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Figure B
4%
113/2765
Figure C
52%
1433/2765
Figure D
25%
701/2765
Figure E
5%
132/2765
Figure F
13%
365/2765
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This patient sustained a high-energy injury to the left knee, including a tibial plateau fracture as well as both anterior cruciate ligament (ACL) and posterolateral corner (PLC) injuries as indicated on the physical examination findings. In addition to ORIF of the plateau fracture, the surgical plan should include ACL reconstruction as well as posterolateral corner (PLC) reconstruction, specifically with lateral meniscal repair and allograft reconstruction of the lateral collateral ligament (LCL,asterisk in Figure C) and popliteofibular ligaments. The PLC consists of static (LCL, popliteus tendon, popliteofibular ligament, lateral capsule) and dynamic (biceps femoris, popliteus muscle, IT band, lateral head of the gastrocnemius) structures. Failure to identify a PLC injury associated with an ACL injury often leads to failure of ACL repair. Stannard et al. reported on the clinical outcomes of 22 patients with PLC injuries (7 isolated) who underwent modified 2-tailed reconstruction of the popliteofibular ligament and LCL utilizing transtibial and transfibular bone tunnels. At an average 29.5 months post-operatively, the authors noted excellent results with restoration of range of motion and stability in both the isolated and multiligamentous injured groups. Stannard et al. reported on a separate cohort of 56 patients with PLC injuries either undergoing direct repair or modified 2-tailed reconstruction. The authors noted significantly inferior results in the repair group (37% failures) compared to the reconstruction group (9%) failures, and concluded that reconstruction is the procedure of choice for the majority of patients who sustain high-energy PLC injuries. Levy et al. reported on 28 patients with multiligament knee injuries undergoing either direct PLC repair with staged cruciate ligament reconstruction or delayed single-stage multiligament reconstruction. The authors noted a significantly higher rate of failure in the repair/staged group compared to the delayed reconstruction group, and deemed reconstruction to be a more reliable option than repair alone in the multiligamentously injured knee. Figure A includes AP and lateral radiographs of the left tibia demonstrating a comminuted lateral tibia plateau fracture. Figure C demonstrates a gross dissection of the posterolateral corner (left knee), with the asterisk on the lateral collateral ligament (LCL) Incorrect answers: Answer 1: Figure B demonstrates a gross dissection of the posterolateral corner (left knee), with the asterisk on the IT band Answer 3: Figure D demonstrates a gross dissection of the posterolateral corner (left knee), with the asterisk on the biceps femoris Answer 4: Figure E demonstrates a gross dissection of the posterolateral corner (left knee), with the asterisk on the peroneal nerve Answer 5: Figure F demonstrates a gross dissection of the posterolateral corner (left knee), with the asterisk on the lateral head of the gastrocnemius
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