Treatment of acute and chronic injuries to the posterolateral and lateral knee

Acute and chronic posterolateral injury is often associated with cruciate injury. Surgical reconstructions for acuteposterolateral instability achieve better results than reconstructions for chronic posterolateral instability, and whenever possible, we perform acute reconstruction of posterolateral injury. First, any associated cruciate injury is reconstructed. Then the posterolateral corner is exposed through an open lateral incision. We attempt to anatomically repair or reconstruct the major supporting structures of the posterolateral corner. They are the lateral collateral ligament, the popliteus, and the popliteofibular ligament. In acute injury we first attempt direct repair, advancement and recession, or augmentation. Occasionally, reconstruction with patellar tendon autografts or allografts or with achilles allografts is required. In the patient with chronic posterolateral instability and varus alignment, a proximal valgus tibial osteotomy is performed. If required, additional posterolateral reconstruction is performed on a staged basis. In the patient with chronic posterolateral instability and valgus alignment, reconstruction with patellar tendon or Achilles allograft is performed. This article reviews the techniques for reconstruction of acute and chronic injuries to the popliteofibular ligament, and popliteal attachment to the tibia and the lateral collateral ligament.