POSTEROLATERAL CORNER (PLC) SURGERY
The Posterolateral Corner (PLC) is a group of structures on the outside of the knee that provides the knee with rotational stability. The main anatomic structures of the posterolateral aspect of the knee are the lateral collateral ligament (LCL) the popliteus tendon, and the popliteofibular ligament. In patients who sustain a significant injury to one or all of the structures that make up the PLC, Dr. Welch usually recommends surgery.
The goal of PCL surgery is to stabilize the knee by preventing abnormal external rotation of the tibia bone and abnormal gapping on the outside of the knee (varus instability). Surgery involves reconstructing the structures of the PLC, usually with a hamstring allograft (donor tissue). There are multiple techniques for PLC reconstruction, and Dr. Welch typically employs a “fibular-based” technique, similar to the technique used for LCL reconstruction. During surgery, Dr. Welch makes an incision on the outside of the knee and identifies the spots on the femur bone and fibula bone where the torn structures should attach. Dr. Welch then creates bony “tunnels” at the appropriate positions. The donor tissue is then placed under appropriate tension and is fixed to the tunnels with medical screws.
Following surgery, patients are limited to a “safe zone” of knee motion based on findings during surgery. Dr. Welch recommends crutches and non weight-bearing on the affected leg for six weeks following surgery. Dr. Welch also recommends intermittent icing, straight leg raises for quad strength, and starting a dedicated physical therapy protocol two weeks after surgery. Physical therapy focuses on reducing swelling in the knee, restoring strength to the knee, and gradual return of range of motion. Dr. Welch recommends advancing the physical therapy program to cutting, pivoting, and sport-specific activities only after the patient has achieved certain goals (for example, appropriate quadriceps strength, appropriate range of motion, etc.). Most patients start sport-specific training approximately 4-6 months after surgery. Most patients return to competitive sports approximately six months after surgery. It is very important to follow the rehabilitation process carefully to achieve the best outcome.