Posterolateral Reconstruction of the Knee: Capsular Procedures

It is well recognized that significant morbidity can result from undiagnosed and untreated components of posterolateral instability of the knee. Restoration of normal knee anatomy is crucial to obtain a good surgical outcome. During direct capsular repairs, a comprehensive understanding of this anatomy allows surgeons to repair the injured structures with the aim of restoring function to both the static and the dynamic components of the region. Compared with the direct approach, an osteotomy of the lateral femoral condyle often permits superior visualization of the injured structures. These include the attachments of the fibular collateral ligament, the popliteal tendon, the popliteofibular ligament, and the lateral meniscus and its attachment, as well as the deeper structures. The osteotomy permits not only enhanced visualization, but also the proper positioning of sutures in the posterior capsule; this in turn allows a capsular shift to tighten and repair the injured structures following their direct repair. The extensile exposure provided by the osteotomy allows the deep structures to be repaired with subsequent reattachment of the bone block and attached structures without appreciably affecting the anatomical isometry. Although an osteotomy is not needed in every case of capsular posterolateral knee reconstruction, it does allow for excellent visualization of the deeper structures when needed. The capsular shift can be done alone or in combination with other reconstructive procedures for the treatment of the injured posterolateral corner.