A single-surgeon cohort comparing two strategies for the multiligament-injured knee with FCL/PLC involvement. One group had FCL/PLC repair with staged cruciate reconstruction; the other had single-stage reconstruction of all structures. The question: does repairing the posterolateral corner hold up, or should it be reconstructed?
When you see a multiligament knee injury with posterolateral corner involvement, plan to reconstruct the FCL/PLC rather than repair it.
This cohort showed a 40% repair failure rate versus 6% for reconstruction, and the numbers track almost exactly with Stannard's prospective series (37% vs 9%). Two independent datasets reaching the same answer is what makes this a teaching point rather than a single-center quirk.
The mental model: suture-anchor reattachment of torn native posterolateral tissue does not reliably restore the static varus and rotational restraint of the FCL and popliteus. A graft fixed at the isometric point does.
Note the nuance for exams: after revision, final IKDC and Lysholm scores were equivalent. So the cost of repair is not permanent disability but a second operation and the morbidity that comes with it. Clinically, confirm the diagnosis with varus stress testing. Laxity at 30° flexion points to the FCL/PLC, while laxity in full extension signals a more severe combined injury.
A single-surgeon cohort comparing two strategies for the multiligament-injured knee with FCL/PLC involvement. One group had FCL/PLC repair with staged cruciate reconstruction; the other had single-stage reconstruction of all structures. The question: does repairing the posterolateral corner hold up, or should it be reconstructed?
When you see a multiligament knee injury with posterolateral corner involvement, plan to reconstruct the FCL/PLC rather than repair it.
This cohort showed a 40% repair failure rate versus 6% for reconstruction, and the numbers track almost exactly with Stannard's prospective series (37% vs 9%). Two independent datasets reaching the same answer is what makes this a teaching point rather than a single-center quirk.
The mental model: suture-anchor reattachment of torn native posterolateral tissue does not reliably restore the static varus and rotational restraint of the FCL and popliteus. A graft fixed at the isometric point does.
Note the nuance for exams: after revision, final IKDC and Lysholm scores were equivalent. So the cost of repair is not permanent disability but a second operation and the morbidity that comes with it. Clinically, confirm the diagnosis with varus stress testing. Laxity at 30° flexion points to the FCL/PLC, while laxity in full extension signals a more severe combined injury.