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Pinsala sa posterolateral corner

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Updated Sep 2026
Illustration: knee

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang iyong nararamdaman

Ang posterolateral corner ay isang maliit na kumpol ng mga ligament at tendon sa panlabas na likurang bahagi ng iyong tuhod. Kapag ang mga istrukturang ito ay napinsala, ang sakit ay karaniwang nasa labas o likod ng tuhod. Maaaring maramdamang hindi matatag ang tuhod, na tila gusto nitong bumigay kapag ikaw ay pumipihit o nagpapalit ng direksyon.

Ang pinsalang ito ay madalas na nangyayari kasabay ng pinsala sa iba pang mga ligament sa parehong tuhod, lalo na ang mga cruciate ligament sa malalim na bahagi ng joint. Iyan ang isang dahilan kung bakit maaaring mahirap itong matukoy sa simula: ang mga palatandaan ng ilang pinsala ay nagpapatong-patong, at maaaring makaligtaan ang outer corner habang ang atensyon ay nakatuon sa mas halatang pinsala. Ang paglalakad sa mga slope o hagdan, pagpihit para abutin ang isang bagay, o pagtayo sa isang binti ay maaaring maramdamang hindi maaasahan. Maaaring mapansin mong maluwag ang tuhod o umiikot palabas kapag nilalagyan mo ito ng bigat.

Ang discomfort ay may tendensiyang lumala pagkatapos ng aktibidad, kapag ang tuhod ay nabigatan o napihit. Ang pamamaga at paninigas ay maaaring magdulot ng hirap sa pagbaluktot ng tuhod nang lubos, na ginagawang maingat at mabusising gawain ang mga simpleng gawain tulad ng pag-squat sa mababang shelf, pagluhod sa hardin, o pagsakay sa kotse. Ang mahahabang lakad o pagtayo sa loob ng mahabang oras ay maaaring mag-iwan ng kirot sa labas ng tuhod.

Kung ang pinsala ay nagmula sa isang high-energy event tulad ng pagkahulog, banggaan, o pagpihit na may malakas na puwersa, maaaring maramdamang ang buong tuhod ay lumabas sa puwesto. Sa mga sandaling iyon, ang mga istruktura ng outer corner ay madalas na napupunit kasama ng iba pang mga ligament, at ang tuhod ay maaaring maiwang pakiramdam na hindi matatag sa pangkalahatan sa halip na masakit lamang sa isang partikular na spot.

Dahil ang corner na ito ay madaling makaligtaan sa unang assessment, mahalagang sabihin sa iyong surgeon kung aling mga paggalaw ang nararamdamang hindi ligtas at kung saan naroon ang sakit. Ang detalyeng iyon ay tumutulong sa pagbuo ng malinaw na larawan kung ano ang napinsala at kung ano ang kailangang gamutin.

Ano ang aktwal na nangyayari

Ang posterolateral corner ay isang maliit na kumpol ng mga ligament at tendon sa panlabas na likurang bahagi ng iyong tuhod. Isipin ito bilang isang set ng mga guy rope na nag-aangkla sa panlabas na bahagi ng joint at pumipigil dito na bumaluktot palabas o pumilipit nang husto. Ang pangunahing ligament sa grupong ito ay tumatakbo mula sa dulo ng buto sa hita pababa sa itaas ng mas maliit na buto sa labas ng iyong ibabang binti. Ang tungkulin nito ay panatilihing matatag ang tuhod kapag may bigat na tumutulak sa panlabas na bahagi, at limitahan ang pagpilipit na nagpapaikot sa iyong ibabang binti palabas.

Kapag napinsala ang corner na ito, ang mga guy rope na iyon ay lumuluwag o napupunit. Ang tuhod ay maaari nang dumulas o umikot sa mga paraang hindi ito idinisenyo, na siyang pagluwag at outward rotation na maaaring napansin mo. Dahil ang corner ay tumutulong din sa pagkontrol ng pagpilipit habang ibinabaluktot ang tuhod, ang mga slope, hagdan, at pivoting movements ay pakiramdam na hindi maaasahan.

Ang pinsalang ito ay bihirang mag-isa. Madalas itong nangyayari kasabay ng pinsala sa isa sa mga cruciate ligament sa malalim na bahagi ng joint. Kapag nangyari iyon, ang dalawang problema ay nagpapalala sa isa't isa: ang isang muling binuong cruciate ligament ay maaaring ma-overload at mabigo kung ang outer corner ay maluwag pa rin. Iyan ang dahilan kung bakit mahalaga na hindi makaligtaan ang corner na ito sa unang assessment, at kung bakit ito susuriing mabuti ng iyong surgeon.

Ang pinsala ay madalas na inilalarawan sa mga grade. Ang mild grade ay nangangahulugang ang mga ligament ay nabanat ngunit nakakapit pa rin. Ang severe grade, na kung minsan ay tinatawag na complete tear, ay nangangahulugang ang mga structure ng corner ay lubos na napunit at ang tuhod ay malinaw na unstable. Ang mga severe grade, lalo na kapag may iba pang mga ligament na napunit din, ang mga karaniwang nangangailangan ng surgery.

Isang bagay pa na dapat malaman: may isang nerve na nagbibigay ng pakiramdam at paggalaw sa ibabang binti na dumadaan mismo sa corner na ito, sa paligid ng itaas ng panlabas na butong iyon. Ito ay isang dahilan kung bakit ang pinsalang ito, at anumang surgery dito, ay nangangailangan ng maingat na pagpaplano.

Ano ang maaari naming gawin tungkol dito

Ang isang maingat na pagsusuri ng ligament kasama ang isang MRI scan ang standard na paraan upang malaman kung ano ang napunit. Kahit ganoon, ang bahaging ito ng tuhod ay madaling makaligtaan sa mga scan, kaya sinusuri rin namin ito nang direkta habang isinasagawa ang keyhole surgery kung mayroon kaming pag-aalinlangan.

Para sa mga mas mild na pinsala kung saan ang mga ligament ay nabanat sa halip na tuluyang napunit, karaniwan kaming nagsisimula sa non-operative care. Nangangahulugan ito ng pagbabago sa kung paano mo binibigatan ang tuhod, at isang kurso ng physiotherapy na naglalayong palakasin ang paligid ng iyong balakang at hita at muling sanayin ang balanse at kontrol na nagpapanatiling matatag sa tuhod sa mga slope, hagdan, at pivots. Binibigyan namin ito ng sapat na pagsubok bago pag-usapan ang anumang susunod na hakbang.

Para sa mga pinsala kung saan ang mga corner structure ay tuluyang napunit, lalo na kapag ang ibang mga ligament sa parehong tuhod ay napunit din, karaniwan kaming magrerekomenda ng surgery nang walang waiting period. Binubuo muli ng operasyon ang mga napinsalang ligament sa outer back ng tuhod, at kapag may napunit ding cruciate ligament, pareho itong nirereconstruct sa isang procedure. Ang pagbubuo muli (rebuilding) sa halip na pagtahi (stitching) sa napunit na corner ay may tendensiyang mas tumagal sa mga bagong pinsala. Kapag ang problema ay matagal na at unti-unting lumuwag ang tuhod, makakatulong pa rin ang surgery: ang pagtutuwid ng alignment ng binti at ang sabay na pagbubuo muli ng mga ligament ay maaaring magbalik ng sapat na stability para sa mga pang-araw-araw na aktibidad at low level sport. Dahil ang corner na ito ay malapit sa isang nerve na nagbibigay ng pakiramdam at paggalaw sa ibabang bahagi ng binti, maingat naming pinaplano ang operasyon sa paligid nito.

Kung imumungkahi namin ang pag-oopera agad o pagkatapos ng pagsubok sa physiotherapy ay depende sa kung aling mga structure ang napunit, kung gaano kaluwag ang iyong tuhod, at kung ano ang kailangan mong magawa nito. Pag-uusapan namin ang mga opsyon kasama ka at magdedesisyon tayo nang magkasama.

Ano ang dapat asahan

Ang outlook ay nakadepende sa kung gaano kalala ang pagkapunit ng corner at kung may iba pang mga ligament na kasamang napunit. Ang isang mild stretch, kung saan nakakapit pa rin ang mga ligament, ay madalas na gumagaling sa pamamagitan ng physiotherapy at pagbabago sa kung paano mo binibigatan ang tuhod. Ang isang complete tear, lalo na ang nagmula sa pagkahulog, banggaan, o pagpihit na may malakas na puwersa, ay karaniwang hindi gumagaling nang kusa. Kapag hinayaan, ang pagkaluwag ay may tendensiyang manatili, at maaari nitong mapudpod ang cartilage sa loob ng joint sa paglipas ng panahon.

Mahalaga ang timing. Kapag ang operasyon sa corner na ito ay naantala ng higit sa 4 na linggo mula sa pinsala, ang mga outcome ay hindi gaanong predictable kumpara sa kapag ginawa ito nang maaga. Ang parehong pattern ay makikita sa tuhod sa mas malawak na paraan: habang mas matagal ang pagitan ng pinsala at ng muling pagbubuo (rebuilding) ng mga ligament, mas malaki ang posibilidad na naapektuhan ang mga joint surface. Iyan ang isang dahilan kung bakit gugustuhin ng iyong surgeon ang isang malinaw na diagnosis nang maaga kaysa maghintay upang makita kung paano lalakad ang mga bagay-bagay.

Kapag ang corner ay muling binuo kasama ang anumang napunit na cruciate ligaments, karamihan sa mga tao ay nababawi ang stability. Sa isang grupo ng mga pasyente na parehong muling binuo ang mga ito nang magkasama, 80% ang nag-ulat ng mabubuting resulta at isang tuhod na nananatiling matatag sa pang-araw-araw na buhay. Ang external rotation, ang pagpihit na nagpapaikot sa iyong ibabang binti palabas, ay nababawi sa karamihan ng mga pasyente. Ang pagtutuwid laban sa outward bowing ay nababawi sa karamihan ngunit hindi sa lahat ng mga tuhod. Ang mga resulta ay may tendensiyang maging mas mabuti kapag ang mga ligament ay muling binuo agad pagkatapos ng pinsala kaysa pagkalipas ng maraming taon, at ang mga taong sumailalim na sa knee ligament surgery noon ay madalas na nag-uulat ng mas mababang kalidad ng buhay kaysa sa mga hindi pa nakaranas nito.

Maging realistiko tungkol sa trabaho at aktibidad. Sa isang grupo ng mga pasyente na may combined ligament tears, 10% sa kabuuan ang kinailangang magpalit ng trabaho dahil sa tuhod. Para sa mga labourers, ang pigurang ito ay 25%. Maraming tao ang bumabalik sa mga pang-araw-araw na aktibidad at low level sport, ngunit ang isang tuhod na sumailalim sa rebuilding ng ilang ligament ay maaaring hindi maramdaman na katulad na katulad ng mayroon ka bago ang pinsala. Tatalakayin ng iyong surgeon kung ano ang hitsura ng isang realistiko na recovery para sa iyong tuhod, sa iyong trabaho, at sa mga aktibidad na nais mong mabalikan.

Kailan dapat magpatingin

Magpatingin agad sa iyong GP pagkatapos ng anumang pinsala sa tuhod kung saan naramdaman na ang tuhod ay lumabas sa puwesto, o kung ang panlabas na likurang bahagi ng tuhod ay masakit at ang tuhod ay pakiramdam na maluwag o bumibigay. Ang sulok na ito ng tuhod ay madaling makaligtaan, at hindi ito laging nakikita sa mga scan, kaya mas mabuting masuri ito nang maaga kaysa maghintay. Humingi ng pagsusuri ng isang espesyalista kung ang iyong tuhod ay pakiramdam na hindi pa rin matatag sa mga slope, hagdan, o mga pivoting movement pagkatapos ng ilang linggo, o kung ang isang nakaraang cruciate ligament reconstruction ay nagsimula nang maramdamang maluwag. Mahalaga ang timing dito: ang operasyon sa sulok na ito ay pinaka-epektibo sa loob ng unang 4 na linggo mula sa pinsala, at ang mga resulta ay hindi gaanong predictable kapag ito ay naantala nang lampas doon.

Reviewed by AI synthesis (v2) — pending human review · 9 September 2026.

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Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Anatomy & Pathophysiology

Bony Anatomy

  • The bones of the knee are the distal femur, the proximal tibia, and the patella [1].
  • The medial femoral condyle is larger and projects farther posteriorly and distally than the lateral condyle [6].
  • The lateral femoral condyle projects farther anteriorly and is wider in the medial-lateral direction than the medial femoral condyle [6].
  • The sulcus terminalis is a small ridge on the lateral femoral condyle just distal to the intercondylar notch that separates the patellofemoral and tibiofemoral articular surfaces [6].
  • The tibial articular surface slopes 7° to 10° in the sagittal plane [6].
  • The medial tibial plateau is larger than the lateral plateau and is concave in its frontal and sagittal planes [6].
  • The lateral tibial plateau is smaller and more circular than the medial plateau, concave in the frontal plane and convex in the sagittal plane [6].
  • The proximal fibula articulates with a facet of the lateral cortex of the tibia and is not part of the knee articulation [6].
  • The Gerdy’s tubercle is the insertion site of the iliotibial band and is located 2 to 3 cm lateral to the tibial tubercle on the proximal tibia [6].
  • The fibular head is located a mean of 1.5 cm distal to the joint line, with a range of 6 to 32 mm [18].

Ligaments

  • The lateral collateral ligament (LCL) runs from the lateral femoral condyle to the head of the fibula and is the main stabilizer against varus stress [1].
  • The LCL is part of the posterolateral “complex” or “corner” of the knee that also resists external rotation [1].
  • The popliteofibular ligament is present in 90% of knees and runs from the tendon of the popliteus muscle to the styloid on the posterior fibular head [1].
  • The LCL resists varus tibial translation as its primary function and tibial external rotation, especially at 30 degrees of knee flexion, as its secondary function [7].
  • The popliteus tendon resists tibial external rotation, especially in knee flexion, as its primary function and varus tibial translation as its secondary function [7].
  • The popliteofibular ligament resists tibial external rotation, especially in knee flexion, as its primary function and posterior tibial displacement as its secondary function [7].
  • The oblique popliteal ligament resists knee hyperextension as its primary function and varus tibial translation as its secondary function [7].
  • The posterolateral corner (PLC) is made up of the FCL, the iliotibial band, the popliteofibular ligament, the biceps femoris, and the popliteus tendon [24].
  • The PLC resists posterior translation, external rotation, and varus angulation of the tibia [24].
  • The popliteus tendon originates on the posterocentral tibia and inserts anterior and distal to the LCL on the lateral femoral epicondyle [18].
  • The popliteus tendon has an intra-articular course through the popliteal hiatus [18].

Menisci

  • The menisci are C-shaped fibrocartilaginous disks that provide shock absorption, increase congruency between joint surfaces, enhance joint stability, and aid in distribution of synovial fluid [1].
  • The medial meniscus is firmly attached to the joint capsule along its entire peripheral edge [1].
  • The lateral meniscus is attached to the anterior and posterior capsule, but there is a region posterolaterally where it is not firmly attached [1].
  • The lateral meniscus is larger than the medial meniscus and carries a greater share of the lateral compartment pressure than the medial meniscus carries for the medial compartment [1].
  • The lateral meniscus has a more circular C-shape with symmetric sizes of the anterior and posterior horns [15].
  • The popliteomeniscal fascicles extend from the lateral meniscus to the posterior capsule to create the popliteal hiatus [15].
  • The less continuous attachment of the lateral meniscus to the capsule allows for greater meniscal mobility [15].
  • Mean lateral meniscus excursion from knee extension to flexion is 11.2 mm, compared to a mean medial meniscus excursion of 5.1 mm [15].
  • The lateral meniscus covers a larger proportion of the tibial plateau than the medial meniscus [18].
  • The lateral meniscus has a mobility of 10 mm, while the medial meniscus has a mobility of 5 mm [18].

Vascular and Nerve Anatomy

  • The blood supply to the knee is formed from an anastomosis around the knee derived from the descending geniculate artery, medial and lateral superior geniculate arteries, medial and lateral inferior geniculate arteries, middle geniculate artery, and anterior tibial recurrent arteries [6].
  • The inferior geniculate arteries pass deep to their respective collateral ligaments [6].
  • The knee is innervated by branches of the femoral nerve (L2, L3, L4), obturator nerve (L2, L3, L4), and sciatic nerve (L4, L5, S1, S2) [6].
  • The largest nerve providing innervation of the intra-articular knee is the posterior articular branch of the tibial nerve [6].
  • The popliteus artery travels through the adductor hiatus, where it is relatively immobile, and distally through the fibrous arch deep to the soleus muscle [24].
  • The common peroneal nerve travels along the posterior edge of the biceps femoris and continues distally around the fibular neck [24].
  • The tibial nerve courses distally through the center of the popliteus fossa after branching from the sciatic nerve [24].

Pathophysiology and Biomechanics

  • If the menisci are not present, the convex femoral condyles articulate with the relatively flat tibial plateaus, decreasing surface area of contact and increasing pressure on the articular cartilage [1].
  • The medial meniscus has less mobility than the lateral meniscus and is more susceptible to tearing when trapped between the femoral condyle and tibial plateau [1].
  • Biomechanical studies show a significantly higher graft force during varus loading at 0 and 30 degrees of knee flexion after transection of the LCL than with intact posterolateral structures [5].
  • In knees with grade III posterolateral injuries and evidence of varus or coupled posterior-external rotation instability, repair or reconstruction of the posterolateral structures should be performed at the time of PCL reconstruction to decrease the chance of later graft failure [5].
  • The menisci bear one-third to one-half body weight and help with load transmission [19].
  • Removal of the menisci increases contact stresses, with up to four times the load transfer to bone [19].

Investigations

Physical Examination

  • A thorough knee examination should be performed to evaluate for coexisting knee pathology in patients with LCL and/or posterolateral corner injury [31].
  • A careful neurovascular examination should be performed because the incidence of neurovascular injury, particularly peroneal nerve injury, has been reported in 12–29% of posterolateral knee injuries [31].
  • The integrity of the LCL is assessed by placing a varus stress with the knee in full extension and 30 degrees of flexion [31].
  • Baseline varus opening is widely variable and should be compared to the contralateral leg [31].
  • The average baseline for varus opening is 7 degrees [31].
  • Exam findings with an isolated LCL injury include varus laxity at 30 degrees of flexion and no instability in full extension [31].
  • A significant posterolateral knee injury can be present without significant varus laxity [31].
  • The dial test is the most useful test to evaluate for posterolateral instability [31].
  • The dial test is performed by externally rotating each tibia and noting the angle subtended between the thigh and the foot at 30 and 90 degrees of flexion [31].
  • A significant difference in the dial test is an angle 5 degrees or greater than the contralateral leg [31].
  • Greater external rotation at 30 degrees on the dial test confirms injury to the posterolateral capsule alone [31].
  • Greater external rotation at 90 degrees on the dial test confirms an isolated PCL injury [31].
  • Greater rotation at both 30 and 90 degrees compared to the uninjured leg on the dial test confirms injury to both posterolateral capsule and PCL structures [31].
  • The reverse pivot shift test involves starting with the knee flexed to 90 degrees, extending the knee while applying axial load and valgus stress, and holding the foot in external rotation [31].
  • A palpable shift is noted during the reverse pivot shift test as the tibia reduces from its posteriorly subluxed position as the knee is extended [31].
  • The external rotation recurvatum test is performed with the patient supine and the hip and knee fully extended [31].
  • In the external rotation recurvatum test, the leg is lifted off the bed by the toes [31].
  • Hyperextension, varus instability, and external rotation of the tibial tubercle occur with adequate quadriceps relaxation in a patient with posterolateral instability during the external rotation recurvatum test [31].
  • The posterolateral drawer test is performed with the tibia in internal rotation, neutral, and externally rotated positions [31].
  • With posterolateral injury, the magnitude of the posterior drawer displacement is greatest with external tibial rotation [31].
  • An examination under anesthesia is extremely useful, particularly in the acute setting [31].
  • If a patient with a multiligamentous knee injury is taken to the operating room, examining the knee without guarding improves the accuracy of the examination [31].

Imaging Studies

  • A series of knee radiographs should be obtained in any patient with a suspected knee injury [31].
  • Radiographs should be inspected for acute fractures, lateral capsular avulsion (Segond fracture), loose bodies, fibular head avulsions, and evidence of patellar dislocation [31].
  • With chronic posterolateral instability, degenerative changes of the lateral compartment are often noted on radiographs [31].
  • Lateral joint space narrowing with osteophytes and subchondral sclerosis can be seen on radiographs in chronic posterolateral instability [31].
  • Stress radiographs can help to better quantify the amount of varus angulation present [31].
  • MRI is often a useful adjunct for diagnosing posterolateral corner and LCL injuries in the severely injured knee [31].
  • MRI findings can refocus the examination to the posterolateral structures when this injury has gone unnoticed during an initial evaluation [31].
  • Pain and guarding at the time of injury can often obscure posterolateral injury, making MRI an extremely valuable adjunct in diagnosis [31].
  • MRI should be obtained as a useful adjunct to help diagnose posterolateral corner injuries [31].
  • MRI may identify edema, avulsion, or discontinuity for the MCL/lateral collateral ligament (LCL) or associated posteromedial and posterolateral ligamentous complexes [22].

Non-Operative Management

  • Isolated grade I and II tears of the lateral collateral ligament (LCL) can be managed with nonsurgical treatment and early rehabilitation [5].
  • Nonsurgical management of isolated grade III LCL injuries produced poor results in clinical studies by Krukaug et al. and Kannus [5].
  • In a cohort of National Football League players, isolated grade III LCL injuries managed nonoperatively were as likely to return to play as those managed surgically and did so more quickly [5].
  • Despite controversial results regarding nonoperative management of grade III LCL injuries in NFL players, the authors recommended surgical treatment for most grade III injuries [5].

Operative Management

  • For acute lateral compartment disruptions, the knee is examined for instability classification and systematic grading after the patient has been anesthetized [5].
  • Systematic arthroscopic examination is usually carried out to assess and rule out other intraarticular pathologic conditions before proceeding with repair or reconstruction of the posterolateral corner [5].
  • Biomechanical studies have shown a significantly higher graft force during varus loading at 0 and 30 degrees of knee flexion after transection of the LCL than with intact posterolateral structures [5].
  • Posteromedial corner injuries have been implicated in anteromedial rotary instability and failed ACL reconstructions [5].
  • The anterolateral ligament (ALL) is not an isometric ligament; its length increases with knee flexion as well as internal rotation [5].
  • The ALL usually originates on the femur, posterior and proximal to the lateral femoral epicondyle, although some have located it either directly on the lateral epicondyle or anterior and distal to the attachment site of the LCL [5].
  • The tibial attachment site of the ALL resides halfway between the center of Gerdy’s tubercle and the anterior margin of the fibular head and 1 cm distal to the joint line [5].
  • The ALL has a mean ultimate load to failure between 50N and 205N, a mean stiffness of 20 to 42 N/mm, and a mean ultimate strain of 36% [5].
  • Cadaver and biomechanical studies have shown the importance of the ALL as a restraint to internal tibial rotation and anterior tibial translation and in preventing the knee pivot shift phenomenon [5].
  • Experimental sectioning of the ALL was found to invariably induce high-grade pivot shifts in ACL-deficient cadaver knees, unlike isolated ACL injury [5].
  • There is no consensus regarding the proper angle of knee flexion at which fixation of ALL reconstruction should occur [5].
  • Anatomic ALL reconstruction at all graft fixation angles significantly overconstrained internal rotation of the knee joint beyond 30 degrees of flexion and at 45 and 60 degrees during the pivot shift test [5].
  • There were no significant kinematic differences between any tested graft fixation angles during anterior drawer, pivot shift, and internal rotation tests [5].
  • Most authors report fixing the ALL reconstruction graft at 30 degrees of flexion to avoid overconstraint [5].
  • Sonnery-Cottet et al. reported full range of motion in 83 patients at a minimum 2-year follow-up after combined reconstructions of the ACL and ALL [5].
  • In the study by Sonnery-Cottet et al., 76 patients had a negative pivot shift and seven had a grade 1 pivot shift after combined ACL and ALL reconstruction [5].
  • Sonnery-Cottet et al. reported significant improvements in Lysholm scores, subjective IKDC scores, and objective IKDC scores after combined ACL and ALL reconstruction [5].
  • Sonnery-Cottet et al. found that ALL reconstruction protected the repaired medial meniscus [5].
  • Indications for combined ACL and ALL reconstructions reported by Sonnery-Cottet et al. include an associated Segond fracture, a chronic ACL lesion, grade 3 pivot shift, high level of sports activity, participation in pivoting sports, and lateral femoral notch sign on radiographs [5].
  • Other surgeons have included revision ACL reconstruction as an indication for ALL reconstruction [5].
  • In a study of 552 patients who had primary ACL reconstruction, Gaunder et al. identified 47 patients who required revision ACL reconstruction [5].
  • The incidence of Segond fractures was 6% in the primary ACL reconstruction group studied by Gaunder et al. [5].
  • After ACL reconstruction, the Segond fracture healed in 90% of patients in the study by Gaunder et al. [5].
  • No patient with revision surgery had a Segond fracture, and no patient with a Segond fracture had graft failure in the study by Gaunder et al. [5].

References

[1] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 3Sports Medicine > Image KNEE INJURIES.

[5] Campbell S Operative Orthopaedics 4 Volume Set. LATERAL COMPARTMENT (COLLATERAL) DISRUPTIONS.

[6] Aaos Comprehensive Orthopaedic Review 3. Anatomy and Biomechanics of the Knee > I. Anatomy.

[7] Miller S Review Of Orthopaedics. SECTION 1 KNEE > ANATOMY (FIG. 4.1).

[15] Orthopaedic Basic Science Fifth Edition Print Ebook. Biology and Mechanics of the Skeletal Extracellular Matrix > Gross Anatomy.

[18] Aaos Comprehensive Orthopaedic Review 3. Radiographic Evaluation and Surgical Anatomy of the Knee > II. Surgical Anatomy of the Knee.

[19] Miller S Review Of Orthopaedics. ARTHRODESIS PERSON > Kinetics.

[22] Aaos Comprehensive Orthopaedic Review 3. Radiographic Evaluation and Surgical Anatomy of the Knee > I. Radiographic Evaluation.

[24] Aaos Comprehensive Orthopaedic Review 3. Knee Dislocations and Patellar Fractures* > I. Knee Dislocations.

[31] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 3Sports Medicine > 2. Lateral Collateral Ligament Injuries.

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Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.