Management of Complex PCL-PLC Injury With Concomitant Cartilage Defect
Alberto Fogacci, Vito Gaetano Rinaldi, Stefano Zaffagnini, Giulio Maria Marcheggiani MuccioliBackground:
Posterolateral corner (PLC) injuries frequently coexist with posterior cruciate ligament (PCL) tears. Untreated PLC deficiency may result in persistent posterolateral rotatory instability, increased PCL graft stress, and compromised reconstruction outcomes. Concomitant focal osteochondral defects further complicate multiligament knee injury management. This video presents the surgical strategy, technical considerations, and outcomes of combined PCL-PLC reconstruction with osteochondral autograft transfer (OAT) for a concomitant focal osteochondral defect.
Indications:
Combined PCL-PLC reconstruction is indicated in symptomatic posterolateral rotatory instability, whereas OAT may be considered for symptomatic, contained, full-thickness focal cartilage defects in the weightbearing area, in appropriately selected patients with neutral or near-neutral alignment.
Technique Description:
A single-stage procedure combined arthroscopic single-plug OAT with single-bundle PCL and anatomic PLC reconstruction. OAT was performed first using a press-fit osteochondral autograft harvested from the nonweightbearing superomedial trochlea, which was implanted flush or slightly recessed. PCL reconstruction used hamstring autograft, with arthroscopic landmarks guiding tunnel placement and careful tibial tunnel orientation minimizing killer-turn and graft abrasion. PLC reconstruction was performed using a hamstring allograft according to the Arciero technique, with common peroneal nerve protection and an anatomic anterolateral-to-posteromedial transfibular tunnel. FCL and popliteus guidewires were oriented to avoid femoral PCL tunnel violation. The PCL was tensioned first at 90° with anterior drawer reduction, followed by PLC fixation at 30° with slight valgus and internal rotation to avoid overconstraint.
Results:
Current evidence supports combined PCL-PLC reconstruction for improved posterolateral and rotational stability and reduced residual laxity compared with isolated PCL reconstruction. Clinical outcomes are generally favorable, with significant functional improvement and high return-to-sport (RTS) rates. For focal osteochondral lesions, OAT provides durable functional improvement with high RTS rates.
Discussion/Conclusion:
Successful management of combined PCL-PLC injuries requires addressing both components to restore knee stability. With concomitant focal cartilage defects, knee stability and alignment are essential to support cartilage restoration. PCL-PLC reconstruction combined with OAT may provide favorable outcomes in appropriately selected patients, supporting an individualized treatment strategy. However, evidence for this combined approach remains limited, and further studies are needed to define optimal treatment strategies and long-term outcomes.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.