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Arch Orthop Trauma Surg (2015) 135:1363–1368

DOI 10.1007/s00402-015-2291-x

ORTHOPAEDIC SURGERY

Outcome of the treatment of chronic isolated and combined


posterolateral corner knee injuries with 2- to 6-year follow-up
Gökay Görmeli1 • Cemile Ayşe Görmeli2 • Nurzat Elmalı3 • Mustafa Karakaplan1 •

Kadir Ertem1 • Yüksel Ersoy4

Received: 11 March 2015 / Published online: 19 July 2015


Ó Springer-Verlag Berlin Heidelberg 2015

Abstract compartment opening on the varus stress radiographs had


Introduction Injuries of the posterolateral corner (PLC) decreased significantly in the postoperative period. How-
of the knee are rare. They are difficult to diagnose and can ever, there was still a significant difference compared with
cause severe disability. This study presents the 20- to the uninjured knee. There was no significant improvement
70-month clinical and radiological outcomes of the in the IKDC-s, Lysholm, or Tegner scores between the nine
anatomical reconstruction technique of LaPrade et al. patients with isolated PLC injuries and twelve with multi-
Materials and methods Twenty-one patients with chronic ligament injuries.
PLC injuries underwent anatomical PLC reconstruction. Conclusions Significant improvement in the objective
The anatomical locations of the popliteus tendon, fibular knee stability scores and clinical outcomes with anatomical
collateral ligament, and popliteofibular ligament were reconstruction showed that this technique can be used to
reconstructed using a 2-graft technique. The patients were treat patients with chronic PLC injured knees. However,
evaluated subjectively with the Tegner, Lysholm, and longer-term multicentre studies and studies with larger
International Knee Documentation Committee (IKDC) groups comparing multiple techniques are required to
subjective knee scores and objectively with the IKDC determine the best treatment method for PLC injuries.
objective scores; additionally, varus stress radiographs
were taken to evaluate knee stability. Keywords Knee  Multi-ligament injury  Posterolateral
Results Significant (p \ 0.05) improvements were corner  Reconstruction
observed in the postoperative Lysholm, IKDC-s, and
Tegner scores compared with preoperatively. The IKDC
objective subscores (lateral joint opening at 20° of knee Introduction
extension, external rotation at 30° and 90°, and the reverse
pivot-shift test) had improved significantly at the time of Posterolateral corner injuries, which are rare, result from
the final 40.9 ± 13.7-month follow-up. Lateral high-energy trauma with hyperextension and varus or
external rotation forces affecting the knee, causing pos-
terolateral rotatory instability and posterolateral tibial
& Gökay Görmeli subluxation [1]. Because of the anatomical complexity, the
ggormeli@yahoo.com
diagnosis of a posterolateral corner (PLC) injury can be
1
Department of Orthopedics and Traumatology, Inonu elusive unless there is a high degree of clinical suspicion of
University, Turgut Ozal Medical Center, Malatya, Turkey a possible injury in this region and other injured ligaments
2
Department of Radiology, Inonu University, Turgut Ozal [2, 3].
Medical Center, Malatya, Turkey The lateral collateral ligament (LCL), popliteofibular
3
Department of Orthopedics and Traumatology, Vakıf Gureba ligament (PFL), and popliteus muscle and tendon (PM and
University, İstanbul, Turkey PT) restrain both posterolateral rotation of the tibia and
4
Department of Physiotherapy and Rehabilitation, Inonu varus opening forces to stabilise the knee. These structures
University, Turgut Ozal Medical Center, Malatya, Turkey are the main components stabilising the PLC [4]. Several

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1364 Arch Orthop Trauma Surg (2015) 135:1363–1368

techniques for reconstructing PLC injuries have been to the nearest 0.1°. Standing anteroposterior and lateral
described [5, 6]. The anatomical reconstruction technique radiographs and magnetic resonance imaging (MRI) were
described by LaPrade et al. seems to be superior, as it obtained for all patients.
reconstructs/reinforces the LCL, PT, and PFL [7]. The Twenty-four patients underwent posterolateral knee
technique is based on the attachment anatomy of the three reconstruction to treat chronic posterolateral knee insta-
main structures that stabilise both the varus and rotational bility, and follow-up data were available for 21. The
laxity components of PLC injuries. Only a few studies have average age of the patients was 31.1 ± 9.2 years at the
evaluated the outcomes of this technique prospectively and time of the surgery. Patients included 15 (71.4 %) males
the additional value of the technique [8–10]. To our and six (28.6 %) females. The right knee was injured in 16
knowledge, this the second study to evaluate the LaPrade (76.1 %) patients, and the left in five (23.8 %). The time
technique outside the LaPrade clinic; we evaluated more interval between the injury and reconstruction was
patients than the first prospective study by van der Wal 8.8 ± 4.3 months. Patients were followed for an average
et al. did [10]. of 40.9 ± 13.7 months postoperatively.
This prospective study evaluated the clinical and radi- According to grading described by Hughston et al. [11];
ological outcomes of the anatomical reconstruction tech- nine patients had a clinical grade III PLC injury ([10 mm
nique described by LaPrade et al. for PLC injuries of the varus and/or [10° rotational instability), and twelve had a
knee. We hypothesised that the LaPrade technique for severe grade II-PLC injury (varus instability of 5–10 mm
reconstructing PLC injuries results in improved knee sta- and/or rotational instability of [10°).
bility, making it the preferred method. Twelve of the patients had concomitant ligament inju-
ries (six ACL injuries, four PCL injuries, and two com-
bined ACL–PCL injuries) that were reconstructed in the
Materials and methods same session. Three patients had lateral meniscal tear and
partial meniscectomy was performed. Two patients had
The local ethics committee approved this study, and peroneal nerve damage at presentation that recovered
informed consent was obtained from all participating completely with no residual damage. Two patients had
patients. This study included 24 patients with chronic drop-foot after reconstruction that also recovered com-
posterolateral corner injuries who underwent PLC recon- pletely without any damage. Four patients had previously
struction as described by LaPrade et al. [7] between 2006 had failed isolated ACL reconstruction. Additionally, four
and 2013. Chronic injuries were defined as injuries that patients had previous failed repairs before the
were treated operatively at least 6 weeks after the injury. reconstruction.
Exclusion criteria were patients with a previous peroneal Five of the injuries occurred during sporting activities,
nerve neuropathy, popliteal artery injury, or previous 13 resulted from traffic accidents, two involved falls from
walking disabilities, those older than 65 years, and those heights, and one cause was unknown.
with grade 4 osteoarthritis according to the Outerbridge The PLC was reconstructed using the technique descri-
classification or connective-tissue diseases, and those with bed by LaPrade et al. [5]. A standard lateral incision was
a previous osteotomy or an indication for an osteotomy for performed; long and short heads of biceps femoris and
varus malalignment assessed on long leg radiographs. iliotibial band was identified. Second incision was made
Patient demographics, time from injury to surgery, grade parallel and posterior to the long head of biceps femoris.
of the PLC injury according to Hughston et al. [11], and Common peroneal nerve was identified and retracted. A
concomitant injuries (anterior (ACL) and posterior (PCL) blunt dissection from the interval between the common
cruciate ligament ruptures, meniscal lesions) were recor- peroneal nerve and the long head of the biceps femoris was
ded. International Knee Documentation Committee made to reach to the posterolateral aspect of the tibia,
(IKDC) objective knee score subgroups [12] (lateral joint posteromedial aspect of the fibular styloid and the posterior
opening at 20° under varus stress, external rotation degree tibial popliteal sulcus. Then, insertion sites of PFL and
at 30° and 90°, and posterolateral rotatory subluxation on fibular collateral ligament (FCL) were identified on pos-
the reverse pivot-shift test) and subjective clinical scores teromedial and lateral aspect of fibula, respectively.
(IKDC-s, Tegner, and Lysholm knee scores) were recor- The fibular and tibial bony tunnels were then drilled by
ded. Varus stress radiographs were measured using the using the cannulated PCL femoral tunnel–aiming device
method described by Heesterbeek et al. [13] in the supine (Arthrex Inc, Naples, Fla). A 7-mm fibular tunnel was
position with the leg in 0° extension. The lateral com- reamed through the insertion site of FCL to the insertion
partment opening was determined as the angle between the site of PFL. Then, a 9-mm tibial tunnel was prepared
tangent to the femoral condyles and the line through the through Gerdy’s tubercle to posterior tibial popliteal sulcus
deepest tibial joint surfaces and measurements were made in an anteroposterior direction.

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Arch Orthop Trauma Surg (2015) 135:1363–1368 1365

For femoral tunnels, a horizontal incision was made IKDC-s score from 34 (14–52) to 64 (46–97) (p \ 0.005)
from intermuscular septum to the proximal part of Gerdy’s (Fig. 1). The Tegner score was also improved from 2 (0–4)
tubercle. Femoral insertion sites of FCL and PT was to 4 (2–7) (p \ 0.005).
identified and two femoral tunnels were drilled using PCL The IKDC objective subscores (lateral joint opening at
femoral aiming device (Arthrex Inc, Naples, Fla) on these 20° knee extension, external rotation at 30° and 90°, and
insertion sites. A 9-mm. tunnel with a depth of 20 mm. was the reverse pivot-shift test) had improved significantly at
then reamed over each guide pin. The bone bridge between the time of the final follow-up (p \ 0.005) (Fig. 2). There
the two tunnels was approximately 8–9 mm in width. were no additional cartilage defects and meniscal lesions in
Two allografts were prepared for reconstruction. The the postoperative period.
first one, which was passed through tibial tunnel, was used The lateral compartment opening on the varus stress
for PT reconstruction. Then the second graft, which was radiographs decreased significantly (p \ 0.005) from 10.4
passed through iliotibial band, biceps femoris and then (6.8–14.8) preoperatively to 5.1 (0.5–8.4) postoperatively,
passed through fibular tunnel, was used for FCL and PFL although the score was still significantly (p = 0.04) higher
reconstruction. Finally, the grafts were fixed and tightened than that for the uninjured knee, which had a score of 2.9
with bioabsorbable interference screws (Arthrex Inc, (0.9–6.1).
Naples, Fla). There was no significant (all p [ 0.05) improvement in
On the first postoperative day, a varus/valgus stabilising the IKDC-s, Lysholm, or Tegner score between patients
brace was applied, and the reconstructed grafts were pro- with isolated PLC injury and those with multi-ligament
tected by immobilisation for the first 4 weeks postopera- injuries (Table 1).
tively. Isometric quadriceps-strengthening exercises and
patella mobilisation were initiated. Weight bearing was
allowed as tolerated. Four weeks postoperatively, flexion of Discussion
the knee as tolerated was permitted. Closed-chain kinetic
exercises were started at 6–8 weeks. Stationary cycling, This study found that the anatomic PLC reconstruction
stair-stepping, and single-leg stance were allowed at technique described by LaPrade et al. [5] resulted in sig-
10–12 weeks. Full squatting was prohibited until 3 months nificant improvement in patients with PLC injuries.
postoperatively; swimming and fast walking were allowed Recent anatomical and biomechanical studies have
at 4–5 months. Return to full activity was allowed demonstrated the effects of the PLC components on knee
6 months postoperatively. function. The LCL is the most important primary static
Patients were recalled for a final follow-up at 2–6 years. stabiliser of the PLC for preventing varus instability of the
The final IKDC objective subscores, subjective clinical knee during the initial 0°–30° of flexion [14]. The PM and
score forms, and postoperative varus stress radiographs PT complex confer static and dynamic stabilisation against
were compared with the preoperative results. At the final posterolateral rotation of the knee, and the PFL is an
follow-up; all patients underwent MRI of the injured knee important stabiliser of external rotation [15, 16].
to identify rerupture, meniscal lesions and cartilage defects.

Statistical analysis

Data are expressed as the median (range) or mean ± s-


tandard deviation, depending on the variable distribution.
Normality was assessed using the Shapiro–Wilk test. The
data were compared using the Mann–Whitney U test or
Wilcoxon test, as appropriate, and p values \0.05 were
considered significant. IBM SPSS ver. 22.0 for Windows
was used for the statistical analyses.

Results

There was a significant improvement in the postoperative


Lysholm, IKDC-s, and Tegner scores compared with pre-
operatively (p \ 0.05). The postoperative Lysholm score Fig. 1 Pre- and postoperative Lysholm and IKDC-subjective scores.
improved from 50 (24–70) to 80 (60–94) (p \ 0.005), the The horizontal line indicates the median score

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Fig. 2 Pre- and postoperative 23 D


IKDC objective scores. C
A normal, B nearly normal, B
C abnormal, D severely 15
A
abnormal

0
Preop Postop Preop Postop Preop Postop Preop Postop
Lateral joint Lateral joint External External External External Reverse Reverse
opening at opening at rotaon at rotaon at rotaon at rotaon at pivot shi pivot shi
20° 20° 30° 30° 90° 90°

Table 1 Comparison of the


Variablesa Isolated PLC Multi-ligament knee p values
results between patients with
reconstruction reconstruction
isolated PLC injuries and those
with multi-ligament injuries IKDC-s scores median (range) 28 (22–42) 29 (20–38) 0.748
Lysholm scores median (range) 34 (20–46) 28 (10–38) 0.153
Tegner scores median (range) 2 (1–3) 2 (1–4) 0.842
a
Results are the mean change between the pre- and postoperative scores

Additionally, the iliotibial band confers knee stability anatomic reconstructive surgery in 21 patients. After
against varus opening forces [16]. Consequently, recon- 12 months, they found that anatomic reconstruction of the
structing the three main stabilisers (the LCL, PT, and PFL) posterolateral corner resulted in less varus laxity and tibial
based on their quantitative attachment anatomy is impor- external rotation compared with the non-anatomical pos-
tant for providing varus stability and limiting posterolateral terolateral corner sling procedure. In a two-centre outcome
translation in patients with PLC instability. study, LaPrade et al. [9] analysed 54 patients with grade 3
Various surgical techniques for reconstructing the pos- chronic posterolateral instability. After 4.3 years, they
terolateral corner have been reported. Some non-anatomi- found significant IKDC objective score improvement for
cal techniques give good results. Hughston [11] reported a varus opening at 20°, external rotation at 30°, reverse pivot
method that moved the arcuate complex with bone shift, and single-leg hop. Similarly, we found a significant
advancement, and Clancy [17] described a method of improvement in terms of the IKDC objective scores. This
rerouting the biceps tendon to the lateral epicondyle with supports the notion that the reconstruction of PLC injuries
excellent results. Nevertheless, anatomical reconstruction using an anatomical technique provides added value in
techniques are more effective at restoring stability and terms of knee stability.
reducing postoperative limitations on knee motion [18]. A significant improvement was achieved in subjective
Kim et al. [19] described the single fibula and double clinical scores. Several studies evaluated patients using
femoral sling method that was recommended for PLC subjective clinical scores, and all found similar significant
injuries with its simplicity and anatomical reconstruction. improvements. In a prospective study of 29 patients with
We think that the posterolateral corner reconstruction grade 3 PLC injuries, the IKDC scores improved from 21.9
technique described by LaPrade et al. [7] is closest to the to 81.4 points and from 29.1 to 81.5 points [8]. In an
native situation. By reconstructing the PT, PFL, and FCL another prospective study performed by van der Wal et al.
based on their attachment anatomy, the surgeon is able to [10], 16 patients underwent PLC reconstruction with the
restore static laxity under varus and external rotation. LaPrade technique. Those authors reported significant
In an in vitro biomechanical study, LaPrade et al. [20] improvements in the Tegner score, from 2.0 (0–4) to 3.5
tested 10 cadaver specimens in three states (intact knee, (0–8), the Lysholm score, from 58.5 (0–82) to 82 (16–100),
grade III injury, reconstructed knee) and found no differ- and IKDC-s, from 44 (11–55) to 67 (22–99). LaPrade et al.
ence between the intact and reconstructed knees in terms of [9] found significant improvement using the Cincinnati
varus translation and external rotation forces. Yoon et al. score in their study discussed above. Based on the signif-
[21] reconstructed PLC injuries with the posterolateral icant improvement seen in all studies, including ours, we
corner sling procedure in 25 patients and performed believe that anatomical reconstruction with this technique

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Arch Orthop Trauma Surg (2015) 135:1363–1368 1367

would improve the clinical outcomes in terms of the sub- to avoid misdiagnosis are the most important parts of the
jective clinical scores. treatment procedure.
Varus laxity was evaluated by using both the varus There are some limitations to this study. The major
stress test and stress radiographs. We consider varus stress limitation is the lack of a comparison group treated with a
radiographs to be more objective measurements than a technique other than PLC reconstruction. A randomised
clinical examination using varus stress tests. As discussed double-blind treatment protocol comparing this with
above, van der Wal et al. [10] found a significant decrease another technique would be better for determining the
in the median opening of the lateral compartment on stress optimal treatment method. Consequently, we cannot
radiographs from 9.6° (6.6–17.1) to 6.3° (0.3–13.4). In unequivocally state that the LaPrade technique has better
agreement with our results, however, they noted that the results than other techniques have. However, based on the
postoperative varus laxity did not return to the level of the results of biomechanical and anatomical studies, we prefer
uninjured knee. Geeslin et al. [8] also evaluated the varus this technique for all patients over any non-anatomical
laxity with stress radiographs and obtained better results technique. Another weakness of our study is the concurrent
than ours or those of van der Wal et al. [10] Their lateral ligament injuries, which might affect the outcomes.
compartment gap was 0.1 mm, whereas the preoperative Although our results showed no difference between the
gap was 6.2 mm. They also found improved stability on the multi-ligament injury and isolated injury groups, a group
uninjured side. The difference between our results and consisting only of isolated PLC injuries would be better for
those of Geeslin et al. [6] may be related to the relative evaluating the technique. However, patients with isolated
short-term outcomes of their study or to the fact that the PLC injuries are uncommon, making it difficult to obtain
patient group they investigated had undergone various an optimal sample size. Another weakness is the small size
surgeries, including a repair, a reconstruction, or both. and variety of the cohort. Nevertheless, to our knowledge,
The posterolateral corner structures of the knee interact this is the largest prospective series conducted outside
functionally with both cruciate ligaments. Markolf et al. LaPrade’s clinic.
[22] found that varus loading resulted in increased force on In conclusion, the anatomical reconstruction technique
the intact ACL after cutting the posterolateral corner resulted in significant improvement in the objective knee
structures. Zantop et al. [23] found that; additional LCL stability scores and subjective knee scores. Unfortunately,
injury with ACL rupture significantly increased the anterior the injured knees were not as stable as the uninjured side.
rotational instability of the knee. Mauro et al. [24] exam- Nevertheless, the clinical and functional results indicate
ined the force on PCL grafts in 10 cadaveric knees and that this anatomical reconstruction technique can be used to
found an increased risk of graft failure due to increased treat patients with chronic PLC knee injuries. Therefore,
in situ force in the PLC-deficient knee. Unrecognised or possible consequences of the chronic injury with instability
untreated associated injuries of the knee might cause fail- can be avoid. Longer-term results from multicentre studies
ure of the reconstruction and negatively affect the clinical with larger sample sizes comparing the method with other
outcome. Pacheco et al. [25] retrospectively reviewed the techniques are required to decide the best method for
hospital records of 68 patients with posterolateral corner treating PLC injuries.
knee injuries and found that the correct diagnosis, includ-
Complaince with ethical standards
ing injury to the posterolateral corner, had been made only
in 34 patients (50 %). Therefore, when knee instability Conflicts of interest None.
occurs, a careful history and physical examination must be
done to avoid missing the diagnosis of an injured ligament.
The lateral gutter drive-through sign may be used in References
diagnosing the PLC injuries with additional posteromedial
1. Hughston JC, Jacobson KE (1985) Chronic posterolateral rotatory
structures and cruciate ligament injuries [26]. In our study, instability of the knee. J Bone Joint Surg Am 67(3):351–359
the outcomes of the isolated PLC injury and combined 2. Krukhaug Y, Mølster A, Rodt A, Strand T (1998) Lateral liga-
injury (ACL, PCL, or both injured) groups did not differ, ment injuries of the knee. Knee Surg Sports Traumatol Arthrosc
similar to other comparable studies [8–10]. These com- 6(1):21–25. doi:10.1007/s001670050067
3. Bonanzinga T, Zaffagnini S, Grassi A, Marcheggiani Muccioli
bined injuries would have a negative effect on the clinical GM, Neri MP, Marcacci M (2013) Management of combined
outcome, but the reconstruction of concurrent injuries in anterior cruciate ligament-posterolateral corner tears: a system-
the same session would improve knee stability, as with atic review. Am J Sports Med 42(6):1496–1503. doi:10.1177/
isolated PLC injuries. In a study performed by Lee et al. 0363546513507555
4. LaPrade RF, Terry GC (1997) Injuries to the posterolateral aspect
[27], 7 patients with PLC and PCL injury had stable knees of the knee. Association of anatomic injury patterns with clinical
and showed no complications after reconstruction. In our instability. Am J Sports Med 25(4):433–438. doi:10.1177/
view, a careful history, physical examination, and imaging 036354659702500403

123
1368 Arch Orthop Trauma Surg (2015) 135:1363–1368

5. Kuzma SA, Chow RM, Engasser WM, Stuart MJ, Levy BA secondary to rupture of the posterior cruciate ligament. Report of
(2014) Reconstruction of the posterolateral corner of the knee a new procedure. J Bone Joint Surg Am 65(3):310–322
with Achilles tendon allograft. Arthrosc Tech 3(3):e393–e398. 18. Apsingi S, Nguyen T, Bull AM, Unwin A, Deehan DJ, Amis AA
doi:10.1016/j.eats.2014.02.006 (2009) A comparison of modified Larson and ‘anatomic’ pos-
6. Jung YB, Jung HJ, Kim SJ, Park SJ, Song KS, Lee YS, Lee SH terolateral corner reconstructions in knees with combined PCL
(2008) Posterolateral corner reconstruction for posterolateral and posterolateral corner deficiency. Knee Surg Sports Traumatol
rotatory instability combined with posterior cruciate ligament Arthrosc 17(3):305–312. doi:10.1007/s00167-008-0696-6
injuries: comparison between fibular tunnel and tibial tunnel 19. Kim JG, Ha JG, Lee YS, Yang SJ, Jung JE, Oh SJ (2009) Pos-
techniques. Knee Surg Sports Traumatol Arthrosc 16(3):239–248. terolateral corner anatomy and its anatomical reconstruction with
doi:10.1007/s00167-007-0481-y single fibula and double femoral sling method: anatomical study
7. LaPrade RF, Johansen S, Engebretsen L (2011) Outcomes of an and surgical technique. Arch Orthop Trauma Surg
anatomic posterolateral knee reconstruction: surgical technique. 129(3):381–385. doi:10.1007/s00402-008-0722-7
J Bone Joint Surg Am 93(Suppl 1):10–20. doi:10.2106/JBJS.J. 20. LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg
01243 JL, Tso A (2004) An analysis of an anatomical posterolateral
8. Geeslin AG, LaPrade RF (2011) Outcomes of treatment of acute knee reconstruction: an in vitro biomechanical study and devel-
grade-III isolated and combined posterolateral knee injuries: a opment of a surgical technique. Am J Sports Med
prospective case series and surgical technique. J Bone Joint Surg 32(6):1405–1414. doi:10.1177/0363546503262687
Am 93(18):1672–1683. doi:10.2106/JBJS.J.01639 21. Yoon KH, Bae DK, Ha JH, Park SW (2006) Anatomic recon-
9. LaPrade RF, Johansen S, Agel J, Risberg MA, Moksnes H, structive surgery for posterolateral instability of the knee.
Engebretsen L (2010) Outcomes of an anatomic posterolateral Arthroscopy 22(2):159–165. doi:10.1016/j.arthro.2005.12.003
knee reconstruction. J Bone Joint Surg Am 92(1):16–22. doi:10. 22. Markolf KL, Graves BR, Sigward SM, Jackson SR, McAllister
2106/JBJS.I.00474 DR (2007) How well do anatomical reconstructions of the pos-
10. van der Wal WA, Heesterbeek PJ, van Tienen TG, Busch VJ, van terolateral corner restore varus stability to the posterior cruciate
Ochten JH, Wymenga AB (2014) Anatomical reconstruction of ligament-reconstructed knee? Am J Sports Med
posterolateral corner and combined injuries of the knee. Knee 35(7):1117–1122. doi:10.1177/0363546507299240
Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3369-7 23. Zantop T, Schumacher T, Diermann N, Schanz S, Raschke MJ,
11. Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classi- Petersen W (2007) Anterolateral rotational knee instability: role
fication of knee ligament instabilities Part II. The lateral com- of posterolateral structures. Winner of the AGA-DonJoy Award
partment. J Bone Jt Surg Am 58(2):173–179 2006. Arch Orthop Trauma Surg 127(9):743–752. doi:10.1007/
12. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, s00402-006-0241-3
Neyret P, Richmond JC, Shelborne KD (2001) Development and 24. Mauro CS, Sekiya JK, Stabile KJ, Haemmerle MJ, Harner CD
validation of the International Knee Documentation Committee (2008) Double-bundle PCL and posterolateral corner recon-
subjective knee form. Am J Sports Med 29(5):600–613 struction components are codominant. Clin Orthop Relat Res
13. Heesterbeek PJ, Verdonschot N, Wymenga AB (2008) In vivo 466(9):2247–2254. doi:10.1007/s11999-008-0319-z
knee laxity in flexion and extension: a radiographic study in 30 25. Pacheco RJ, Ayre CA, Bollen SR (2011) Posterolateral corner
older healthy subjects. Knee 15(1):45–49. doi:10.1016/j.knee. injuries of the knee: a serious injury commonly missed. J Bone
2007.09.007 Joint Surg Br 93(2):194–197. doi:10.1302/0301-620X.93B2.
14. Gollehon DL, Torzilli PA, Warren RF (1987) The role of the 25774
posterolateral and cruciate ligaments in the stability of the human 26. Feng H, Song GY, Shen JW, Zhang H, Wang MY (2014) The
knee. A biomechanical study. J Bone Joint Surg Am ‘‘lateral gutter drive-through’’ sign revisited: a cadaveric study
69(2):233–242 exploring its real mechanism based on the individual postero-
15. Harner CD, Vogrin TM, Höher J, Ma CB, Woo SL (2000) lateral structure of knee joints. Arch Orthop Trauma Surg
Biomechanical analysis of a posterior cruciate ligament recon- 134(12):1745–1751. doi:10.1007/s00402-014-2100-y
struction. Deficiency of the posterolateral structures as a cause of 27. Lee YS, Lim BO, Kim JG, Lee KK, Park HO, An KO, Ryew CC,
graft failure. Am J Sports Med 28(1):32–39 Kim JH (2011) Serial assessment of knee joint moments in
16. Terry GC, LaPrade RF (1996) The posterolateral aspect of the posterior cruciate ligament and posterolateral corner recon-
knee. Anatomy and surgical approach. Am J Sports Med structed patients during a turn running task. Arch Orthop Trauma
24(6):732–739. doi:10.1177/036354659602400606 Surg 131(3):335–341. doi:10.1007/s00402-010-1168-2
17. Clancy WG Jr, Shelbourne KD, Zoellner GB, Keene JS, Reider
B, Rosenberg TD (1983) Treatment of knee joint instability

123
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