7/23/2018 1 Vishnu Potini, MD Director of Sports Medicine St. Francis Orthopaedic Institute; Columbus, GA Team Doctor: Brookstone School POSTEROLATERAL CORNER KNEE INJURIES OUTLINE • Case • Background • Anatomy • Biomechanics • Clinical/Radiographic Evaluation • Treatment • Case CASE PRESENTATION • 17yo male s/p bicycle crash into tree • CC: L-knee pain, swelling • PMH: None • PSH: None • Meds: None • Allergy: NKDA
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POSTEROLATERAL CORNER KNEE INJURIES · • Posterolateral corner knee injuries are uncommon in isolation, but in the setting of a multi-ligamentous knee injury are critical to diagnose
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7/23/2018
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Vishnu Potini, MD
Director of Sports Medicine
St. Francis Orthopaedic Institute; Columbus, GA
Team Doctor: Brookstone School
POSTEROLATERAL CORNERKNEE INJURIES
OUTLINE
• Case
• Background
• Anatomy
• Biomechanics
• Clinical/Radiographic Evaluation
• Treatment
• Case
CASE PRESENTATION
• 17yo male s/p bicycle crash into tree
• CC: L-knee pain, swelling
• PMH: None
• PSH: None
• Meds: None
• Allergy: NKDA
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PHYSICAL EXAM
• Significant swelling L-knee
• Motor: 0/5 TA, 0/5 EHL
• Sensory: Decreased sensation over dorsum of foot
• Pulses: ABI: PT > 1, DP>1
• (+) Lachman’s, (+) anterior/posterior drawer
• (+) unstable to varus stress, (+) posterolateral drawer
X-RAYS
MRI
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MRI
BACKGROUND
• Multi-ligamentous knee injuries account for less than 1% of all Orthopaedic injuries
• Isolated PLC injuries account for less than 2% of acute knee ligament injuries
• Injuries to the posterolateral corner are infequent, often missed injuries
• These multi-ligamentous injuries are often the result of knee dislocations, which may present after spontaneous reduction
• Tunnel convergence• 0 degrees in the coronal plane, max of 40 in the
axial plane, and limit lateral tunnel depth to 25mm at the max
COMPLICATIONS• Compartment syndrome
• Fluid extravasation during athroscopy
• Vascular injury
• More so with concurrent PCL reconstruction
• Persistent knee pain
• Tibiofemoral DJD
• HO
• Arthrofibrosis – particularly if done acutely with ACL/PCL
• Malalignment - varus
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CASE
• Planned for staged reconstruction of PLC and cruciates
• First stage
• Exploration of common, superficial, deep peroneal nerves
• Lateral-sided reconstruction
• Primary repair of posterolateral corner, capsule
• LCL reconstruction
• ORIF fibular head avulsion fracture
CASE
CASE
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FOLLOW-UP
• Most recent follow-up (07/12/18); POD 17
• Incisions well-healed, staples removed
• 4/5 EHL, 4/5 TA
• Sensation improved in dorsum of foot, but still with paresthesias
SUMMARY
• Posterolateral corner knee injuries are uncommon in isolation, but in the setting of a multi-ligamentous knee injury are critical to diagnose and treat
• Pre-op: Thorough neurovascular exam due to possibility of nerve or vascular injury in knee dislocations
• Reconstruction or repair with augmentation preferred
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