with this distinguished group of contributing authors who are experts in the evaluation and treatment of posterolateral instability of the knee. Topics presented in this issue include anatomy and biomechanics and their surgical implications, physical examination, diagnostic imaging, isolated fibular collateral ligament injuries in athletes, repair versus reconstruction in acute posterolateral instability of the knee, posterolateral reconstruction using capsular procedures, fibular head–based procedures, and 2-tailed graft procedures. In addition, papers addressing complications of posterolateral corner injuries of the knee and how to avoid them, and the results of treatment of posterolateral instability of the knee, are presented, creating a very comprehensive overview of this very complex topic in knee surgery.

The purpose of this issue of Sports Medicine and Arthroscopy Review is to provide experienced knee surgeons, general orthopedic surgeons, fellows, residents, medical students, and other health care professionals with an interest in posterolateral knee injuries with an overview for the evaluation and surgical management of these complex knee injuries.

On the Cover:

Postoperative anteroposterior (A) and lateral (B) radiographs following posterolateral reconstruction using the fibular head-based figure-of-eight surgical technique combined with posterolateral capsular shift procedure. The position of the screw and washer enables the 2 limbs of the allograft tissue to approximate the respective anatomic insertion sites of the fibular collateral ligament and popliteus tendon on the distal lateral femoral condyle. The drill hole through the head of the fibula is from anterolateral to posteromedial to promote a more anatomic orientation of the fibular collateral ligament and popliteofibular ligament-popliteus tendon components. Fine tuning of graft orientation is accomplished with multiple permanent braided sutures. [With permission, Gregory C. Fanelli, M.D.]Sports Med Arthrosc Rev.2015;23:33–43.

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