Combined PCL and posterolateral corner reconstruction is a complex operation to rebuild both the posterior cruciate ligament and the posterolateral ligament complex of the knee, typically after a knee dislocation or severe multi-ligament injury.
Multiple incisions are made around the knee. The PCL is reconstructed using an Achilles tendon allograft or quadriceps tendon autograft passed through tibial and femoral tunnels. The posterolateral corner (LCL, popliteus tendon, popliteofibular ligament) is reconstructed using additional tendon grafts through bone tunnels in the fibula and femur. The peroneal nerve is identified and protected throughout. The operation takes three to four hours.
Combined reconstruction is needed when both the PCL and posterolateral corner are torn — usually from a high-energy knee dislocation. Without reconstruction, the knee has severe posterior and varus-rotational instability, making walking and stairs very difficult.
Bracing and physiotherapy may be attempted but are rarely successful for combined PCL/posterolateral corner injuries. Most require surgical reconstruction.
MRI, stress X-rays, vascular assessment. Surgery within two to three weeks of injury. Specialist knee ligament centre.
Restoration of posterior and lateral knee stability. Most patients achieve a functional, stable knee for daily activities. Return to sport is possible but less predictable than isolated ligament reconstruction.
Very common. Loss of full flexion expected initially.
Some degree of persistent posterior laxity is common.
Twelve to eighteen months.
Foot drop. Risk approximately 5%.
One or more grafts may stretch or fail.
Popliteal artery at risk.
Severe stiffness requiring further surgery.
High DVT risk.
General anaesthesia with nerve block. Extended operating time.
Hinged brace for twelve weeks. Crutches for eight weeks. No active hamstring exercises for twelve weeks (protects PCL graft). Graduated rehabilitation. Running at six to nine months. Sport at twelve to eighteen months.
Frequent reviews at two, six weeks, three, six months, one year.
The common peroneal nerve wraps around the fibular neck on the outer knee, directly in the posterolateral surgical field. It is carefully identified and protected.