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Knee

Posterolateral Corner Injuries

Based on expert input from surgeons worldwide, it is established that Grade 1 and Grade 2 PLC injuries can often be managed non-surgically through targeted physical therapy. However, Grade 3 injuries, characterized by complete tears, almost always require surgical intervention.

For cases involving complete lateral collateral ligament (LCL) tears or when multiple structures within the PLC are damaged, the optimal window for surgery is within the first two weeks post-injury. This timing ensures that surgery is performed before significant scar tissue forms or the tissues become weakened, which could hinder the success of the repair. During this initial period, once the range of motion has been sufficiently restored, the knee’s anatomical alignment can be corrected efficiently. Delaying surgery can result in improper healing, leading to a knee that remains in an abnormal position, which complicates future treatment and rehabilitation.

Thanks to advancements in surgical reconstruction techniques, patients today have a much better prognosis following PLC repair. In the past, a severe PLC injury often signaled the end of athletic careers or significantly limited daily activities due to persistent knee instability. Modern surgical methods have changed that outlook, enabling many patients to return to high-level activities post-recovery.

One of the key philosophies in treating PLC injuries is to restore the knee’s natural anatomy as closely as possible. This approach has shown to yield the best outcomes for patients. While various surgical techniques exist, Cinque and his team employ a method that reconstructs all native insertions of the PLC. This comprehensive approach allows for early range of motion, supporting an effective recovery with excellent results.

The surgical procedure typically involves reconstructing or repairing the damaged ligaments and tendons of the PLC, including the LCL. The aim is to re-establish the knee’s stability and ensure that the alignment is anatomically correct. Precise positioning during reconstruction is essential for preventing long-term complications such as chronic pain or instability.

Recovery following a posterolateral corner reconstruction varies based on the severity of the injury and any additional damage to the knee structures. The typical recovery period ranges from 6 to 12 months. Rehabilitation is crucial and begins the day after surgery to promote range of motion. 

During the first six weeks, patients are advised to avoid weight-bearing or limit it to minimal levels. This period focuses on protecting the repair while maintaining range of motion through passive and assisted exercises. Crutches are used for mobility, and the knee is often supported by a brace to prevent unintended movements that could jeopardize the surgical repair.

Starting at approximately six weeks, patients begin a partial weight-bearing program while using crutches. As strength improves, patients gradually transition to full weight-bearing. The goal during this phase is to build strength and improve stability without causing undue stress to the healing tissues. At around seven to eight weeks post-surgery, many patients can start driving if their knee function permits.

The third phase of recovery emphasizes building muscle strength and endurance. At this stage, physical therapy includes more intensive strengthening exercises targeting the quadriceps, hamstrings, and surrounding muscles to support the knee. Agility drills and dynamic movements may also be introduced around the four-month mark, depending on progress.

By the time patients reach the 9 to 12-month period, many can consider returning to sports or high-impact activities. This phase involves sport-specific training, ensuring that the knee can handle the physical demands of activities such as running, jumping, and quick directional changes. The decision to return to full sports participation is determined by demonstrating equal strength in both legs, achieving full range of motion, and passing sport-specific endurance tests.

The path to successful recovery relies not only on the surgical procedure but also on adhering to a structured rehabilitation program. Early-phase exercises include quad sets, straight leg raises, and gentle range-of-motion activities to prevent stiffness. Patients are encouraged to follow their physical therapist’s instructions diligently, as rushing or skipping stages can compromise the repair.

As patients progress through rehabilitation, advanced exercises such as lunges, wall sits, and leg presses help build the strength required for daily and sports activities. It’s important for individuals to gradually incorporate these exercises to avoid overloading the knee prematurely. Additionally, cardio training, such as stationary biking or swimming, can be integrated into the program to boost endurance without placing excessive stress on the joint.

Orthopedic surgeon Dr. Mark Cinque is a sports medicine surgeon in San Diego, California who specializes in the treatment of complex knee injuries. He has spent time training at The Steadman Clinic and Stanford Orthopaedic Surgery. He has published over 100 peer-reviewed manuscripts and has presented research internationally. He uses minimally invasive arthroscopic procedures to preserve the natural joint and reduce recovery time to accelerate his patients’ return to the activities they love.

At a Glance

Mark Cinque, MD

  • Board-certified, fellowship-trained orthopedic surgeon
  • Orthopedic Residency: Stanford University, Fellowship: The Steadman Clinic
  • Authored over 100 peer-reviewed publications
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