Citation

DePhillipo NN, Aman ZS, Dekker TJ. Ann. Jt. 2023; 8: e31.

Copyright

(Copyright © 2023, AME Publishing Company)

DOI

10.21037/aoj-23-42

PMID

38529238

PMCID

PMC10929321

Abstract

The posterolateral corner (PLC) of the knee is made up of three main static stabilizing structures: the fibular collateral ligament (FCL), the popliteus tendon, and the popliteofibular ligament (PFL) (1). In addition, there are multiple structures that provide dynamic and secondary stabilization to the lateral side of the knee, including the distal attachments of the biceps femoris muscle, the iliotibial band, the anterolateral ligament (ALL), posterior horn of lateral meniscus, and the popliteomeniscal fascicles. Once referred to as the "dark side of the knee", researchers and clinicians have made giant advancements over the past two decades in understanding the anatomy, biomechanics, and clinical characteristics of PLC injuries in order to better serve patients (2-4). A common trend reported in the literature is that isolated PLC injuries are extremely rare and typically do not occur without concomitant anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injuries, resulting in multi-ligament knee categorization and treatment (often complex surgery) (3).

In their recent study titled, "Patient demographic and magnetic resonance imaging evaluation of isolated posterolateral corner knee injuries", Costa et al. (5) retrospectively analyzed magnetic resonance images (MRIs) of patients with reported PLC knee injuries over a 5.5-year period in two hospitals in Brazil. Both 1.5T (91%) and 3.0T (9%) magnets were used, and all MRIs were assessed by two experienced radiologists with specialization in musculoskeletal injuries. A total of 248 cases of PLC injuries were identified, however, only 23 patients (9.2%) had isolated PLC injuries. The mean age of patients was 32.0±8.1 years, and the majority of patients were male (91% vs. 9% female). Authors reported that nearly half of all isolated PLC injuries (48%) occurred during Brazilian Jiu-Jitsu, with 35% of injuries resulted from playing soccer. The PFL was damaged in 83% of cases on MRI evaluation, while 0 common peroneal nerve injuries were identified. The most common associated concomitant injury was damage to the ALL, reported in 43% of isolated PLC injuries. Also, bone bruising patterns involving the medial femur and tibia were identified in 22% of isolated PLC cases. Authors reported that PLC injuries were best appreciated on T2 weighted, fat saturation sequences with coronal and axial views most helpful for diagnosing PLC injuries (5).

Language: en

Keywords

anterolateral ligament (ALL); Complex knee; Jiu-Jitsu; knee magnetic resonance image (knee MRI); musculoskeletal imaging