What is a Postero-Lateral Corner Injury?
A posterolateral corner (PLC) injury involves damage to the structures on the outside of the knee joint, including the lateral collateral ligament (LCL), popliteus tendon, popliteofibular ligament, and other supporting structures.
Symptoms of a posterolateral corner (PLC) injury can vary depending on the severity of the injury, but they often include:
Pain: Pain is a common symptom of a PLC injury, especially on the outside of the knee joint. The pain may be sharp or dull and may worsen with movement or weight-bearing activities.
Swelling: Swelling around the outside of the knee joint may occur due to inflammation and fluid accumulation as a result of the injury.
Instability: A feeling of instability or giving way in the knee may be present, particularly when bearing weight or during movements that stress the posterolateral structures of the knee.
Difficulty Walking: Walking may be painful or difficult, especially if the injury affects the stability of the knee joint.
Tenderness: Tenderness to touch may be present over the posterolateral aspect of the knee where the injury has occurred.
Limited Range of Motion: Decreased range of motion in the knee joint, particularly in bending or straightening the knee, may occur due to pain or swelling associated with the injury.
Difficulty Weight Bearing: Putting weight on the affected leg may be uncomfortable or painful, leading to difficulty with activities such as standing, walking, or climbing stairs.
Weakness: Weakness in the muscles surrounding the knee, particularly the quadriceps, hamstrings, and calf muscles, may develop due to pain and disuse following the injury.
Clicking or Popping Sensation: Some individuals may experience clicking, popping, or snapping sensations in the knee joint, particularly during movement.
Numbness or Tingling: In severe cases where nerve involvement occurs, numbness or tingling sensations may be present in the lower leg or foot.
Diagnosis and rehabilitation for a PLC injury typically involve the following steps:
Diagnosis:
Physical examination: A healthcare professional such as a physiotherapist will perform a thorough physical examination of the knee to assess stability, range of motion, and any signs of injury.
Imaging tests: MRI (Magnetic Resonance Imaging) scans can provide detailed images of soft tissue structures to identify any ligament or tendon damage.
Rehabilitation:
Rehabilitation for a PLC injury aims to restore knee stability, function, and range of motion while reducing pain and swelling. The specific components of rehabilitation may vary depending on the severity of the injury and individual factors, but typically include:
Acute Phase (0-72 hours):
Rest, Ice, Compression, Elevation (RICE): Similar to other acute injuries, initial management involves rest, ice application, compression, and elevation to reduce pain and swelling.
Use of a brace: Depending on the severity of the injury, a brace or splint may be used to provide support and stability to the knee during the acute phase.
Early Rehabilitation (1-6 weeks):
Range of motion exercises: Gentle exercises to maintain or restore normal knee range of motion.
Strengthening exercises: Begin with isometric exercises to activate the muscles around the knee without stressing the injured structures.
Proprioception and balance training: Exercises to improve joint position sense and balance to enhance stability.
Intermediate Rehabilitation (6-12 weeks):
Progressive strengthening: Gradually progress to resistance exercises to strengthen the muscles around the knee, including the quadriceps, hamstrings, and calf muscles.
Functional exercises: Incorporate activities that mimic daily tasks or sport-specific movements to improve overall function and stability.
Neuromuscular control training: Focus on exercises that enhance dynamic stability, coordination, and control of movement.
Cardiovascular conditioning: Include low-impact cardiovascular exercises to maintain overall fitness while minimizing stress on the knee.
Advanced Rehabilitation (12+ weeks):
Sport-specific training: Gradually reintroduce activities and movements specific to the individual's sport or activity, with a focus on proper technique and biomechanics.
Plyometric exercises: Incorporate jump training and other explosive movements to improve power, agility, and neuromuscular control.
Functional testing: Perform functional assessments to evaluate readiness to return to sport or other high-level activities.
Gradual Return to Activity:
Before returning to sports or high-level activities, it's essential to ensure that the knee is fully healed and that strength, stability, and range of motion have been restored. A gradual return-to-sport program, supervised by a physiotherapist can help reduce the risk of reinjury.
Rehabilitation for a PLC injury should be individualised based on the specific characteristics of the injury, as well as the patient's goals, functional abilities, and level of activity. Close collaboration with a healthcare professional, such as a physiotherapist is crucial to developing an effective rehabilitation plan and achieving optimal outcomes.
