Surgical treatment of ACL/PCL/ lateral-side knee injuries

Injury to the lateral knee structures is often accompanied by disruption of the posterolateral corner and cruciate ligaments. Failure to recognize and treat posterolateral pathologic laxity can result in persistent symptoms and failure of cruciate-ligament reconstruction efforts. Surgeons should proceed with early repair of the involved lateral and posterolateral structures when possible. Augmentation or reconstruction of the fibular collateral and popliteofibular ligaments is necessary if the existing tissues are inadequate. Late reconstruction is more challenging and requires careful attention to limb alignment. A proximal tibial osteotomy may be essential before ligament reconstruction surgery. Anatomic placement of high-strength grafts affords the best results. Improved surgical techniques, the use of allogeneic graft sources, and controlled postoperative knee range of motion reduce the risk of pathologic laxity and arthrofibrosis. Early surgical repair, augmentation, or reconstruction of the lateral structures combined with reconstruction of the cruciate ligaments provides the highest level of function.