Background: In the multiple ligament injury of the knee joint, apart from the anterior cruciate ligament and the posterior cruciate ligament, the Posterolateral Corner and the Posteromedial Corner are two structures that are easily overlooked. If not properly identified and repaired in one stage, the knee joint may be unstable, even failure of cruciate ligament reconstruction. The purpose of this article was to evaluate the effect of knee joint recovery after PLC (Posterolateral Corner) with or without PMC (Posteromedial Corner) injury.
Methods: From 2016 to 2020, we screened a total of 2564 patients, of which 292 patients met the inclusion and exclusion criteria. In the end, a total of 44 people completed the study. Follow-up was performed at 1, 3, 6, 9, and 12 months after surgery. We used pain visual analog scale (VAS) for pain, IKDC score, Lysholm score, Tegner score. Opti-knee (a portable motion analysis system) was used to evaluate the stability of the knee joint at 1 year. In our prospective cohort study, we used the unpaired Student's t-test for statistical analysis.
Results: The knee joint function of PLC group and PLC combined PMC group was better than that before operation at 3 or 6 months after operation. Except for IKDC at 9-month follow-up and Tegner score at 9-month and 12-month follow-up, there was no significant difference between the other groups.
Conclusions: PLC and PLC combined with PMC injury showed similar prognostic effects, although the PLC group was numerically superior to the other group. We recommend primary repair and reconstruction in patients with confirmed PLC and PMC injuries to achieve the best postoperative recovery.
| [1] |
A. Naraghi, D. H. Pearce, D. B. Whelan, and J. Chahal, “Imaging of the Postoperative Condition of Posterolateral Corner Injuries,” Seminars in Musculoskeletal Radiology 22, no. 4 (2018): 413–423.
|
| [2] |
J. Tang and J. Zhao, “Knee Posterolateral Corner Reconstruction With a Single Tendon,” Arthroscopy Techniques 10, no. 11 (2021): e2479–e2485.
|
| [3] |
M. I. Kennedy, A. Bernhardson, G. Moatshe, P. S. Buckley, L. Engebretsen, and R. F. LaPrade, “Fibular Collateral Ligament/ Posterolateral Corner Injury: When to Repair, Reconstruct, or Both,” Clinics in Sports Medicine 38, no. 2 (2019): 261–274.
|
| [4] |
J. Bicos and R. A. Arciero, “Novel Approach for Reconstruction of the Posterolateral Corner Using a Free Tendon Graft Technique,” Sports Medicine and Arthroscopy Review 14, no. 1 (2006): 28–36.
|
| [5] |
A. G. Geeslin and R. F. LaPrade, “Location of Bone Bruises and Other Osseous Injuries Associated With Acute Grade III Isolated and Combined Posterolateral Knee Injuries,” American Journal of Sports Medicine 38, no. 12 (2010): 2502–2508.
|
| [6] |
R. F. LaPrade and G. C. Terry, “Injuries to the Posterolateral Aspect of the Knee. Association of Anatomic Injury Patterns With Clinical Instability,” American Journal of Sports Medicine 25, no. 4 (1997): 433–438.
|
| [7] |
A. Deichsel, C. Peez, W. Liu, et al., “Restriction of Posterior Tibial Translation During the Posterior Drawer Test in Internal or External Rotation Is Dependent on Peripheral Stabilizers of the Knee: A Biomechanical Robotic Investigation,” American Journal of Sports Medicine 53, no. 5 (2025): 1077–1084.
|
| [8] |
J. C. Hughston, J. R. Andrews, M. J. Cross, and A. Moschi, “Classification of Knee Ligament Instabilities. Part II. The Lateral Compartment,” Journal of Bone & Joint Surgery 58, no. 2 (1976): 173–179.
|
| [9] |
B. Maheshwer, J. Drager, N. S. John, B. T. Williams, R. F. LaPrade, and J. Chahla, “Incidence of Intraoperative and Postoperative Complications After Posterolateral Corner Reconstruction or Repair: A Systematic Review of the Current Literature,” American Journal of Sports Medicine 49, no. 12 (2021): 3443–3452.
|
| [10] |
L. Willinger, K. K. Athwal, S. Holthof, A. B. Imhoff, A. Williams, and A. A. Amis, “Role of the Anterior Cruciate Ligament, Anterolateral Complex, and Lateral Meniscus Posterior Root in Anterolateral Rotatory Knee Instability: A Biomechanical Study,” American Journal of Sports Medicine 51, no. 5 (2023): 1136–1145.
|
| [11] |
P. E. Gelber, J. Drager, B. Maheshwer, et al., “Large Variability Exists in the Management of Posterolateral Corner Injuries in the Global Surgical Community,” Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA 28, no. 7 (2020): 2116–2123.
|
| [12] |
C. P. Helito, M. F. Sobrado, P. N. Giglio, et al., “Clinical Outcomes of Posterolateral Complex Reconstruction Performed With a Single Femoral Tunnel,” Journal of Knee Surgery 34, no. 1 (2021): 67–73.
|
| [13] |
F. R. Noyes and S. D. Barber, “The Effect of an Extra-Articular Procedure on Allograft Reconstructions for Chronic Ruptures of the Anterior Cruciate Ligament,” Journal of Bone & Joint Surgery 73, no. 6 (1991): 882–892.
|
| [14] |
R. F. LaPrade, S. Johansen, F. A. Wentorf, L. Engebretsen, J. L. Esterberg, and A. Tso, “An Analysis of an Anatomical Posterolateral Knee Reconstruction: An In Vitro Biomechanical Study and Development of a Surgical Technique,” American Journal of Sports Medicine 32, no. 6 (2004): 1405–1414.
|
| [15] |
R. Serra Cruz, J. J. Mitchell, C. S. Dean, J. Chahla, G. Moatshe, and R. F. LaPrade, “Anatomic Posterolateral Corner Reconstruction,” Arthroscopy Techniques 5, no. 3 (2016): e563–e572.
|
| [16] |
A. J. Nedopil, S. M. Howell, and M. L. Hull, “More Passive Internal Tibial Rotation With Posterior Cruciate Ligament Retention Than With Excision in a Medial Pivot TKA Implanted With Unrestricted Caliper Verified Kinematic Alignment,” Knee Surgery, Sports Traumatology, Arthroscopy 31, no. 3 (2023): 852–860.
|
| [17] |
S. Gella, D. B. Whelan, J. P. Stannard, and P. B. MacDonald, “Acute Management and Surgical Timing of the Multiligament-Injured Knee,” Instructional Course Lectures 64 (2015): 521–530.
|
| [18] |
M. A. Jokela, T. J. Mäkinen, M. P. Koivikko, J. M. Lindahl, J. Halinen, and J. Lindahl, “Treatment of Medial-Sided Injuries in Patients With Early Bicruciate Ligament Reconstruction for Knee Dislocation,” Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA 29, no. 6 (2021): 1872–1879.
|
| [19] |
J. W. G. Ng, Y. Myint, and F. M. Ali, “Management of Multiligament Knee Injuries,” EFORT Open Reviews 5, no. 3 (2020): 145–155.
|
| [20] |
A. Malige, A. Carbone, D. T. Huang, et al., “Biomechanical Evaluation of Posterolateral Corner Reconstruction With Suture Augmentation in a Posterolateral Corner and Posterior Cruciate Ligament Deficient Knee Model,” Clinical Biomechanics (Bristol) 123 (2025): 106461.
|
| [21] |
E. Herbst, R. J. Muhmann, M. J. Raschke, et al., “The Anterior Fibers of the Superficial MCL and the ACL Restrain Anteromedial Rotatory Instability,” American Journal of Sports Medicine 51, no. 11 (2023): 2928–2935.
|
| [22] |
R. B. Lundquist, G. R. Matcuk, A. J. Schein, et al., “Posteromedial Corner of the Knee: The Neglected Corner,” Radiographics 35, no. 4 (2015): 1123–1137.
|
| [23] |
G. Moatshe, A. R. Vap, A. Getgood, R. F. LaPrade, and L. Engebretsen, “Medial-Sided Injuries in the Multiple Ligament Knee Injury,” Journal of Knee Surgery 33, no. 5 (2020): 431–439.
|
| [24] |
T. J. Gensior, B. Mester, A. Achtnich, et al., “Anatomic Repair and Ligament Bracing as an Alternative Treatment Option for Acute Combined PCL Injuries Involving the Posteromedial or Posterolateral Corner-Results of a Multicentre Study,” Archives of Orthopaedic and Trauma Surgery 143, no. 12 (2023): 7123–7132.
|
| [25] |
P. S. Myles, D. B. Myles, W. Galagher, et al., “Measuring Acute Postoperative Pain Using the Visual Analog Scale: The Minimal Clinically Important Difference and Patient Acceptable Symptom State,” British Journal of Anaesthesia 118, no. 3 (2017): 424–429.
|
| [26] |
R. A. G. Hoogeslag, R. W. Brouwer, B. C. Boer, A. J. de Vries, and R. Huis In 't Veld, “Acute Anterior Cruciate Ligament Rupture: Repair or Reconstruction? Two-Year Results of a Randomized Controlled Clinical Trial,” American Journal of Sports Medicine 47, no. 3 (2019): 567–577.
|
| [27] |
A. L. L. de Andra, A. Castro, B. Livani, and W. D. Belangero, “Association Between Lysholm Score and Muscular Torque Deficit After Anterior Cruciate Ligament Reconstruction,” Journal of Orthopaedic Surgery (Hong Kong) 28, no. 2 (2020): 2309499020933485.
|
| [28] |
N. Mostafaee, H. Negahban, M. J. Shaterzadeh Yazdi, S. Goharpey, M. Mehravar, and N. Pirayeh, “Responsiveness of a Persian Version of Knee Injury and Osteoarthritis Outcome Score and Tegner Activity Scale in Athletes With Anterior Cruciate Ligament Reconstruction Following Physiotherapy Treatment,” Physiotherapy Theory and Practice 36, no. 9 (2020): 1019–1026.
|
| [29] |
S. Wang, X. Zeng, L. Huangfu, et al., “Validation of a Portable Marker-Based Motion Analysis System,” Journal of Orthopaedic Surgery and Research 16, no. 1 (2021): 425.
|
| [30] |
P. Liu, X. Gong, J. Zhang, and Y. Ao, “Anatomic, All-Arthroscopic Reconstruction of Posterolateral Corner of the Knee: A Cadaveric Biomechanical Study,” Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association 36, no. 4 (2020): 1121–1131.
|
| [31] |
G. P. Treme, C. Salas, G. Ortiz, et al., “A Biomechanical Comparison of the Arciero and LaPrade Reconstruction for Posterolateral Corner Knee Injuries,” Orthopaedic Journal of Sports Medicine 7, no. 4 (2019): 2325967119838251.
|
| [32] |
O. Bohe, F. Greve, S. Höger, J. Mehl, S. Siebenlist, and L. Willinger, “Posteromedial Corner Injuries Result in the Same Posterior Translation as Posterolateral Corner Injuries in PCL Ruptures,” Journal of Experimental Orthopaedics 11, no. 4 (2024): e70118.
|
| [33] |
C. K. Schillhammer, “Editorial Commentary: Posterolateral Corner Reconstruction: Is Better (Anatomy) the Enemy of Good?,” Arthroscopy: The Journal of Arthroscopic & Related Surgery 36, no. 5 (2020): 1363–1364.
|
| [34] |
T. Briese, R. Riemer, A. Deichsel, et al., “Combined PCL Instabilities Cannot Be Identified Using Posterior Stress Radiographs in External or Internal Rotation: A Cadaveric Study,” Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA 33, no. 5 (2025): 1586–1593.
|
| [35] |
H. Fahlbusch, S. Weiß, J. Landenberger, et al., “Arthroscopic and Open Reconstruction of the Posterolateral Corner of the Knee Have Equally Good Clinical Results: First Results of a Prospective 12-Month Follow-Up Study,” Archives of Orthopaedic and Trauma Surgery 144, no. 6 (2024): 2745–2752.
|
| [36] |
S. Weiss, M. Krause, and K. H. Frosch, “Clinical Results After Arthroscopic Reconstruction of the Posterolateral Corner of the Knee: A Prospective Randomized Trial Comparing Two Different Surgical Techniques,” Archives of Orthopaedic and Trauma Surgery 143, no. 2 (2023): 967–975.
|
| [37] |
S. J. Kim, D. H. Lee, T. E. Kim, and N. H. Choi, “Concomitant Reconstruction of the Medial Collateral and Posterior Oblique Ligaments for Medial Instability of the Knee,” Journal of Bone and Joint Surgery. British Volume 90, no. 10 (2008): 1323–1327.
|
| [38] |
N. Kitamura, M. Ogawa, E. Kondo, S. Kitayama, H. Tohyama, and K. Yasuda, “A Novel Medial Collateral Ligament Reconstruction Procedure Using Semitendinosus Tendon Autograft in Patients With Multiligamentous Knee Injuries: Clinical Outcomes,” American Journal of Sports Medicine 41, no. 6 (2013): 1274–1281.
|
| [39] |
A. G. Geeslin and R. F. LaPrade, “Outcomes of Treatment of Acute Grade-III Isolated and Combined Posterolateral Knee Injuries: A Prospective Case Series and Surgical Technique,” Journal of Bone and Joint Surgery 93, no. 18 (2011): 1672–1683.
|
| [40] |
T. Vivacqua, S. Vakili, R. Willing, G. Moatshe, R. Degen, and A. M. Getgood, “Biomechanical Assessment of Knee Laxity After a Novel Posterolateral Corner Reconstruction Technique,” American Journal of Sports Medicine 50, no. 4 (2022): 962–967.
|
| [41] |
C. Pioger, P. A. Bouché, T. X. Haen, and N. Pujol, “Comparison of Three Surgical Techniques of Posterolateral Knee Reconstruction: A Cadaver Study,” Orthopaedics & Traumatology, Surgery & Research: OTSR 108, no. 8 (2022): 103414.
|
| [42] |
C. C. Wu, L. M. Ye, X. F. Li, and L. J. Shi, “Sequential Damage Assessment of the Posterolateral Complex of the Knee Joint: A Finite Element Study,” Journal of Orthopaedic Surgery and Research 17, no. 1 (2022): 185.
|
| [43] |
W. F. Sims and K. E. Jacobson, “The Posteromedial Corner of the Knee: Medial-Sided Injury Patterns Revisited,” American Journal of Sports Medicine 32, no. 2 (2004): 337–345.
|
| [44] |
D. Geiger, E. Chang, M. Pathria, and C. B. Chung, “Posterolateral and Posteromedial Corner Injuries of the Knee,” Radiologic Clinics of North America 51, no. 3 (2013): 413–432.
|
| [45] |
C. J. Griffith, C. A. Wijdicks, R. F. LaPrade, B. M. Armitage, S. Johansen, and L. Engebretsen, “Force Measurements on the Posterior Oblique Ligament and Superficial Medial Collateral Ligament Proximal and Distal Divisions to Applied Loads,” American Journal of Sports Medicine 37, no. 1 (2009): 140–148.
|
| [46] |
J. L. Haimes, R. R. Wroble, E. S. Grood, and F. R. Noyes, “Role of the Medial Structures in the Intact and Anterior Cruciate Ligament-Deficient Knee. Limits of Motion in the Human Knee,” American Journal of Sports Medicine 22, no. 3 (1994): 402–409.
|
RIGHTS & PERMISSIONS
2026 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
PDF
(1032KB)
