Editorial Commentary: Knee Posterolateral Corner Reconstruction Shows Low Failure and Complication Rates

High-grade knee posterolateral corner (PLC) injuries are potentially devastating and often associated with high-energy mechanisms. Failure of PLC injury diagnosis or treatment can lead to residual instability after combined cruciate ligament reconstruction because of the increased risk of graft failure, and varus malalignment may lead to early osteoarthritis and meniscal injuries. PLC reconstruction has consistently shown superiority over PLC repair. Biomechanical studies have compared reconstruction techniques, specifically evaluating rotational and varus laxity. Some studies have demonstrated no difference between techniques, whereas other studies have reported improved stability with techniques that include a separate tibial tunnel for reconstruction of the popliteus tendon and popliteofibular ligament. Yet many have suggested that there is less technical difficulty with techniques that do not use a tibial tunnel, and this may be an important consideration in certain settings. Recent reviews showing no differences in clinical outcomes when comparing techniques for PLC reconstruction are based on heterogeneous, low level of evidence, high-risk-of-bias literature. It is well recognized that PLC injuries are heterogeneous, with approximately three quarters occurring in combination with anterior and/or posterior cruciate ligament tears. Further, laxity patterns vary for these injuries including high-grade posterior laxity and knee hyperextension as well as proximal tibial-fibular joint laxity, and these findings may necessitate use of an anatomic (separate tibial tunnel) PLC reconstruction technique. Reassuringly, both techniques show low complication and failure rates.