High-grade posterolateral corner injuries of the knee are rare but potentially devastating injuries. When untreated, it has been shown that these injuries result in persistent instability and progressive articular cartilage damage. Acute high-grade injuries can be successfully treated with direct repair with or without augmentation. However, in patients with symptomatic chronic posterolateral instability, primary repair is rarely successful and reconstruction is recommended.
Because of the anatomic variability of the posterolateral corner and inconsistent combination of injured structures, multiple surgical techniques have been de- scribed for its reconstruction. Published biomechanical data have shown the critical importance of the lateral collateral ligament (LCL) and the popliteofibular ligament (PFL) for resisting, posterior translation, varus opening, and external rotation. Given the biomechanical importance of these anatomic structures, it has been recommended that surgical reconstruction techniques should attempt functional restoration of the LCL and PFL. Based on previous techniques for anatomic reconstruction of the posterolateral corner used at our institution, we have developed a new technique that uses an allograft tendon placed through a tunnel in the fibular head and a unique docking technique to accomplish fixation of the graft at the femoral epicondyle.