Review Article

Lateral Collateral Ligament Injury

About the Knee: Anatomy,
Evaluation, and Management

Abstract
Brian Grawe, MD The lateral collateral ligament is the primary varus stabilizer of the
Amanda J. Schroeder, MD tibiofemoral joint. Diagnosing an injury to this ligament can be
challenging in the setting of multiligamentous trauma; however, failure
Rafael Kakazu, MD
to recognize these injuries can result in instability of the knee and
Malynda S. Messer, BS unsatisfactory outcomes after cruciate ligament reconstruction.
Recent literature exploring the anatomy and biomechanics of the
lateral collateral ligament has enhanced our understanding and
improved diagnosis and management of these injuries. Physical
examination and imaging studies also are important in diagnosis and
can facilitate classification of lateral collateral ligament tears, which
affects treatment decisions. Nonsurgical, reparative, and
reconstructive techniques can all be used to manage lateral collateral
ligament injury about the knee; the optimal treatment is selected on the
basis of injury severity.

T he lateral collateral ligament

From the Department of
Orthopaedics, University of
Cincinnati, Cincinnati, OH.
None of the following authors or any
immediate family member has
received anything of value from or has
stock or stock options held in a
commercial company or institution
related directly or indirectly to the
subject of this article: Dr. Grawe,
Dr. Schroeder, Dr. Kakazu, and
Malynda S. Messer.
J Am Acad Orthop Surg 2018;26:
e120-e127
DOI: 10.5435/JAAOS-D-16-00028
Copyright 2018 by the American
Academy of Orthopaedic Surgeons.
(LCL) is the primary varus sta-
bilizer of the knee.1,2 In addition, the
LCL acts as a secondary restraint to
external rotation and posterior dis-
placement of the tibia.3 Along with
two other key structures, the pop-
liteus muscle-tendon unit and the
popliteofibular ligament (PFL), the
LCL provides stability to the pos-
terolateral corner (PLC) of the knee.4
Anatomy
Healing of the LCL can be unreliable
and often depends on the degree of
injury. Previous confusion about the
anatomic relationships of the liga-
ment may have contributed to failure
after reconstruction. Thus, a thor-
ough understanding of the anatomic
characteristics of the LCL is essential
to improving success rates of repara-
tive or reconstructive surgery.
The structure of the LCL is discrete
and cordlike, with a width of 4 to
5 mm.2 According to anatomic
studies by Wilson et al,3 the ligament
is 2.6 mm thick and 69.9 mm long.
The origin of the LCL is not con-
centric within the center of the lateral
epicondyle, but rather is proximal
(1.4 mm) and posterior (3.1 mm) to
the lateral epicondyle.2
In relation to other structures, the
origin of the popliteus tendon is
18.5 mm anterior and distal to the
LCL.5 The LCL courses deep to the
superficial layer of the iliotibial (IT)
band and is exposed in its distal
quarter both anteriorly and laterally
within the LCL biceps bursa, which
typically serves as a surgical entry
point. The LCL attaches anterior to
the lateral aspect of the fibular head,
covering approximately 38% of the
fibular head width.2
Three separate LCL innervation
patterns have been identified: the

e120 Journal of the American Academy of Orthopaedic Surgeons

Copyright ª the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.

distal third of the thigh from the
muscular branch (tibial nerve) of the
biceps femoris muscle, at the level of
the popliteal fossa from the common
fibular nerve, and at the level of the
proximal fibula from the common
fibular nerve. Two tissue membranes
surround the surface of the LCL but
form an incomplete sheathlike struc-
ture in which peripheral nerve
branches reside; this is thought to be
the source of the indistinct lateral
knee pain that frequently arises with
joint damage.6 The vascular supply
to the LCL comes from both the
inferior lateral genicular and the
anterior tibial recurrent arteries.7
Biomechanics
The LCL, PFL, arcuate ligament, and
fabellofibular ligament constitute the
static stabilizers of the PLC and work
together to prevent posterior tibial
displacement, varus deformation,
and external tibial rotation.8 In this
capacity, the LCL serves primarily to
resist varus forces and secondarily to
resist tibial external rotation in
conjunction with the PFL. In addi-
tion, the posterolateral structures, in
conjunction with the anterior cruci-
ate ligament (ACL), play a secondary
role in preventing anterior displace-
ment of the tibia.
Role of the Lateral Collateral
Ligament With Varus Force
Biomechanical studies have consis-
tently identified the LCL as the pri-
mary restraint to varus motion.
When the knee is flexed to various
angles (eg, 0°, 15°, 30°, 60°, 90°), a
substantial increase in varus laxity
occurs with isolated LCL sectioning
in comparison to the intact knee.1,4
Furthermore, 30° is the angle at
which the maximum amount of
varus laxity is observed with appli-
cation of 10 N
m of force.1 This is of
particular importance for clinicians
March 15, 2018, Vol 26, No 6
Copyright ª the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.
during examination of the integrity
of the LCL after injury.
Role of the Lateral Collateral
Ligament With External and
Internal Rotation
With contributions from the popliteus
tendon, the PFL and LCL play equally
important roles in limiting external
rotation of the tibia when the knee is
extended or mostly extended at 0° and
30°. Conversely, when the knee is in
increasingly flexed positions, the con-
tribution of the LCL to controlling and
preventing external tibial rotation
decreases relative to that of the PFL. As
such, the LCL is preferentially loaded
in the early range of knee flexion.1,4
Recent studies demonstrate that after
sectioning of the LCL, increases in
internal rotation can be observed at all
knee flexion angles.1 In contrast, in
1984 Nielsen et al9 found that the
LCL exerted its most important effects
in resisting internal rotation at higher
flexion angles. Because of these con-
flicting results, pinpointing the angles
at which the LCL maximally stabilizes
internal rotation has been challeng-
ing;1 however, it must be noted that
the LCL, along with capsular contri-
butions, serves as an important
checkrein against internal rotation.
Clinical Evaluation
The LCL should be evaluated as part of
a thorough examination of all liga-
mentous and support structures of the
knee. Injuries to the lateral structures
of the knee are notoriously diffi-
cult to diagnose because of their
rarity and concurrence with other
knee injuries.10,11 Therefore, particular
attention must be paid to the mecha-
nism of injury and presenting symp-
toms during the physical examination.
Patient History
Each injury evaluation should be
approached in a methodical and sys-
Brian Grawe, MD, et al
tematic manner to ensure an accurate
initial assessment. Clinical examina-
tion of the LCL should begin with a
thorough history, which is crucial in
elucidating both the patient’s symp-
tomatology and the mechanism of
injury. Defining the injury as acute
or chronic and determining the
patient’s functional limitations can
aid the clinician in establishing an
appropriate treatment plan.
Mechanisms of injury usually pro-
duce forces of varying degrees in dif-
ferent directions; varus, rotational,
extension, and translational move-
ments all play a role. These injuries
can result from direct contact, such as
a blow to the medial side of the knee,
or noncontact, such as a hyperex-
tension stress across the knee. In a
study of almost 20,000 knee injuries
across a diverse number of sporting
activities, isolated LCL pathology
occurred in ,2% of injuries.12 These
isolated injuries typically resulted
from lower-magnitude forces, which
ultimately led to lower-grade dam-
age to the ligament proper. In a study
examining specific activities related
to various knee injuries, the highest
risk for LCL injury was seen in tennis
and gymnastics, although LCL
injury can occur during virtually
any sporting activity.13 Subjectively,
patients often report a dull pain
and possible feelings of instability,
especially during so-called cutting
activities.
Physical Examination
When a patient is assessed for possible
injury to the LCL, a thorough physical
examination is required because these
lesions rarely occur in isolation.
Swelling about the lateral soft-tissue
envelope of the knee is often present
and can correlate with the degree of
injury to the ligamentous complex.
Because the LCL remains in a relatively
subcutaneous position throughout its
course, the presence of point tender-
ness allows the examiner to assess the
e121
Lateral Collateral Ligament Injury About the Knee
Figure 1
A and B, Illustrations of the physical examination of the lateral collateral
ligament, with the patient’s leg in the figure-of-4 position. The figure-of-4 position
(A) allows the examiner to directly palpate the lateral collateral ligament (B).
location of an injury. Palpation to
assess the integrity of the tendon
can often be aided by placing the
patient in the figure-of-4 position,
which allows the lateral compart-
ment to open up; an intact ligament
will be palpable as a discrete cord-
like structure2 (Figure 1).
The presence and degree of varus
laxity must be elucidated. As pre-
viously mentioned, the LCL can be
isolated at 30° of flexion.1,14 Con-
versely, varus laxity in full extension
frequently denotes injury to one or
both of the cruciate ligaments.14
Historically, a varus opening of
#5 mm has signified a low-grade
LCL injury, an opening of 6 to
10 mm has signified a moderate-
grade injury, and an opening of
.10 mm represented a high-grade
injury.15 The degree of injury can
be confirmed arthroscopically by
applying a varus force to the knee
while inspecting the lateral com-
partment and then using a probe
as a caliper to assess the amount
of opening. Higher-grade injuries
e122
Copyright ª the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.
should alert the surgeon to a poten-
tial multiligamentous knee injury.
The PLC must also be assessed when
an LCL injury is diagnosed. Specific
assessments for the integrity of the PLC
include the dial test, the posterolateral
drawer test, and the recurvatum
test.14,16 The dial test is best per-
formed by comparing the amount of
external rotation in each knee while
the patient is in the prone position. An
increase in external rotation of .10°
with the knee flexed to 30° is indica-
tive of a PLC injury. With the pos-
terolateral drawer test, the examiner
evaluates the PLC by applying a pos-
teriorly directed force and external
rotation torque to the knee with the
foot in 15° of external rotation. A
positive test result is indicated by
increased external rotation compared
with the contralateral side. The re-
curvatum test is performed with the
knee held in extension. While stabi-
lizing the thigh, the examiner lifts the
ipsilateral great toe and measures the
distance the heel can be lifted (ie,
hyperextension or recurvatum). An
Journal of the American Academy of Orthopaedic Surgeons
increased distance compared with that
of the contralateral knee indicates a
PLC injury.
Imaging
When an LCL injury is suspected,
imaging studies should include a
dedicated weight-bearing knee series
and can include stress radiographs.
MRI is considered the benchmark
when a patient is evaluated for an
LCL injury; the signal changes pro-
vided by this modality, which indi-
cate ultrastructural injury, offer an
accurate picture of the entire knee
while allowing gradation of the LCL
injury itself14 (Figure 2).
Various bone bruise patterns have
also been studied in association with
mechanisms of injury. Of particular
interest regarding the LCL are medial
compartment bruises, which have been
correlated with LCL/PLC injury as a
result of a hyperextension-varus
mechanism. A widely dispersed bruis-
ing pattern around the medial and lat-
eral knee with patellar involvement is
seen with PLC and associated liga-
mentous injuries (eg, LCL injury).17
Bonadio et al18 reported a poor
correlation between examination
under anesthesia and MRI results for
diagnosis of LCL injuries, with a sen-
sitivity of only 58% for detection of
LCL lesions. Because these lesions are
often found in conjunction with other
injuries, it is difficult to determine on
physical examination which PLC
structure is damaged and the degree of
injury to that structure.5,19 In general,
MRI has an accuracy of up to 95% for
detecting injury to PLC structures,
such as lesions of the ACL.18 Typi-
cally, MRI can demonstrate an LCL
failure at its fibular attachment or at
the midsubstance of the ligament.3
Classification
LCL tears are typically classified on
the basis of MRI results and are
graded by the severity of interstitial
 Brian Grawe, MD, et al

injury. Grade I is the least severe Figure 2

injury and is defined as sub-
cutaneous fluid surrounding the
midsubstance of the ligament at one
or both insertions. Grade II entails
morphologic disruption of the liga-
ment involving partial tearing of
ligament fibers at either the mid-
substance or one of the insertions, with
increased edema in the area. Internal
hyperintensity may be seen within the
ligament and/or in the bursal fluid
around the ligament, with loss of
demarcation of adjacent subcutaneous
fat. Grade III is the most severe injury,
with complete tearing of ligament
fibers at either the midsubstance or one A, Axial T1-weighted MRI of a knee demonstrating moderate periligamentous
of the insertions, and is associated with edema consistent with a lateral collateral ligament (LCL) tear. B, Coronal T2-
increased edema.12,20-22 Additional weighted MRI of a knee demonstrating discontinuity of the LCL. The arrows
characteristics, such as fluid in the indicate a midsubstance tear of the LCL.
bursa, edema of the periligamentous
fascia, and loss of demarcation of
adjacent subcutaneous fat, may be management and early mobiliza- and neurolysis of the common pero-
found in conjunction with avulsion tion.23 This was demonstrated neal nerve are performed.
of the ligamentous insertion.12,20-22 in clinical studies by Krukhaug The LCL is encountered via a
To assign a grade to these lesions, et al11 and Kannus.24 Nonsurgical horizontal incision at the biceps
an oblique coronal T2-weighted management of grade III injuries femoris bursa, and a traction suture
cut should be obtained because it yielded poor results in these stud- can be placed in the ligament to
allows optimal visualization for ies, however. Conversely, in a determine whether a repair is possi-
identifying the intra-oblique artic- cohort study of National Football ble. The IT band should be split from
ular portion.18 League athletes with isolated grade the lateral epicondyle to its insertion
III LCL injuries, Bushnell et al12 at the Gerdy tubercle. The proximal
found that players with non- origin of the LCL can be identified
Management surgically managed isolated grade by tensioning the traction suture,
III injuries were as likely as those unless the ligament is completely
Whether to proceed with nonsurgical
with surgically managed injuries to avulsed from the femur. In that case,
or surgical management of LCL tears
return to professional play, and the original attachment site should
is determined on the basis of grade of
they did so more quickly. Despite be identified. At this point, non-
injury as well as the presence of
these controversial results, Bush- bioabsorbable suture anchors with a
concomitant injuries to other struc-
nell et al12 still advocate for sur- small footprint can be used to re-
tures in the knee. When injuries to
gical treatment of most grade III attach the LCL to its proximal
other ligamentous structures are
injuries. attachment site. This technique may
present, early surgical intervention is
also be used for a femoral-side
advantageous.23 It has been dem-
avulsion25 (Figure 3).
onstrated that a torn LCL does not Surgical
heal as well as a torn medial col-
Repair Reconstruction
lateral ligament does;3 as a result, we
For the isolated acute LCL grade III In the setting of a complete mid-
advocate a lower threshold for sur-
tear, repair can be performed when substance tear or intrasubstance stretch
gical intervention for an LCL tear.
the ligament is avulsed from an injury, ligamentous reconstruction is
attachment site and an anatomic necessary.25-28 LCL reconstruction
Nonsurgical reduction remains possible with the should also be performed when ana-
Isolated LCL grade I and II tears can knee in full extension. In these cases, a tomic reduction is not possible.25
often be managed with nonsurgical lateral incision over the mid-IT band Reconstruction is also recommended

March 15, 2018, Vol 26, No 6 e123

Copyright ª the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.
Lateral Collateral Ligament Injury About the Knee
Figure 3
Illustration demonstrating an avulsion lateral collateral ligament tear that was
repaired using a traction suture.
rather than primary repair in the
case of chronic injury to the lateral
structures of the knee. Studies have
demonstrated improved outcomes in
multiligamentous knee injuries man-
aged with reconstruction of the LCL
and PLC compared with repair, with
substantially higher failure rates re-
ported when the LCL is repaired.27
Regardless of which surgical tech-
nique is preferred for LCL recon-
struction, meniscal and concomitant
cruciate ligament injuries should also
be managed as necessary during this
procedure.29
Reconstructions can be classified as
nonanatomic, isometric, or ana-
tomic. Clancy30 originally described
and popularized a surgical technique
involving biceps femoris tenodesis.
With this technique, a posterolateral
knee incision is made, and an
approach is undertaken as described
in the repair section of this article. A
hole is drilled just anterior to the
LCL femoral attachment site in
preparation for an attempt at iso-
metric tenodesis. A 6.5-mm screw
and spiked washer are placed, with
e124
Copyright ª the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.
0.5 inch left prominent. The poste-
rior intermuscular septum is split,
and the biceps tendon is transferred
anteromedially to the IT band. At
this point, the knee should be flexed
to 90°. As the knee is slowly
extended, the tendon is levered over
the screw post. After the knee has
been fully extended, the screw and
washer are secured. Range of motion
is evaluated while assessing for any
tendon subluxation or IT band
snapping, and this evaluation is
repeated after the IT band is closed31
(Figure 4).
Latimer et al29 described isometric
reconstruction of the LCL with a
patellar tendon allograft. After the
superior fibula is freed from all soft
tissue, a tunnel is created at the
superior aspect of the fibula and then
enlarged with serial reaming. The IT
band is split at its midline, and a
tunnel is created in the femur
approximately 6 mm anterior to the
center of the femoral insertion of the
LCL and exiting proximally and
anteriorly to the medial femoral ep-
icondyle. Isometry can be confirmed
Journal of the American Academy of Orthopaedic Surgeons
Figure 4
Illustration demonstrating an
isometric lateral collateral ligament
reconstruction using biceps femoris
tenodesis.
with the use of a small Kirschner
wire and a looped suture. The graft is
appropriately contoured and secured
with interference screw fixation in
the fibula and passed through the
femur with a suture. With the knee in
20° to 30° of flexion and with valgus
force applied to properly tension the
graft, another interference screw is
placed in the femur (Figure 5). Sim-
ilar isometric techniques have been
described using alternative grafts,
such as Achilles tendon graft.27,32
As mentioned previously, the origin
of the LCL is not concentric within
the center of the lateral epicondyle.2
Consequently, nonanatomic graft
placement has been proposed as a
potential explanation for LCL
reconstruction failure. Coobs et al1
first biomechanically validated an
anatomic approach for isolated LCL
injury; they believed that isolated
fibular LCL reconstruction with a
semitendinosus graft would restore
knee biomechanics more precisely
 Brian Grawe, MD, et al

Figure 5 Figure 6

Illustrations demonstrating an isometric reconstruction of the lateral collateral

ligament (LCL) using a patellar tendon allograft. A, The iliotibial band is split
along the midline, exposing the anatomic insertion of the LCL. The tunnel is
created 6 mm anterior to the center of the femoral insertion of the LCL, exiting
proximally and anteriorly to the medial femoral epicondyle. A small Kirschner
wire and a looped suture are used to confirm isometry. B, Illustration of the knee
demonstrating appropriate graft position with interference screw fixation at the
fibula and femur.

than a nonanatomic attachment

would. LaPrade et al33 described the
use of a semitendinosus tendon graft
with this anatomic approach. A
tunnel is created where the LCL
attaches to the fibular head. The IT
band is divided, the attachment site
is identified, and then a femoral
tunnel is drilled. With the knee in 20°
of flexion and valgus force applied,
the graft is secured into each tunnel
with an interference screw. After an
examination is performed to verify
the integrity and function of the
graft, it is sutured to itself to ensure
adequate fixation (Figure 6).
Numerous surgical techniques have
been described for combined recon-
struction of the LCL and PLC. These
techniques can be broadly categorized
as fibula-based approaches27,32,34 and
combined fibula- and tibia-based
approaches.1,2,5,25,26,33 Each has
advantages and disadvantages, and a
full discussion of these approaches is
beyond the scope of this article.
Outcomes
As discussed previously, Bushnell
et al12 evaluated the outcomes of
MRI-documented, isolated LCL
grade III injuries in National Football
League players. From 1994 to 2004,
they identified nine players who met
the criteria for the study and con-
cluded that nonsurgical management
resulted in faster return to play
without the risks of surgery. This
study highlighted the rarity of isolated
LCL grade III injuries as well as data
from a direct comparison of non-
surgical and surgical management of
these injuries in professional athletes.
Of the various reconstruction tech-
niques described, anatomic recon-
struction using a semitendinosus graft
has demonstrated improvements in
both subjective and objective outcome
measures. In 2010, LaPrade et al33
reported on the outcomes of LCL
reconstruction using an anatomic
Illustration demonstrating anatomic
reconstruction of the lateral collateral
ligament.
technique with a semitendinosus graft
in 20 patients. At an average of 2
years, the authors of the study noted
substantial improvement in modified
Cincinnati scores as well as Interna-
tional Knee Documentation Com-
mittee (IKDC) scores. In a subsequent
study, Moulton et al26 reported that
subjective outcomes in 36 patients
undergoing anatomic LCL recon-
struction improved markedly as
measured by Western Ontario and
McMaster Universities Osteoarthritis
Index score (including pain, stiffness,
and function subset scores), median
Medical Outcomes Study 12-Item
Short Form physical component
score, and Tegner activity scale. In
that study, proposed benefits of
anatomic reconstruction included

March 15, 2018, Vol 26, No 6 e125

Copyright ª the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.
Lateral Collateral Ligament Injury About the Knee
restoration of forces on the graft
during physical activity, which allows
early range of motion during
rehabilitation.
The rarity of isolated LCL injuries
and the large variety of surgical tech-
niques complicates comparisons of
treatment superiority. In fact, there is
debate regarding repair versus recon-
struction for LCL injuries. In 2007,
Shelbourne et al35 published results
of an en masse surgical technique
for repairing lateral side knee
injuries after dislocation. This tech-
nique involved concurrent ACL
reconstruction using a bone-patellar
tendon-bone graft along with re-
attachment of the combined mass of
healing lateral structures to the tibia.
A total of 23 patients underwent this
repair technique, with outcome mea-
sures reported approximately 5 years
postoperatively. IKDC objective rat-
ings were normal for 10 patients and
nearly normal for 7 patients. Fifteen
patients had normal lateral laxity,
with 2 patients graded as 11. Final
follow-up MRI revealed thickened
but intact lateral structures. Mean
subjective scores for IKDC, modified
Noyes, and activity were 91.3, 93.0,
and 8.0, respectively. Shelbourne
et al35 believe this approach takes
advantage of the body’s ability to heal
and gives the patient an excellent
balance of motion and stability.
In contrast, other studies have
shown that reconstruction is also
effective for the management of iso-
lated LCL injuries. In 2005, Stannard
et al28 reported results from a pro-
spective study evaluating repair ver-
sus reconstruction of the PLC in 57
knees. Of note, 44 of 57 knees (77%)
had multiligamentous injuries. At
a minimum follow-up of 24 months,
the authors of the study found
notably higher failure rates in the
repaired knees than in the re-
constructed knees (37% and 9%,
respectively). They also noted a
substantial difference in clinical sta-
bility that favored reconstruction.
e126
Copyright ª the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.
In 2010, Levy et al27 reported on 28
knees with multiligamentous injuries
that were treated with either repair
or reconstruction of lateral struc-
tures (minimum follow-up, 24
months). The repair was done in a
staged fashion, with lateral struc-
tures repaired initially, followed by
delayed reconstruction of cruciate
ligaments. Reconstruction, which
was performed in a single procedure,
involved the use of the Achilles ten-
don with bone allograft. Sub-
stantially higher rates of failure
occurred in the repair group. The
failed repairs were subsequently re-
constructed, with results similar to
those of the primary reconstructions,
as measured by IKDC and Lysholm
scale scores. Levy et al27 concluded
that reconstruction of lateral struc-
tures may be more reliable than
repair in knees with multi-
ligamentous injuries.
Summary
The LCL is an essential stabilizer for
the PLC of the knee. Typically, LCL
injuries occur in conjunction with
other knee pathology. A variety of
techniques has been described for
surgical intervention, with anatomic
reconstruction gaining popularity in
recent years in part because of bio-
mechanical studies emphasizing
physiologic knee anatomy. Early rec-
ognition and repair or reconstruction
of these injuries is vital because early
intervention influences the success of
other ligamentous repairs.
References
Evidence-based Medicine: Levels of
evidence are described in the table of
contents. In this article, references
25, 28, and 33 are level II studies.
References 3, 4, 9, 20, 21, 27, and 34
are level III studies. References 1, 2,
5-8, 10-19, 22-24, 26, 29-32, and 35
are level IV studies.
Journal of the American Academy of Orthopaedic Surgeons
References printed in bold type are
those published within the past 5
years.
1. Coobs BR, LaPrade RF, Griffith CJ, Nelson
BJ: Biomechanical analysis of an isolated
fibular (lateral) collateral ligament
reconstruction using an autogenous
semitendinosus graft. Am J Sports Med
2007;35(9):1521-1527.
2. Moorman CT III, LaPrade RF: Anatomy
and biomechanics of the posterolateral
corner of the knee. J Knee Surg 2005;18(2):
137-145.
3. Wilson WT, Deakin AH, Payne AP, Picard
F, Wearing SC: Comparative analysis of the
structural properties of the collateral
ligaments of the human knee. J Orthop
Sports Phys Ther 2012;42(4):345-351.
4. Lim HC, Bae JH, Bae TS, Moon BC,
Shyam AK, Wang JH: Relative role
changing of lateral collateral ligament
on the posterolateral rotatory instability
according to the knee flexion angles: A
biomechanical comparative study of role
of lateral collateral ligament and
popliteofibular ligament. Arch
Orthop Trauma Surg 2012;132(11):
1631-1636.
5. LaPrade RF, Griffith CJ, Coobs BR, Geeslin
AG, Johansen S, Engebretsen L: Improving
outcomes for posterolateral knee injuries. J
Orthop Res 2014;32(4):485-491.
6. Yan J, Sasaki W, Hitomi J: Anatomical
study of the lateral collateral ligament and
its circumference structures in the human
knee joint. Surg Radiol Anat 2010;32(2):
99-106.
7. Hannouche D, Duparc F, Beaufils P: The
arterial vascularization of the lateral tibial
condyle: Anatomy and surgical applications.
Surg Radiol Anat 2006;28(1):38-45.
8. Buzzi R, Aglietti P, Vena LM, Giron F:
Lateral collateral ligament reconstruction
using a semitendinosus graft. Knee Surg
Sports Traumatol Arthrosc 2004;12(1):
36-42.
9. Nielsen S, Rasmussen O, Ovesen J,
Andersen K: Rotatory instability of cadaver
knees after transection of collateral
ligaments and capsule. Arch Orthop
Trauma Surg 1984;103(3):165-169.
10. Hughston JC, Andrews JR, Cross MJ,
Moschi A: Classification of knee ligament
instabilities: Part II. The lateral
compartment. J Bone Joint Surg Am 1976;
58(2):173-179.
11. Krukhaug Y, Mølster A, Rodt A, Strand T:
Lateral ligament injuries of the knee. Knee
Surg Sports Traumatol Arthrosc 1998;6(1):
21-25.
12. Bushnell BD, Bitting SS, Crain JM, Boublik
M, Schlegel TF: Treatment of magnetic
resonance imaging-documented isolated
grade III lateral collateral ligament injuries

in National Football League athletes. Am J
Sports Med 2010;38(1):86-91.
13. Majewski M, Susanne H, Klaus S:
Epidemiology of athletic knee injuries: A
10-year study. Knee 2006;13(3):184-188.
14. Devitt BM, Whelan DB: Physical
examination and imaging of the lateral
collateral ligament and posterolateral
corner of the knee. Sports Med Arthrosc
2015;23(1):10-16.
15. Hughston JC, Andrews JR, Cross MJ,
Moschi A: Classification of knee ligament
instabilities: Part I. The medial
compartment and cruciate ligaments. J
Bone Joint Surg Am 1976;58(2):159-172.
16. Bahk MS, Cosgarea AJ: Physical
examination and imaging of the lateral
collateral ligament and posterolateral
corner of the knee. Sports Med Arthrosc
2006;14(1):12-19.
17. Chin YC, Wijaya R, Chong R, Chang HC,
Lee YH: Bone bruise patterns in knee
injuries: Where are they found? Eur J
Orthop Surg Traumatol 2014;24(8):
1481-1487.
18. Bonadio MB, Helito CP, Gury LA,
Demange MK, Pécora JR, Angelini FJ:
Correlation between magnetic resonance
imaging and physical exam in assessment of
injuries to posterolateral corner of the knee.
Acta Ortop Bras 2014;22(3):124-126.
19. Crawford B, Zehnder S, Cutuk A, Farrow
LD, Kaar SG: Arthroscopic evaluation of
knee lateral compartment widening after
lateral ligamentous injury. Knee Surg
Sports Traumatol Arthrosc 2013;21(7):
1534-1539.
20. Mirowitz SA, Shu HH: MR imaging
evaluation of knee collateral ligaments and
related injuries: Comparison of T1-
weighted, T2-weighted, and fat-saturated
March 15, 2018, Vol 26, No 6
Copyright ª the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.
T2-weighted sequences. Correlation with
clinical findings. J Magn Reson Imaging
1994;4(5):725-732.
21. Schweitzer ME, Tran D, Deely DM, Hume
EL: Medial collateral ligament injuries:
Evaluation of multiple signs, prevalence
and location of associated bone bruises, and
assessment with MR imaging. Radiology
1995;194(3):825-829.
22. Recondo JA, Salvador E, Villanúa JA,
Barrera MC, Gervás C, Alústiza JM:
Lateral stabilizing structures of the knee:
Functional anatomy and injuries assessed
with MR imaging. Radiographics 2000;20
(Spec No):S91-S102.
23. Stevenson WW III, Johnson DL:
Management of acute lateral side ligament
injuries of the knee. Orthopedics 2006;29
(12):1089-1093.
24. Kannus P: Nonoperative treatment of grade
II and III sprains of the lateral ligament
compartment of the knee. Am J Sports Med
1989;17(1):83-88.
25. Geeslin AG, LaPrade RF: Outcomes of
treatment of acute grade-III isolated and
combined posterolateral knee injuries: A
prospective case series and surgical
technique. J Bone Joint Surg Am 2011;93
(18):1672-1683.
26. Moulton SG, Matheny LM, James EW,
LaPrade RF: Outcomes following anatomic
fibular (lateral) collateral ligament
reconstruction. Knee Surg Sports
Traumatol Arthrosc 2015;23(10):
2960-2966.
27. Levy BA, Dajani KA, Morgan JA, Shah JP,
Dahm DL, Stuart MJ: Repair versus
reconstruction of the fibular collateral
ligament and posterolateral corner in the
multiligament-injured knee. Am J Sports
Med 2010;38(4):804-809.
Brian Grawe, MD, et al
28. Stannard JP, Brown SL, Farris RC,
McGwin G Jr, Volgas DA: The
posterolateral corner of the knee: Repair
versus reconstruction. Am J Sports Med
2005;33(6):881-888.
29. Latimer HA, Tibone JE, ElAttrache NS,
McMahon PJ: Reconstruction of the lateral
collateral ligament of the knee with patellar
tendon allograft: Report of a new technique
in combined ligament injuries. Am J Sports
Med 1998;26(5):656-662.
30. Clancy WG: Repair and reconstruction of
the posterior cruciate ligament, in
Chapman MW, ed: Operative
Orthopaedics. Philadelphia, PA, JB
Lippincott, 1988, vol 3, pp 1651-1665.
31. Bach BR, Jewell BF, Dworsky B:
Posterolateral knee reconstruction using
Clancy biceps tenodesis: Surgical technique.
Am J Knee Surg 1993;6(3):97-103.
32. Schechinger SJ, Levy BA, Dajani KA, Shah
JP, Herrera DA, Marx RG: Achilles tendon
allograft reconstruction of the fibular
collateral ligament and posterolateral
corner. Arthroscopy 2009;25(3):232-242.
33. LaPrade RF, Spiridonov SI, Coobs BR,
Ruckert PR, Griffith CJ: Fibular collateral
ligament anatomical reconstructions: A
prospective outcomes study. Am J Sports
Med 2010;38(10):2005-2011.
34. Rios CG, Leger RR, Cote MP, Yang C,
Arciero RA: Posterolateral corner
reconstruction of the knee: Evaluation of a
technique with clinical outcomes and stress
radiography. Am J Sports Med 2010;38(8):
1564-1574.
35. Shelbourne KD, Haro MS, Gray T: Knee
dislocation with lateral side injury: Results
of an en masse surgical repair technique of
the lateral side. Am J Sports Med 2007;35
(7):1105-1116.
e127