Shoulder Pain is an extremely common complain that has many causes:

SUBACROMIAL BURSITIS

• Sudden blow to antero-medial knee
• Varus blow to flex knee
• Contact and non-contact hyper extension injuries.
• Knee dislocation.

PLC is an important structure that includes

• Lateral collateral ligament
• Poplitius tendon
• Popliteo fibular ligament
• Lateral Capsule

Postero lateral complex works synergistically with the PCL to control external rotation, Varus and posterior translation of tibia

Symptoms

Patients has instability symptoms when knee is in full extension.

Difficulty on stairs, pivoting and cutting

Altered sensation to dorsum of foot and weak ankle dorsiflexion due to associated peroneal nerve injury.

Imaging

MRI is the investigation of choice to look for injury to LCL, poplitius & biceps tendon.

Xray may show an avulsion fracture of the fibular head or femoral condylc.

Surgical Reconstment

Anatomical postero-lateral corner reconstruction (Laprade technique)

Rehabilitation after PLC reconstruction

Week 1 to Week 2

• A long knee hinged brace (Breg or donjoy) is given immediately after the surgery.
• Patient is instructed to do passive flexion in prone with the brace locked at 30°.
• Active flexion should be avoided for 4 weeks.
• Static quadriceps to be done every 2 hourly to maintain the strength in quads.

Week 2-4

• Straight leg raise to be started with the brace on
• Passive range of motion – aim 0-60° in 4 weeks

Week 4-6

• Continue stastic quads and leg raises (Aim Rom 0-90°).
• Partial weight bearing to be started in 6 weeks.

Week 6-8

Full weight bearing walking

Initiate active Rom. (knee flexion)

unlock brace, slow transition to wean off brace.

Wall slides & step ups to be started

Week 8-12

Introduce more progressive exercises i.e theraband, partial squats, lunges stationary cycling.