Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Lateral cruciate ligament injury and posterior lateral instability

Lateral cruciate ligament injury and posterior lateral instability
The LCL is the primary restraint to varus stress of the knee (when the distal lower leg is pressed inward). It is most commonly injured in combination with one of the cruciate ligaments. The mechanism of injury is gait for increased external rotation of the foot, painful heel strike, or the presence of a varus thrust (i.e. the injured knee is moved outward in a sudden jerking motion when the leg is weightbearing).

Athletes who have acute posterolateral rotatory instability need urgent surgical repair. The peroneal nerve needs to be evaluated during the procedure. Postoperatively the patient is fitted with a brace allowing motion of 0–60° and restricted to partial weightbearing for 1–2 weeks.Thereafter, range of motion and weightbearing can increase as tolerated.The greatest attention should be paid to injury of the posterolateral corner of the knee, as this is perhaps
the most disabling of all ligament injuries to the knee. Many questions remain unanswered concerning PCL and posterolateral corner injuries. It is unclear what functional mechanical characteristics of the
posterolateral structures makes this injury more disabling than other combined or isolated knee ligament injuries.

Combined ACL-LCL injuries
Injuries to the LCL and posterolateral corner are probably the most disabling of all three ligament injuries (this is even more true of combined injuries). If such injuries are recognized late they are extremely difficult to treat and have high failure rates; the best option is to repair them within the first 2 weeks. In combined ACL-LCL injuries, the ACL should be treated at the same time, usually be reconstruction.

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