Large variability exists in the management of posterolateral corner injuries in the global surgical community

Abstract

Purpose The management of posterolateral corner (PLC) injuries has significantly evolved over the past 2 decades. The purpose of this study was to determine the current worldview of key concepts on the diagnosis, treatment strategy, and rehabilitation for patients presenting with PLC injuries. Methods A 12-question multiple-choice online survey was designed to address key questions in the diagnosis, treatment, and rehabilitation of PLC injuries. The survey was distributed to the most important international sports medicine societies worldwide. Clinical agreement was defined as > 80% of agreement in responses and general agreement was defined as > 60% of agreement in responses. Results 975 surgeons completed the survey with 49% from Europe, 21% from North America, 12% from Latin America, 12% from Asia, and smaller percentages from Africa and Oceania. Less than 14% of respondents manage more than ten PCL injuries yearly. Clinical agreement of > 80% was only evident in the use of MRI in the diagnosis of PLC injury. Responses for surgical treatment were split between isometric fibular-based reconstruction techniques and anatomically based fibular and tibial-based reconstructions. A general agreement of > 60% was present for the use of a post-operative brace in the early rehabilitation. ConclusionIn the global surgical community, there remains a significant variability in the diagnosis, treatment, and postoperative management of PLC injuries. The number of PLC injuries treated yearly by most surgeons remains low. As global clinical consensus for PLC remains elusive, societies will need to play an important role in the dissemination of evidencebased practices for PLC injuries. Level of evidence IV.

Overprescribing and Undereducating: a Survey of Pre- and Postoperative Pain Protocols for Pediatric Anterior Cruciate Ligament Surgery

“…Similar to previous survey studies, statistical analyses were not performed. 14 , 15 , 16 , 17 Clinical agreement among responses was defined by a minimum of 80% agreement in responses, whereas general agreement was defined as a minimum of 60% agreement. 14 , 18 , 19 Responses were analyzed according to practice type, provider sex, and fellowship training (pediatric orthopaedics, sports medicine, or dual pediatric orthopaedics and sports medicine).…”

Posterolateral corner knee injuries: a narrative review

“… 34 This is likely a result of these injuries most often presenting as part of a variety of different complex multiligamentous injuries rather than in isolation, as well as their lower incidence in comparison to single-ligament injuries. 35 In a recent international expert consensus review on the PLC, Chahla et al identified multiple areas reaching an expert consensus such as diagnostic aids, timing of treatment, and the need for anatomical reconstruction of injured structures. 34 …”

Knee Posterolateral Corner Reconstruction with a Single Tendon

“…Various methods of PLC reconstruction have been reported regarding the structures, the type of grafts and the fixations. 1 However, an easily performed procedure is still needed, 2 and there is still much room for improvement regarding the clinical results. 3 , 4 , 5 Thus, we would like to introduce a PLC reconstruction technique in which a single tendon is used to reconstruct or augment the LCL, the PFL and the PT, and 1 femoral tunnel is created for the reconstruction of all 3 structures.…”