The posterolateral corner is known as the dark side of the knee. James Nowosielski sheds light on PLC injuries in sports and helps clinicians understand the biomechanics, assessment, and treatment.
Los Angeles Rams wide receiver Austin Trammell is upended by Denver Broncos safety JL Skinner as safety Devon Key defends in the third quarter at Empower Field at Mile High. Mandatory Credit: Isaiah J. Downing-USA TODAY Sports
Injuries are commonplace in sports. On average, professional male football athletes will suffer 8.1 injuries per 1000 hours of exposure. During game time, this increases significantly to 36 injuries per 1000 hours, almost ten times higher than the prevalence of injuries sustained in training (3.7 per 1000 hours). Lower limb injuries are the most common at 6.8 per 1000 hours(1).
If clinicians encounter individuals who engage in or participate in any sport, they will likely come across cases of ACL or meniscus injuries. Furthermore, many of these clinicians will also encounter individuals with osteoarthritis. Some injuries, however, have a considerably lower profile.
Posterolateral corner (PLC) injuries may be more common than clinicians think, with up to 16% of all knee ligament injuries affecting the PLC complex. Given that they are usually associated with ACL or PCL injuries, a missed diagnosis can lead to the failure of any reconstruction, which would understandably be catastrophic for the athlete.
Approximately 7-16% of knee ligament injuries are to the PLC complex. The incidence of isolated PLC injuries may be as high as 28%. Still, most will accompany an ACL or PCL tear and can contribute to ligament reconstruction graft failure if not recognized and treated(2). Posterolateral corner deficiency may lead to residual instability and chronic pain due to biomechanical overloading when not appropriately treated(3). Therefore, clinicians must maintain a high suspicion when assessing traumatic knee injuries.
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