Avoiding Collateral Damage: Identifying and Treating MCL and FCL (PLC) Injuries of the Knee (04:21)
The Medical Education Committee requests participants evaluate the sessions immediately following the talk. The introducer shows three videos highlighting common MCL, ACL and FCL injuries.
Anatomical Base (03:26)
When Dr. Robert LaPrade began his fellowship, collateral ligament tears were treated with non-anatomical procedures. Dr. Hughston was a founder of orthopedic sports medicine. Dr. LaPrade wrote 63 peer reviewed articles on posterolateral knee injuries; he reviews the locations of the medial, adductor, and gastrocnemius tubercles.
Superficial MCL (03:09)
Dr. LaPrade explains how the medial collateral, fibular collateral, and the posterior oblique ligaments function. The distal attachment for the MCL is always six centimeters to the joint which helps with reconstruction techniques. The posterolateral side of the knee is inherently unstable because the joint has two convex surfaces and is harder to repair.
Tendon and Ligament (04:04)
Dr. LaPrade reviews the anatomy of the popliteus tendon and the popliteofibular ligament. He developed a reconstruction technique that uses more than one graft. The superficial MCL is the primary stabilizer to the valgus while the POL stabilizes rotation.
Valgus Stress X-Ray Study (03:01)
Physicians measure medial knee injuries using valgus stress radiographs. Dr. LaPrade explains clinically relevant medial knee biometrics of the superficial MCL and POL. If the FCL is still intact, there is no gapping in varus.
Effect of PLC Injuries on ACL Reconstructions (04:34)
Repair or reconstruct PLC injuries at the same time as an ACL reconstruction to reduce the risk of graft failure. Dr. LaPrade did a canine and rabbit study where none of the knees healed because the anatomy is different. He explains how to examine and palpate knee injuries.
Grading of Knee Injuries (04:54)
Dr. Hughston created the American Medical Association's (AMA) classification of knee injuries; the International Knee Documentation Committee (IKDC) revised it. Take valgus stress x-rays pre-operatively and post-operatively to assess results. Dr. LaPrade describes how he diagnoses posterolateral knee injuries.
Avulsion Fractures (04:13)
Saigon fractures cause knee instabilities. Stress x-rays are cheaper and easier to assess for posterolateral corner injuries; MRI films must also show the coronal oblique. Dr. LaPrade explains how bone bruises correlate to ACL, PCL, and MCL injuries.
Treating Medial Knee Injuries (04:05)
Follow the RICE (rest, ice, compression, and elevation) protocol; most medial knee injuries heal without surgery. Heal the MCL prior to surgery for the ACL. Medial knee acute repairs occur when the knee dislocates.
Dr. LaPrade will not begin an arthroscopy until he has dissected down to the joint and seen the structures. Surgery carries an increased risk of arthrofibrosis; begin knee motion as soon as possible. Assess for heterotopic ossification in chronic medial isolated knee injuries; LaPrade helped create a protocol for medial knee reconstruction.
PLC Treatment (04:33)
Dr. LaPrade discusses how he surgically repairs acute posterolateral corner injuries. Peroneal nerve neurolysis helps surgeons reach the back of the fibular head. Using a semitendinosus is more advantageous than the patellar tendon.
Chronic PLC Injuries (04:42)
Dr. LaPrade discusses how he rehabilitates chronic posterolateral corner injuries and recommends biplanar osteotomies. He helped create a protocol for posterolateral knee reconstruction. The procedure takes thirty minutes and allows for early muscle motion and reaction.
Posterolateral Outcomes Studies (03:27)
About 40% of Dr. LaPrade's patients do not need soft tissue reconstruction. His technique shows high success rates. Obtain pre-operative and post-operative stress x-rays to assess the reconstruction's effectiveness.
Credits: Avoiding Collateral Damage: Identifying and Treating MCL and FCL (PLC) Injuries of the Knee (00:25)
Credits: Avoiding Collateral Damage: Identifying and Treating MCL and FCL (PLC) Injuries of the Knee
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