Collateral Ligaments and other non-cruciate tendons & ligaments around the knee :
Post lateral Corner? - - Posted by Kevlar (Kevlar), 25 August 2003
I had my ACL reconstructed for the 2nd time in January this time using my hamstring. This was done using a new method from Japan (1st person in GB to have this). Don`t know if this has worked yet cos I`ve just been back in July to have my Post Lateral Corner done, again using hamstring graft. There is no information about this procedure on the web and I don`t know of anybody who has had this done. People I speak to who have had ACL,PCL...have never heard of it. All I know is that it is a little `box`of tissue, fibres, ligaments and mine was wrecked.
Can anyone shed any light on it please.
Posted by amazonia (amazonia), 5 September 2003
Hi Kevlar,
I had complete tears to my ACL/PCL and PLC (posterior lateral corner - also known as the lateral collateral ligament) I just had the PCL and PLC reconstructed at the end of May - PLC using a hamstring graft. I'm not sure what your question is actually.... I just did a search and found info on the internet on posterior lateral corner - so there is info. out there! It's just another name for the lateral collateral ligament - and injuries to that area of the knee. If I can be of any other help - let me know - as it's a very unusual injury to do - not a lot of people tear the lateral ligament, and as my surgeon has told me, it's "uncharted" territory having multi ligament injuries involving the PLC and the best ways of fixing them. MCL/PCL and ACL injuries are much more common for multi ligament injuries - called the terrible triad. However, you're not alone out there....feel free to email me, and I hope your recovery is going well! How did you injure your knee?
Anne
Posted by KJ (KJ), 5 September 2003
Yup,
There are some of us out there. I've had PCL/ACL/MCL + posterolateral corner damage 2yrs ago. My PL corner was not dealt with and so even though I had PCL and ACL reconstructions I still have an unstable knee.
I'm going in next week to have a posterolateral reconstruction (using cadaver graft as both my hamstrings had been used already) + osteotomy _+ possible ACL/PCL revisions with donor grafts as well.
Sometimes called "the dark side of the knee", one very experienced French multi-ligament surgeon says "you so much look at the posterolateral corner and there's trouble".
There is an excellent very comprehensive review of posterolateral corner injuries by Dana Covey, (possibly in the Journal of Bone and Joint Surgery) although I'm not sure if there is free access to this, it might be worth sticking her name + [osterolateral in a search engine - you won't see a more through article.
KJ
BTW, the lateral collateral ligament is only one part of teh posterolateral corner/complex, it is complicated set of structures including popliteus, the popliteofibular ligament
I've found a powerpoint presentation on line of her article - it has good pictures
[url]www.vghtpe.gov.tw/~orth/Morning%20Meeting/2002/SM/ Posterolateral%20corner%20of%20knee%20injury.ppt[/url]
One more thing - the terrible triad is actually ACL, MCL and medical meniscus tear, - sorry to be pedantic
I've been thinking of you Anne - I hope things are going well for you
Jane
Posted by amazonia (amazonia), 5 September 2003
Thanks for the corrections Jane! I'm still a knee Geek....
and actually realized the LCL/ PLC part after I'd sent it.
Your surgery is next week? I hope it goes well, and please let me know (when you can) how you're doing. I'll be thinking about you! What date is it on?
I just started physio last week, and am going twice/week. Going to physio really makes one realize how far there is still to go - so although I'm able to work and walk around OK, there's not much more than that I can do. Lots of work ahead of me, but I'm a trooper and will do all that I can to get my knee as good as it can be. It doesn't feel much like a knee anymore though - more like a block of wood.
Anyway Jane - good to hear from you, and I'll be thinking of you next week and hoping it all goes well.
Anne
Posted by KJ (KJ), 6 September 2003
Hi anne
I'm going in on 11th September for surgery the following day and due to stay in until the 16th. I remember that "block of wood" feeling - it's a very good description. When you have it for months and months you think your knee will never feel anything like normal again - but somehow eventually it does. For me last time it probably took nearly a year after the last reconstructive sugery.
I hope that I can remind myself this time when things are tough that almost certainly all that "knee is the centre of my body" feeling, will go away.
Let's hope so anyway
Keep persevering with the physio
Jane
Posted by alexander (alexander), 8 November 2003
Dear all on this page ,
i am pleased to find fellow "limpers" who can appreciate the pain and frustration this injury and operation(s) cause.
I have just been told that my ACL and PLC are both injured after a car accident where i was shunted by a drunk driver from behind. My op is scheduled for 20 nov 03 .
I have also enlisted the help of several specialists for recovery ....... one is someone from the martial arts world , another does all nutrition for English rugby team and another does personal training for recovery for sports professionals ( athletes , footballers and rugby players). I am hoping that a combination of a specific diet , specific excercises and also my physio ( who does the uk judo team and specialises in knee trauma ) will aid the healing process post op. As you can imagine all of this will cost a small fortune , but i am going to put it into a small panphlet . May as well do something round the house when i'm not allowed to train. Will post again when i have something to aid you in your recoveries.
Posted by amazonia (amazonia), 17 November 2003
Good luck with your operation this week - I hope it all goes well. What are they using for the PCL reconstruction?
I go back to see my surgeon next Monday for my 6 mo. post PCL/PLC reconstruction appointment. PCL seems to have held really well - even did a 10km hike last week, plus a 15km bike ride. I'm not as pleased with the PLC though - still a lot of instability, and since I don't have an ACL, that doesn't help the situation. I'll be interested to hear the surgeon's thoughts as to what the plan is for the ACL - as I hate to think this is as good as it's ever going to be. I can do quite a bit, but still have severe limitations.
Good luck again - let us know how it goes!
Posted by Kevlar (Kevlar), 17 November 2003
Hello all,
I started this page, so you check my notes up there save me repeating myself. Just thought I`d update you that none of my operations have worked, knee is worse now than ever, it is not a question of building the muscles up around the knee (although this will help), it will never be right. It wobbles from side to side, front to back. After they measured my ACL movement it know moves 18mm (3/4"), my "good knee" only moves 7mm. It also goes out sideways at will, think that might be it now,wish I would never have bothered now. Go back in January to see surgeon.
Kevlar 
Posted by amazonia (amazonia), 17 November 2003
Sorry to hear things have not worked out for you Kevlar. I'm also not very happy with my PLC reconstruction, and also have a lot of lateral instability. Since I don't have an ACL, that also adds to the problem, so I can really relate to what you're going through. I know my knee will never be 'right', but I'm really hoping that this isn't as good as it's going to be...
My thoughts are with you - and I understand your frustration!
Anne
Posted by KJ (KJ), 17 November 2003
I'm sorry that things are not going very well for either of you.
I'm now 2 months post op (HTO, PLC, & revision ACL/PCL) and so far so good. The osteotomy has healed and I'm weightbearing fully (although it is still very painful now that I'm doing more)
However the stability at the moment feels better than at any time since injury.
I will probably be having a MUA around Christmas time because flexion isn't coming on at all since getting to 100.
My PLC recon was a bone-patellar tendon-bone allograft together with an advancement of existing posterolateral structures - I'm hoping that with the new ACL and PCL as well (achilles and B-PT-B allografts) that I can maintain a reasonable stability.
It is very hard to explain to anyone (including many orthopaedic surgeons) just how odd complex knee instability feels - they just don't realise how debilitating it is
KJ
BTW Anne I have emailed you separately & Kevlar I've sent you a private message
Posted by tanneri (tanneri), 25 November 2003
Hi,
We make our choices! No regrets!
I had a bike crash 23 years ago snapping everything that could be snapped that wasn't bone. I had various attempts at reconstructive surgery to re-build the knee ligaments & they also removed most of the cartilage at that time. I then played US football & Rugby for 9 years until it got so bad that I could not change direction without falling over, time to give up I thought!
Last Oct 02, I had a Tibia Osteotomy & escaped the frame in Jan 03, though I did get a bone infection, which delayed things somewhat. This has definitely helped the lateral instability & I would definitely consider it as an option if offered.
I have a number of opps ahead of me, they are Medial ACL, PCL & Post Lateral corner reconstruction, all with alographs both hamstring and patella. The first procedure should be in December & then continuing throughout next year.
The first in about 2 weeks is an alograph reconstruction of the medial ligament & an attempt at reconstructive surgery of my own ligament again. They will also be removing the Dacron from previous ACL, PCL. MCL attempts and bone grafting the screw holes with bone from my pelvis so they can reuse the site again.
Nowadays I concentrate on walking in a straight line on flat level ground, hoping I do not have to go down any steps, they are the worst as with no ACL, PCL & Post Lateral corner, my knee moves about somewhat. I have used a brace on & off for years, but have always found that they did very little.
I want to end up with more stability so I am able to do more with my kids & delay the inevitable knee replacement. Unfortunately the joint is flatting out and arthritis is getting quite bad nowadays. But as the knee is so unstable & being 41 they want to put it off for as long as possible hence the opps.
Best wishes to you all.
Ian.T
Posted by KJ (KJ), 26 November 2003
Go for it Ian and good luck,
Like you I had a non-functioning ACL, PCL and posterolateral corner (MCL was also completely torn but healed reasonably) After failed first reconstructions I have recently had tibial osteotomy, ACL, PCL revisions and PLC reconstruction all in one big op.
The worst is over, although I have soft tissue soreness I can now fully weight bear (at 2 and 1/2 months) and I can tell that the knee is now stable.
I can certainly recognise that need to think about putting my knee straight down on a flat surface with every step - the way things feel at the moment, even with the pain - walking seems more normal.
Good luck
KJ
Posted by amazonia (amazonia), 28 December 2003
Hello all you fellow multi ligament injury sufferers! Best wishes for a wonderful New Year - less pain/ more stability/ and happiness!
Nice to hear that you're doing well KJ! You go girl!
Nice to hear about your progress too Ian - I've also had a tibial osteotomy a year ago, and feel that it has made a big difference with overall stability.
Saw my OS about a month ago, and he confirmed that my lateral ligament reconstruction has failed (from May) - it wasn't something that surprised me, I'd pretty much figured that out. So, now I'm left with no ACL, a failed lateral reconstruction, but a good PCL reconstruction! 
He said I am doing better than 90% of people who've had ligament reconstruction, and I'm not in pain, which is a big thing. Now it's a waiting game - I want to wait to see how I do this year - going to push myself a bit to see what I can and can't do, and then decide about ACL recon and a 2nd lateral corner recon. Also will give the bone more time to heal and strengthen, as I injured the fibula in the original injury - which is likely why the lateral side has failed - pulled right through the soft bone.
What I have come to realize, is that there isn't an 'end' - just a continuation and progression - and that one has to be very resilient and positive about the little things that make a big difference. I sincerely wish all of you an easier year in 2004, and my support if things get hard.
Anne
Posted by KJ (KJ), 30 December 2003
Anne
I'm sorry about the news - from what you said before you seemed to know that was coming.
Do you think it was because the ACL wasn't done at the same time? I felt quite scared at the prospect of having everything done at once (ACL,PCL revisions + PLC) but it does seem to make sense as far as not overloading the grafts.
Whilst stability is good, as expected my knee is lacking flexion and I'm having an MUA on 12th January then staying in hospital for a few days to maintain ROM.
You're right about the ups and downs - at each surgery I get optimistic that things will be sorted but in reality things aren't made normal again - not after these injuries.
Still I'm very optimistic that I have stability - at least for a while.
Good luck to all you other posterolateral people
KJ
Posted by alanfleri (alanfleri), 19 January 2004
Hey all , alexander here , lost my files / password etc.. so had to start over ..
Thought i would let you know of progress i have made !!!
I opted out of the operation - osteotamy- becasue they said the success rate wwas not good so i cancelled.
Instead i went to some specialists to see what we could do to the knee.
I am fortunate in that amongst my friends and training partners are some of the top people within their fields.
I can tell you that i had fantastic results but have had a set back -- please beware.
A nutritionist has recommended the following from health food shops - collagen suppliamnet pills (new on the market) / glucosamine sulphate with chorodite ( new on market ) and cod liver oil. Eat fish and lean red meat. You will feel your knee pulsing - very strange .
Excersise- i devised a programme with a former MR UNIVERSE to strenghten the legs.he now treats top sports professionals in post op / injury recovery programmes.
WEAR A GOOD SUPPORT FOR ALL THESE !!!!!!! 
Lunges with light weights to the front and to and angel of 45% outwards.
Calf lifts on the fixed bench press machine - use a step / wooden plank to get a good lift .
If you have a leg press machine where you can lie down or are on the floor pushing up the these are excellent.
Light weights - do a normal set of ten. Then lie on your side and use one leg only ...like a side kick ...turn the foot on its outside against the plate and push ----try an picture a karate kick ....if you can , bring the knee to the shoulder and then re-extend . Don't worry to much about weight- get the technique right. Try it with your good leg first!!!!.The chenge sides and do it slowly with your injured knee .
I started with 30kg on my good leg and 10kg on my bad leg -- i then build up to 30 kg on bad leg over two months.
the main problem i found was that becasue the injury took so long to recover from my muscles deteriorated and left my leg weaker ....therefore the acl instability became worse.
If any of you have those old lolo balls- remember them - or a new stability ball (found in most gyms today for abs) then these help to . Simply trying to balance is pretty tricky - but my knee seems to remember where it should stop and start . <My problem is comounded becasue after 15 years of taekwondo and aikido my joints hyperextend anyway due to all the stretching.
Last week my overconfidence was my undoing. I went to a kickboxing class and of course my knee gave way!! OOOOOUUUUUCCHHHH! that hurt - 
Basically what i have discovered is that the knee does not give way from one action being too much for it - it is the angle of the knee twisting / pivoting , no matter how slowly or quickly. A fast movement such as running on a treadmill does not have an instability feeling . But if someone is walking in front of me and stops and i have to shift my weight to the left knee then i feel it.
I have now learened that the purpose of the osteotamy is to throw the weight of the knee through the outer half - i will try to deise excserises to develop this and get back to you all
Posted by amazonia (amazonia), 20 January 2004
Good luck to you in your progress - you sound very enthusiastic about your new program. I think as long as you are getting your advise from a trained professional such as a physiotherapist or sports therapist, then the exercises should help to strengthen the muscles. Did you need surgery for your torn ACL and PCL?
I'm not sure where you live, but with an osteotomy what seems to be most important is that you see an OS who has done them before and has experience and knows what they're talking about and doing.
I also take glucosamine + chondroitin everyday - and seeing as I don't have a lot of knee joint pain now, I'm not going to give them up - don't know whether they've actually made a difference or not, but since my knee doesn't hurt - I'll keep taking them!
Best wishes in your recovery - I still go to physio - now nearly 8 months after my PCL and PLC reconstruction. Today is the 2 year anniversary of my knee injury!
Anne
Posted by alanfleri (alanfleri), 23 January 2004
Hey Anne , and others ,
Yesterday i decided to go and buy a brace because i had had enough of the knee's instability holding me back ....it wasn't cheap , £400. But i put it on and straight away felt the difference in stability within the knee. I recommend them .
I live in West London and so i went to see Technology in Motion in Wimbledon.
You cannot claim this of standard health insurance so beware . The insurers have told me they will only pay for braces if needed after an operation.
technologyinmotion.co.uk
so now i look and feel a bit like robocop . But i went kick boxing again last night, despite my setback last week . i didn't push it too far , but for the first time in ages i was able to work on my fitness instead of my knee. I felt the difference. Of course i didn't risk jumping kicks etc....but i can pivot on the left leg ,whereas i couldn't before
I have another session with some other very experienced fighters on Sunday , will see how I go .
The acl : i am going to work on this with "close chain" excercises and with water excerises.
I beleived that this healed over xmas and that this was due to mild excercises , rest , swimming and the tablets i mentioned before. I felt the difference- hence going back to kickboxing last week. The problem with all of us is the instability in the plc.... if that moves , everything tears again , as is my understanding.
Anne , i also take homeopathic remdies ....rhus tox and rhuta grav ....these do help a little ...i take these throughout the day and then switch to the other tablets at night. The focus of all of these treatments is to draw fluid to the damaged area in order to aid with healing and also to stop abbrasive movements . But if you take as uch as i am the you end up with a knee the size of a balloon after 1 hour........but they work! so i take them at night and my knee feels fine in the morning and throughout the rest of day .
I have also found Voltarol to be extremley effective when the knee is too painful....ask your GP...... it is quite strong - don't get hooked ,,, pain lets you know when you are pushig the knee too hard ...just have them in case of emergancy if you twist it / fall etc..
regards to all
alan
Posted by ATsoccergirl (ATsoccergirl), 25 January 2004
Alan-
I'm just curious, what type of brace did you get?
Posted by alanfleri (alanfleri), 13 March 2004
The brace i bought was an "edge" brace ...they make three or four different ones , he person fitting you will no which one is right for you , so don't worry too much .
I was thankful to have it at kickboxing a week ago ...some punk kicked my knee full contact ...i didn't evenfeel it ....think he broke his toes ...should teachhim to go easy on a cripple.
Posted by mike_motor (mike_motor), 12 April 2004
I had an ACL recon w/ patella tendon, PLC recon w/ hammy and meniscus repair on 3/23. For those of you that have had this combination, what were your timeframes for "basic" recovery. I'm more interested in walking, driving, etc. right now but if you have some imput on athletic activity, etc. that would be appreciated as well.
Also, have you seen increase stability w/ the reconstructions of both the ligaments. From what I understand this is very uncommond to tear up all of this at the same time, but evidently I did...this doesn't include the removal of 40% of my lateral meniscus before this surgery...don't have much that hasn't been worked on at this point.
As for me I'm 3 weeks post op and I'm still non weight-bearing, hopefully will be allowed to start weight-bearing after my 4/19 visit. PT says I'm doing great and way ahead of even the ACL-only folks that are at the same stage.
Posted by grudier (grudier), 30 June 2004
Greetings all, excited to finally find a website of fellow injurees (made that up I think), especially those with multi ligament injuries. I tore my ACL, PCL, and LCL and also ruptured my illiotibial band. MY OS said in 25 years that was the first time he had seen that. Had surgery on 14 Nov 03, Still not sure what procedure was used as I am in the army and they didn't see fit to tell me. I have requested the surgical report but that could take months. I did have a patella tendon graft, 2 hamstring grafts and two smaller grafts taken from the inside of my thighs taken out. I was in a full leg cast for six weeks, then was readmitted for a staph infection, they had to go back in and clean it out and then I was in a splint 3 more weeks. So all told it was 10 weeks before I got to bend it. No PT until almost 12 weeks post op. Still I am healing well, I walk without pain most days, and have been told by my ortho doctor here that I am about a year ahead of schedule. I hope to be running by 1 year post op. I have had to back off on my rehab twice so far because of pain and swelling. I have gotten up to 115 degrees ROM, and have been told by army doctors that it's considered functional. Anybody else ever heard of rupturing an IT Band let me know.
Updated Sun Sep 7 2008