Treatment of<unk>  varies with the location and grade of severity of the injuries. Patients with grade I and II (partial) injuries to the<unk><unk>  can usually be managed conservatively. Studies have reported that patients with grade III (complete) injuries do poorly with conservative management and typically will require surgical intervention followed by rehabilitation. Nonoperative treatment Conservative treatment relies on immobilizing the knee in full extension to allow the stretched or torn ligaments to heal. It is imperative that the patient keep the knee immobilized and not bear weight on the joint for 3 to 4 weeks to allow sufficient time for the structures to heal. Following immobilization, the patient can begin exercises to improve range of motion and begin bearing weight on crutches only. The crutches can be discontinued when the patient can walk without limping. Quadriceps strengthening exercises are allowed, but no isolated hamstring exercises should be attempted for 6 – 10 weeks following the injury. If after 10 weeks, pain or instability continue, the patient should be reevaluated for surgical treatment. Operative treatment This portion of the knee is felt to contain the most complex anatomy and to be the rarest type of knee injury. For this reason, consideration should be given to referral to a complex knee specialist for treatment. Surgical treatment of<unk>  depend on whether the injury is of an acute or chronic nature and whether it is isolated to the<unk><unk>  or combined with another ligamentous injury. Operative treatment is aimed at an anatomical repair or reconstruction rather than a non-anatomic reconstruction of the torn structures when possible, because this provides the highest odds of a successful return to function. The optimal time for treatment of acute injuries is within the first 3 weeks to avoid complications caused by scar tissue and the body's repair mechanisms. Chronic PLC injuries are less likely to be amenable to repair due to complications from scar tissue and limb malalignment; these injuries will likely necessitate reconstruction. Knees in varus alignment and which have chronic injuries (evaluated by long leg standing radiographs) will require a staged procedure that starts with an opening wedge osteotomy. This procedure lessens the constraint on the knee and prevents the reconstruction grafts from stretching out. If the patient still has instability, the PLC reconstruction will take place approximately 6 months later. MRI scans will be helpful in determining whether torn structures are amenable to repair or will require reconstruction with allografts. The structures considered for potential reconstruction are the fibular collateral ligament, popliteus tendon, and popliteofibular ligament. The FCL and/or popliteus tendon are only considered for acute repair when they are avulsed off bone and can be reattached anatomically with the knee in extension. The PFL can be repaired when it is torn directly off of the fibular head and the popliteus is still intact. Reconstruction is preferred when the ligaments/tendons have mid-substance tears or other tears not amenable to repair. Reconstruction of either the FCL or popliteus tendon is typically completed utilizing a patient's hamstring (semitendinous) for a graft; however when reconstructing both the FCL and popliteus an Achilles tendon graft from a cadaver is preferred. Acute isolated<unk>  Isolated injuries to the<unk><unk>  are best repaired in an anatomic fashion by attempting to reestablish the previous location of the damaged structure. Typically damaged structures can be directly sutured or anchored back to their bony attachments. The goal is to always achieve a stable and secure repair so that patients can initiate ROM exercises. Certain situations require more complicated repairs: Femoral avulsions of the FCL or popliteus typically require a slightly more complex repair using a recess procedure in which stitches are placed through a bone tunnel and around the avulsed structure to provide further stabilization and return to range of motion exercises. Avulsion fractures that occur at the fibular head or fibular styloid typically are caused by detachment of the popliteofibular ligament, direct arm of either the long or short heads of the biceps femoris or FCL. These fractures are best repaired with nonabsorbable suture or with wires. If the fracture is large enough, open fixation with surgical hardware may be required. Midsubstance tears of the FCL or popliteus tendon are best treated with anatomic reconstructions. An all arthroscopic popliteus sling reconstruction through the "popliteus portal" can be performed for<unk>  rotatory instability. Acute combined<unk>  Treatment for patients with combined grade III<unk>  injuries is quite similar to that of isolated PLC injuries. Repair or anatomic reconstruction of the<unk>  structures should be scheduled within 3 weeks of the initial injury. The other structures damaged should be reconstructed concurrently with the<unk>  structures so that the patient can readily return to a rehab program stressing range of motion exercises. This acts to prevent the development of arthrofibrosis (excessive scar tissue build up). Chronic isolated<unk>  Patients with chronic isolated<unk>  that are in varus alignment will require a staged procedure that starts with an opening wedge osteotomy. Multiple studies agree that reconstruction of chronic grade III PLC injuries have significantly better outcomes than repairs; however, If MRI reveals repairable damage of some individual structures in the PLC, repairs can done in a similar fashion the method described above for acute<unk>  injuries. These structures which can be repaired include the biceps femoris and mid-third lateral capsular ligament. The vast majority of these patients will require reconstruction of the torn structures using an autograft or allograft to restore stability and function of the damaged structures. Anatomic (grafts placed in the exact attachment sites) allograft reconstruction of the FCL and/or popliteus tendon and popliteofibular ligament complex restore the static stabilizers of the<unk>  knee, which allows for early postoperative range of motion. Chronic combined<unk>  Similar to chronic isolated injuries, patients with chronic combined<unk>  knee injuries showing varus alignment will first require an opening wedge osteotomy as part of a staged procedure. With chronic combined PLC injuries the surgeon should treat the injury as if it was isolated with an anatomic reconstruction concurrent with a standard reconstruction of the accompanying ACL and/or PCL injuries. The key point here is that the multiligament reconstructions be done at the same time and not as a staged procedure. This will allow for early range of motion (ROM) exercises to begin and prevent the formation of arthrofibrosis in the joint. In addition, failing to address a chronic<unk>  knee injury when repairing a deficient ACL or PCL has been shown to cause increased forces of the graft leading to cruciate reconstruction graft stretching and/or failure. Rehabilitation Rehabilitation protocols for post-op patients with repaired or reconstructed<unk>  focus on strengthening and achieving full range of motion. Similar to nonoperative treatments, the patient is non-weightbearing for 6 weeks followed by a return to partial weight-bearing on crutches. Range of motion exercises begin first at 1 to 2 days postoperatively, followed by progressive strength training. Patients can typically begin riding a stationary bike and using a quadriceps machine around 6 to 8 weeks, but isolated hamstring exercises should be avoided for a minimum of 4 months postoperatively. Patients can progress to leg presses after 6 weeks, but the weight should be very light. Jogging and more aggressive strength training can begin around 4 – 6 months at the surgeon and physical therapists discretion. Patients should not be casted after surgery unless absolutely necessary.
Posterolateral corner injuries
Retrolisthesis
Tennis injuries
Dural tear
Avulsion fracture
Jones fracture
Greenstick fracture
Rolando fracture