Posterolateral Corner (PLC) Reconstruction

What is Posterolateral Corner (PLC) Reconstruction?

The “posterolateral corner” is a complex arrangement of multiple ligaments, tendons, muscles and a joint capsule in your knee. It is located on the outside back corner of the knee. 

PLC reconstruction is the surgical treatment of PLC injuries.

Most PLC injuries occur due to trauma such as sporting injuries or from a motor vehicle accident. Other possible causes can be:

  • Hyperextended knee
  • Knee dislocation 

However, PLC injuries are often associated with damage to other ligaments in the knee such as the cruciate ligaments.

Significance of the PLC

The PLC stabilises the knee against certain directional forces and protects against: 

  • External rotation (motion away from the centre of the body leading to locking of the knee)
  • Varus rotation (inward angulation of the knee resulting in bowlegs)
  • Posterior translation, which can lead to a posterior cruciate ligament tear in the knee

Who may benefit from PLC Reconstruction?

PLC reconstruction is recommended if you experience the following:

  • Pain and swelling along the outside back of your knee 
  • Discomfort along the joint line of the knee
  • Excessive rotation of the knee
  • Knee instability during full extension
  • Difficulty with using stairs, pivoting
  • Altered walking pattern with the foot turned outwards
  • ‘Thrust’ of the knee while walking
  • A sensation of the knee giving out  

What happens in the surgery?

PLC reconstruction typically involves the recreation of the injured PLC structures by using other body tissues as grafts. 

Two types of grafts are used to recreate the PLC:

  • Autograft (tissue taken from another part of the patient) 
  • Allografts (tissues obtained from a deceased or live donor) 

During the procedure:

  • An incision is made on the outer back aspect of the knee.
  • The graft is placed through the head of the fibula (the smaller bone of the leg).
  • Using a screw device or a tendon anchor, the graft is secured in the outer aspect of the femur.
  • The incision is then closed with sutures to complete the reconstruction.

Risks Associated with PLC Reconstruction

Possible complications of a PLC reconstruction include:

  • Stiffness of the knee or arthrofibrosis (limited knee motion)
  • Constant  swelling of the knee
  • Persistent pain over the front aspect of the knee 
  • Blood clots in the veins (deep venous thrombosis)
  • Infection of the knee (though rare, it is a serious risk)
  • Numbness on the front of the leg or the inner aspect of the leg
  • Peroneal nerve (fibular nerve) injury or palsy 
  • Failure of the graft causing the knee to start giving way again

After Surgery Care

As you recover from the PLC reconstruction, you are advised to:

  • Ensure protected or partial weight-bearing for 4 weeks
  • Use a brace
  • Avoid active hamstring exercises as they are likely to stress the PLC
  • Start passive ROM about 4 weeks after the procedure to avoid arthrofibrosis

Benefits of PLC Reconstruction

PLC reconstruction ensures a more stable and better functioning knee. 

  • The General Medical Council
  • The British Medical Association (BMA)
  • NHS website
  • The Royal College of Surgeons of England
  • British Orthopaedic Association
  • British Association for Surgery of the Knee
  • European Society for Sports Traumatology, Knee Surgery and Arthroscopy
  • American Academy of Orthopaedic Surgeons
  • Top Doctors
  • Percival Pott Club
  • Magellan Orthopaedic Society