Posterolateral corner of the knee: an expert consensus statement on diagnosis, classification, treatment, and rehabilitation

Abstract

Purpose To develop a statement on the diagnosis, classification, treatment, and rehabilitation concepts of posterolateral corner (PLC) injuries of the knee using a modified Delphi technique. Methods A working group of three individuals generated a list of statements relating to the diagnosis, classification, treatment, and rehabilitation of PLC injuries to form the basis of an initial survey for rating by an international group of experts. The PLC expert group (composed of 27 experts throughout the world) was surveyed on three occasions to establish consensus on the inclusion/exclusion of each item. In addition to rating agreement, experts were invited to propose further items for inclusion or to suggest modifications of existing items at each round. Pre‐defined criteria were used to refine item lists after each survey. Statements reaching consensus in round three were included within the final consensus document. Results Twenty‐seven experts (100% response rate) completed three rounds of surveys. After three rounds, 29 items achieved consensus with over 75% agreement and less than 5% disagreement. Consensus was reached in 92% of the statements relating to diagnosis of PLC injuries, 100% relating to classification, 70% relating to treatment and in 88% of items relating to rehabilitation statements, with an overall consensus of 81%. Conclusions This study has established a consensus statement relating to the diagnosis, classification, treatment, and rehabilitation of PLC injuries. Further research is needed to develop updated classification systems, and better understand the role of non‐invasive and minimally invasive approaches along with standardized rehabilitation protocols. Level of evidence Consensus of expert opinion, Level V.

Single-Stage Arthroscopic Anterior and Posterior Cruciate Ligament Repairs and Open Medial Collateral Ligament Repair for Acute Knee Dislocation

“…Surgery is recommended for multiple ligament knee injuries as after conservative treatment, the rate of return to sports and work, the Lysholm score, the International Knee Documentation Committee (IKDC) score, and the Lachman test results are all inferior to those observed after surgical treatment [3]. However, there are no clearly established guidelines regarding surgical methods or the timing of surgery [1].…”

“…There is no current gold standard for treating multiple ligament knee injuries [1]. Although this type of injury is rare, accounting for less than 0.02% of orthopedic injuries [2], the instability of the knee results in persistent severe symptoms if appropriate treatment is not administered.…”

Comparative analysis of the results of the posterior cruciate ligament restoration with «inlay» methods and transtibial canal conduction

“…Повреждения ЗКС встречаются относительно редко -3-7 % от всех травм коленного сустава [9][10][11][12]. По данным разных авторов, не менее чем в 80 % случаев наряду с разрывом ЗКС происходит сопутствующее травмирование структур заднелатерального отдела коленного сустава [13][14][15][16][17].…”

Arthroscopic Surgical Treatment of Patients With Posterolateral Knee Instability

“…Связано это прежде всего с относительно низкой частотой встречаемости повреждений задней крестообразной связки (3-6% от всей патологии связочного аппарата, по данным литературных источников). В настоящее время многие авторы сходятся во мнении, что повреждение задней крестообразной связки чаще всего сочетается с повреждением структур заднелатерального угла (ЗЛУ) и приводит к возникновению не только задней, но и заднелатеральной ротационной нестабильности [1]. Понятие «заднелатеральный угол» появилось относительно недавно, в 1980-х гг.…”

“…Лишь наиболее свежие исследования позволили относительно четко сформировать мнение о его строении [1]. В настоящее время к структурам ЗЛУ принято относить: сухожилие подколенной мышцы (СПМ), пателлофибулярную связку, малоберцовую коллатеральную связку, а также дугообразную связку (утолщение заднего отдела капсулы коленного сустава) [1,3].…”