Dr. Kevin Yip

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

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Posterior Lateral Corner Injuries

SYMPTOMS

The symptoms are immediate haemarthrosis and pain in the posterior lateral corner of the knee. This injury is common in contact sports such as football and rugby. The diagnosis is often missed.

AETIOLOGY

The typical athlete suffers a hyperextension and varus rotation sprain during sport. The posterior lateral corner structures involve the capsule, the popliteus tendon and the lateral collateral ligament and can rupture partially or completely. This injury is often associated with other injuries to cartilage, menisci, capsule or other ligaments.

CLINICAL FINDINGS

There is intra-articular bleeding (haemarthrosis) in most cases. If there is a capsule rupture, blood can penetrate from the joint and cause bruising. Dyer’s test is positive. Since there are often associated injuries, the examination must include tests for collateral ligaments and menisci.

INVESTIGATIONS

Clinical examination is the most important tool for diagnosis and should include tests for all ligaments and other structures in the knee. X-ray is valuable to rule out fractures. MRI is valuable for evaluating associated injuries.

TREATMENT

An athlete with haemarthrosis and suspected posterior lateral corner injury should be seen by an orthopaedic surgeon to consider arthroscopy. This procedure can verify the diagnosis and deal with associated injuries. Surgery is often indicated but has to be determined individually and by a knee specialist. Surgery (reconstruction) will allow a return to professional sport within around six months. The reconstruction will protect the knee from further meniscus or cartilage injuries and restore function but it is technically difficult and a good outcome cannot be guaranteed. This injury is often missed if combined with an ACL tear. When the ACL has been reconstructed, rotational instability
will remain.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon for further investigations to verify the extent of the injury. Physiotherapists will be involved in close collaboration with the surgeon.

EXERCISE PRESCRIPTION

Cycling and swimming (but not breaststroke) are good alternatives to keep up general fitness. Rehabilitation back to full sport usually takes around six months.

EVALUATION OF TREATMENT OUTCOMES

Monitor clinical symptoms and signs. Different functional knee scores for different sports are available to measure when the knee allows a return to full sport.

DIFFERENTIAL DIAGNOSES

ACL or PCL rupture.

PROGNOSIS

Good-Poor. This is an injury that can halt a professional career.

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