Acute PLC Management



Early repair < 3/52 better than late repair

Able to identify and repair structues such as LCL and popliteus

Typically only if off the femur


Keep in mind

- many papers show that repair inferior to reconstruction

- high failure rate, especially in muliligament knee injury

- augment with reconstruction




1.  Isolated LCL Injuries 

2.  LCL + Posterolateral Corner

3.  PCL + PLC

4.  ACL + PLC


Need to repair / reconstruct


1. LCL

2. PL capsule

3. Popliteus

4. Popliteo-fibular ligament


Plus ACL / PCL as indicated









Surgical Algorithm


1.  Capsule

- with anchors / staples

- may need to repair lateral meniscus capsular avulsion


2.  Popliteus


A.  Direct repair of femoral origin

- suture anchors / staple


B.  Reconstruct

- musculotendinous junction injury


This patient will often have increased external rotation of the tibia

- indicates popliteus injury


Laprade technique

- allograft

- drill hole into popliteus insertion

- secure allograft

- tibial drill hole

- medial to gerdy's tubercle, below plateau

- posteriorly, elevate gastrocnemius

- exit in popliteal sulcus, 15 mm medial to tib-fib joint

- secure with front to back screw in tibia


3.  Popliteofibular ligament


A.  Direct repair of fibular avulsion

- usually attached with LCL to bony fragment


B.  Reconstruct

- Laprade Technique with LCL / Popliteus

- see chronic reconstruction


4.  LCL


A.  Direct repair of avulsion from femur or fibula

- trans-osseous drill holes

- suture anchors


B.  Reconstruct midsubstance tear


Modified Larson

- single drill hole in epicondyle

- anterolateral to posteromedial drill hole in fibula

- 7 mm tunnel

- ensure doesn't blow out superior fibula

- pass graft through fibula

- secure both limbs in single femoral tunnel

- reconstructs both LCL and popliteofibular ligament


LCLLCL graft passed through fibula


LCL Recon 2LCL Reconstruction Final


LCL ReconstructionLCL Reconstruction Lateral



- same fibular drill

- femoral tunnels in anatomic location of LCL and popliteus

- again, reconstructs both LCL and popliteofibular ligament


C.  Large Bony Avulsion


Fixate with screw into fibular or tibia


Repair Fibular Avulsion


5.  Biceps Tendon


Repair fibular avulsion

- suture anchors to fibular head

- advance to proximal tibia and secure with staples (Shelbourne)


Combination injuries


1.  Acute PCL + PLC


PCL insertion injury

- open repair via medial parapatella incision

- sutures into PCL

- pass beath pins into insertion on MFC

- medial approach to distal femur, elevate VMO

- tie sutures over medial femur with endobutton / over cortex


PCL midsubstance

- Lars acute repair

- autograft / allograft reconstruction


2.  Acute ACL + PLC


Reconstruct ACL


3.  Acute ACL / PCL / PLC


Reconstruct ACL and PCL


Repair / reconstruct PCL


Alternative Management


Shelbourne Am J Sports Med 2007


Enmass surgical repair of lateral side

- advance tissue (capsule / LCL / biceps / popliteus) to tibia

- don't dissect out individual structures

- pass sutures into tissue

- freshen tibial bone, staple to tibia


CPM 0 - 30o overnight

- CPM during first week to 130o

- ROM brace


Posterolateral Corner Aute Advancement Plus ACL



- only 2 of 17 had 1+ laxity



- doesn't deal with LCL / Popliteus femoral avulsion




Lock in extension 3 weeks

- isometric quads exercises

- 4-8 weeks gentle ROM in ROM brace

- no active hamstrings

- quads exercises


Can get very stiff


Literature Review


Reconstruction v Repair


1.  Stannard et al Am J Sports Med 2005

- reconstruction v repair

- reconstruction better outcomes


A.  Repair if < 3 weeks and able to

- suture anchor repair LCL to fibula / Popliteus avulsion from femur

- ORIF of femoral bone avulsion

- all other structures repaired as able

- 22 successful, 13 failed (37%)

- good results when able to ORIF fibular head attachments


B.  Reconstruction with allograft

- LCL 2 limbs + popliteus

- 20 successful, 2 failed (9%)



- non randomised

- multiligaments included / staged ACLR performed


2.  Levy et al Am J Sports Med 2010


Multiligament knees


A. Repair of injured structures / delayed reconstruction PCL / ALC

- 40% failure


B.  Reconstruction (allograft LCL / Popliteus) with PCL / ACL

- 6% failure



- very heterogenous groups