From the Research
The management of posterior lateral corner (PLC) knee injuries should prioritize early diagnosis and treatment to prevent chronic instability and accelerated knee arthritis, with grade III injuries typically requiring surgical repair within 2-3 weeks of injury for optimal outcomes, as supported by the most recent and highest quality study 1. The PLC of the knee is a complex structure that provides stability to the outer knee, and injuries to this area can occur from direct trauma, hyperextension, or twisting injuries.
- Treatment depends on injury severity, with grade I (mild) injuries often managed conservatively through rest, ice, compression, elevation (RICE), anti-inflammatory medications like ibuprofen (400-800mg three times daily), and physical therapy focusing on strengthening exercises for 6-8 weeks.
- Grade II (moderate) injuries may require similar conservative treatment but with a longer rehabilitation period of 8-12 weeks.
- Grade III (severe) injuries with complete tears typically require surgical repair within 2-3 weeks of injury for optimal outcomes, followed by 6-12 months of rehabilitation, as indicated by the expert consensus statement 1. The incidence of postoperative complications after PLC reconstruction or repair is significant, with a rate of 20% reported in a systematic review of the current literature 2, highlighting the importance of careful patient selection and management. Diagnosis involves physical examination tests like the dial test and varus stress test, often confirmed with MRI, and recovery prognosis depends on injury severity, timing of treatment, and patient compliance with rehabilitation protocols, as noted in the study on the evaluation and management of PLC injuries 3. In terms of pain management, intravenous acetaminophen may be considered as part of a multimodal pain protocol for perioperative orthopedic patients, including those undergoing PLC reconstruction or repair, due to its efficacy and safety profile 4. However, the most recent study on the safety profile of an intravenous acetaminophen/ibuprofen fixed dose combination 5 suggests that this combination may be a viable option for postoperative pain management, but its use in PLC injury management is not explicitly stated. Therefore, the primary focus should be on early diagnosis and treatment of PLC injuries, with a multidisciplinary approach to management, including physical therapy, pain management, and surgical intervention when necessary, to optimize outcomes and minimize complications 1.