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7th Congress of the European Federation of National Associations of Orthopaedics and Traumatology, Lisbon - 4-7 June, 2005


Anatomy & Biomechanics

  • Lateral Collateral Ligament (LCL)

    • Primary stabilizer to varus opening

    • Femoral attachment – proximal/posterior to lateral epicondyle

    • Fibular attachment – midway along lateral fibular head

  • Popliteus Complex

    • Important stabilizer to posterolateral rotation

    • Stabilizer to varus opening

    • Popliteus attachment on femur

      • 18mm anterior/distal to LCL

      • anterior fifth of popliteal sulcus

    • Popliteofibular ligament (PFL)

      • originates at musculo-tendinous junction of popliteus

      • attaches at medial aspect of fibular styloid

  • Mid-Third Lateral Capsular Ligament

    • Secondary stabilizer to varus opening

    • Thickening of lateral midline capsule

    • Meniscotibial portion often injured. Segond injury

  • Biceps Femoris Complex

    • Short head of biceps

    • Long head of biceps

  • Lateral Meniscus

Injury Mechanism

  • Rarely isolated injury

  • Usually as a combined ligamentous injury

    • ACL/PLC

    • PCL/PLC

    • Knee Dislocation

  • Hyperextension

  • Varus blow

  • Noncontact twisting

Importance of injury

  • Grade III injuries do not heal

  • Lead to instability and osteoarthritis

  • Compromise cruciate ligament reconstructions

Diagnosis of LCL/PLC injury

  • History

    • Usually due to varus/hyperextension injuries

    • 15 % have a peroneal nerve injury

    • Usually combined ligamentous injury

  • Clinical exam

    • Varus stress test

    • External rotation recurvatum test

    • Posterolateral drawer test

    • Dial test

    • Reverse pivot shift test

    • Varus thrust gait

  • Radiographs

  • MRI

  • Arthroscopic evaluation

Treatment for acute posterolateral knee injuries

  • Acute grade I and II injuries

    • Brace 6 weeks

    • Full ROM

    • Partial weight bearing

  • Acute grade III injuries

    • Repair/reconstruct within 2 weeks after injury

    • Attempt anatomic repair

    • Each structure repaired individually

    • Consider augmentation in midsubstance tears

    • Anatomic reconstruction

Treatment For Chronic Grade III Injuries

  • Assess for varus alignment

  • Proximal tibial opening wedge osteotomy

  • Reassess after 6 months for need for soft tissue reconstruction

  • Anatomic reconsruction of posterolateral structures

    • Two tailed reconstruction of LCL, PFLand popliteus tendon

    • Biomechanically restores function of native ligaments

Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.