Modern concepts of treating posterolateral corner injuries

Background. Posterolateral corner (PLC) injuries remain a challenging clinical problem that often determines treatment outcome in patients with multiligamentous knee injuries; insufficient attention to this region leads to persistent varus-rotational instability. The choice between repair and reconstruction, the timing of intervention, and technical solutions remain debatable. The aim of the study was to summarize current concepts of surgical treatment of PLC injuries based on an analysis of contemporary literature. Materials and methods. Relevant literature from PubMed, Scopus, and Google Scholar for 2022–2026 was analyzed using topic-related search terms on PLC injuries, together with classic sources from earlier years; this narrative review covers conservative approaches, surgical repair and reconstruction, the rehabilitation protocol, and complications. Results. Isolated grade I–II injuries respond well to nonoperative treatment, whereas complete tears require surgical management. An acute injury (within 3 weeks) with preserved tissues may be treated with repair, often with augmentation, whereas a chronic injury requires plastic reconstruction; for complete tears, reconstruction shows a higher success rate than isolated primary repair. Anatomic reconstruction of the fibular collateral ligament, popliteofibular ligament, and popliteus tendon outperforms non-anatomic techniques such as biceps tenodesis; among anatomic techniques, the tibial-based approach is more often used clinically, whereas the fibular-based technique with two femoral tunnels shows the lowest residual laxity in biomechanical studies. Rehabilitation includes six weeks of immobilization, restriction of isolated hamstring weightbearing for up to four months, and return to sport at approximately six months. The main complications of surgical treatment are persistent instability, common peroneal nerve injury, deep vein thrombosis, and surgical site infection. Fixed-length popliteus tendon graft fixation is non-anatomic, because the tendon’s length changes with tibial rotation during knee flexion, which has been confirmed by data from 3D modeling with axial weightbearing. Conclusions. Posterolateral reconstruction, especially anatomic one, provides better functional outcomes than isolated repair; at the same time, current techniques only partly reproduce popliteus complex physiology and still require more precise graft fixation points and tensioning.