Lateral Side Injury

Unlike medial-side injury, there is widespread agreement that grade III lateral-side injuries in association with ACL/PCL injury are best treated with acute repair.36,37 Grade III lateral-side injuries most commonly represent avulsions from the tibia/fibula. Direct anatomic repair of all injured structures will provide the greatest chance of favorable outcome.37

The posterolateral corner is approached through a curvilinear incision extending from the lateral epicondyle to Gerdy's tubercle. A systematic evaluation of all structures should take place including the iliotibial band, biceps femoris, lateral collateral ligament, popliteus, popliteofibular ligament, lateral meniscus, and peroneal nerve. Repair should proceed from deep to superficial with either a direct end-to-end suture repair or suture anchors as needed. Repairs should be performed with the knee in 30 degrees of flexion.

In cases of significant mid-substance injury or poor tissue quality, direct repair may be augmented with hamstring auto-graft, allograft, biceps femoris, or iliotibial band tendon. Numerous techniques have been described.38-40 These same techniques can be applied to cases of chronic laxity requiring reconstructions. We perform reconstructions of the fibular collateral ligament and popliteofibular ligament using a split Achilles tendon allograft fixed on the lateral femoral condyle with an interference screw and passed through tunnels in the proximal tibia and fibula with interference screw fixation.

Table 56-4 Algorithm for Rehabilitation Following Multiligament Knee Surgery

Table 56-4 Algorithm for Rehabilitation Following Multiligament Knee Surgery

From Harner CD, Waltrip RL, Bennett CH, et al: Surgical management of knee dislocations. J Bone Joint Surg 2004;86:262-273.

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