Arthroscopic-Assisted Posterolateral Corner Reconstruction of the Knee: Novel Technique, Classification, Surgical Algorithm, and Midterm Results

Objectives: This study aimed to introduce a new arthroscopic method to reconstruct the popliteus tendon (PT). This minimally invasive technique is performed through the posterolateral corner (PLC) of the knee, which can reconstruct the posterolateral rotary instability (PLRI) of the knee. Methods: Thirty-nine patients (8 females, 31 males) with PLC injury and normal knee alignment underwent arthroscopic PT reconstruction. Among them, 27 patients had combined ACL and PLC injuries, and 9 had been involved in PCL and PLRI. In 3 of them, injuries involved ACL, PCL, and PLC. Physical examination, imaging, and arthroscopic evaluation were performed to assess instability stages. In grade I instability, when the PT had not been injured, the patient was treated with the modified Larson technique and semitendinosus autograft. With grade II injury involving the PT component, arthroscopic reconstruction of the PT was the preferred technique. In grade III injuries, arthroscopic PT reconstruction and the modified Larson technique were used concurrently. Results: All patients were followed up for 58 ± 1 months postoperatively. Varus and external rotation instability were restored with arthroscopic PLC reconstruction. All patients gained near-normal knee stability and significant improvement with pain, along with improved ability to carry out daily activities. In cases of varus instability, a significant improvement was observed in external rotation and reverse pivot shift. There were no cases of arthrofibrosis or limitations in knee motion. Conclusion: Arthroscopic reconstruction of the PT, using our protocol for PLC reconstruction of the knee (with midterm follow-up), showed encouraging results while minimizing surgical morbidity.