A Contemporary International Expert Consensus Statement on the Evaluation, Diagnosis, Treatment, and Rehabilitation of Injuries to the Posterolateral Corner of the Knee

PURPOSE: To use a modified Delphi technique to generate an expert consensus statement on the evaluation, diagnosis, treatment, and rehabilitation of posterolateral corner (PLC) injuries of the knee. METHODS: A 5-individual working group developed a list of 62 statements regarding PLC injuries for use in a 3-round modified Delphi series. Ultimately, 40 statements were retained, and a 100% participation rate was observed in all rounds. Consensus for each statement was quantified. RESULTS: Overall, 82.5% of statements reached consensus. Consensus was reached regarding the following: (1) The dial, posterolateral drawer, and external rotation recurvatum tests, magnetic resonance imaging, varus-stress radiographs, and bilateral hip-to-ankle radiographs have diagnostic utility. (2) The presence of concomitant meniscal pathology or neuromuscular injury influences surgical timing. (3) Useful classification systems to guide treatment of PLC injuries currently do not exist. (4) Acute soft-tissue avulsions involving a single stabilizing structure can be repaired. (5) Isolated repair of grade III PLC tears should not be performed without augmentation or reconstruction, and complete grade III PLC injuries should undergo PLC reconstruction. (6) No universally accepted PLC reconstruction technique exists, although the LaPrade technique (anatomic reconstruction of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament using 2 grafts secured in 2 femoral tunnels, 1 fibular tunnel, and 1 tibial tunnel) may confer superior outcomes. (7) There is no consensus on the utility of routine postoperative varus stress radiographs as an objective measure of surgical success. CONCLUSIONS: Statements that achieved unanimous consensus (all experts stating they "strongly agree") concerned routine use of physical and radiographic evaluations to confirm varus laxity due to PLC injuries and bilateral hip-to-ankle radiographs in the setting of chronic PLC injuries. Individualized treatment based on the presence of concomitant injuries and staged rehabilitation programs are essential. The significance of a grade III posterolateral drawer test in detecting external rotational laxity and whether common peroneal nerve neurolysis should be routinely performed remain in question. No single reconstruction technique confers optimal clinical outcomes. Postoperative varus stress radiographs are not reliable for determining residual laxity. LEVEL OF EVIDENCE: Level V, consensus of expert opinion.