LCL and Posterolateral Corner (PLC) Injuries in Bath & Bristol

Lateral collateral ligament (LCL) injuries and posterolateral corner (PLC) injuries affect the key stabilisers on the outer side of the knee. These structures control side-to-side stability and, importantly, rotational stability. If they are not diagnosed and treated appropriately, the knee can remain unstable and other reconstructions (such as ACL or PCL surgery) may be placed under extra strain.

Mr Simon Abram, Consultant Specialist Knee Surgeon, provides specialist assessment and treatment planning for LCL and PLC injuries in Bristol and Bath. Treatment may include rehabilitation and bracing in selected cases, but higher-grade PLC injuries often require surgical reconstruction to restore reliable stability.

What are the LCL and the posterolateral corner?

LCL (lateral collateral ligament)

The LCL is a strong ligament on the outside of the knee. It helps prevent the knee from opening up on the outer side (varus stress) and contributes to stability during cutting and pivoting movements.

Posterolateral corner (PLC)

The PLC is a group of structures at the back-outside of the knee that work together to control:

External rotation of the shin bone
Varus (outer-side opening) stability
Posterior and rotational stability in combination with the PCL and ACL

Because the PLC is complex, these injuries are sometimes missed early. Accurate diagnosis matters.

How do LCL and PLC injuries happen?

These injuries often occur after significant force, for example:

A blow to the inside of the knee causing the outer side to stretch (varus stress)
Hyperextension injuries (knee forced too straight)
High-energy trauma (road traffic collisions, falls)
Sports injuries (contact, awkward landings, high-speed pivots)
Knee dislocation patterns (even if the knee relocates)

LCL/PLC injuries are frequently combined with ACL or PCL injuries, and can be associated with meniscus and cartilage damage.

Symptoms of LCL/PLC injury

Pain and tenderness on the outer side or back-outside of the knee
Swelling and bruising (often more noticeable laterally)
A feeling the knee is unstable, particularly with turning or on uneven ground
“Varus” instability (knee feels as if it opens on the outside)
Difficulty trusting the knee during pivoting or deceleration
Sometimes a sensation of the knee shifting backward/outward with movement

Red flags

Because severe lateral injuries can occur in high-energy trauma, seek urgent assessment if you have numbness or weakness in the foot (including foot drop), a cold/pale foot, severe swelling, or suspected knee dislocation.

Assessment and diagnosis (Bath & Bristol)

LCL and PLC injuries require careful evaluation of stability in multiple directions. Mr Simon Abram offers specialist assessment for lateral ligament and PLC injuries in Bristol and Bath.

Assessment usually includes:

History: mechanism (varus, hyperextension, contact), swelling timing, instability episodes, ability to weight-bear
Examination: varus stability testing, rotational stability tests, assessment of ACL/PCL/MCL, range of motion and swelling
Neurovascular assessment: important in severe injury patterns
X-rays: to assess fractures, avulsion injuries, and alignment
MRI scan: to map ligament injury, meniscus/cartilage damage, and bone bruising
Long-leg alignment imaging (selected cases): especially if chronic instability or varus alignment is present

Correct diagnosis is crucial because untreated PLC laxity can compromise ACL or PCL reconstructions and increase failure risk.

Non-surgical treatment (selected cases)

Some lower-grade LCL sprains can heal with structured non-operative care, including:

Activity modification and swelling control
Bracing in selected cases to protect the lateral side while healing
Physiotherapy to restore movement, strength, and neuromuscular control
Criteria-based return to sport

However, higher-grade PLC injuries are less likely to heal reliably with rehabilitation alone, particularly when instability is significant or when combined ligament injuries are present.

When surgery is considered

Surgery is considered when the knee remains unstable, when injury severity is high, or when PLC laxity would compromise other ligament reconstructions.

LCL/PLC repair (acute cases)

Repair may be considered in selected acute injuries, particularly when there is a repairable tear pattern or an avulsion-type injury where tissue can be reattached. Repair is time-sensitive and relies on good tissue quality.

LCL/PLC reconstruction (usually required for high-grade injuries)

Reconstruction rebuilds the damaged stabilisers using graft tissue. It is commonly considered when:

There is high-grade instability or a complete PLC disruption
The injury is chronic and tissues have healed in a lengthened or scarred position
There is combined ligament injury (for example PCL + PLC or ACL + PLC)
There is persistent rotational instability affecting function and safety

Reconstruction aims to restore both side-to-side and rotational control, which is essential for reliable stability.

PLC reconstruction techniques (Arciero and LaPrade-type approaches)

Because the PLC is a complex stabilising unit, reconstruction techniques are designed to restore the key stabilisers in a structured way. Mr Simon Abram primarily adapts two well-known techniques, Arciero-type and LaPrade-type reconstructions, to the individual injury pattern in the context of a range of patient-specific assessments.

Posterolateral Corner (PLC) reconstruction: Arciero-type vs LaPrade-type techniques

If you have an injury to the outer-side stabilisers of the knee (the lateral collateral ligament (LCL/FCL) and the posterolateral corner (PLC)), reconstruction may be recommended to restore reliable side-to-side and rotational stability. Two widely used, evidence-based approaches are commonly described as Arciero-type and LaPrade-type PLC reconstructions. Both aim to reduce “giving way”, protect the knee during pivoting, and reduce strain on other ligament reconstructions (such as ACL or PCL surgery) when performed as part of a combined plan.

Mr Simon Abram, Consultant Specialist Knee Surgeon, assesses PLC and LCL injuries in Bath and Bristol and will recommend the technique that best matches your instability pattern, anatomy, and overall reconstruction strategy.

The most appropriate technique depends on your exact injury pattern (which structures are torn), whether the injury is acute or chronic, your alignment, and whether other ligaments (ACL/PCL) are being reconstructed at the same time.

Alignment and combined procedures (why it matters)

In chronic PLC deficiency, overall limb alignment can be a major driver of failure risk. If the leg is significantly varus (bow-legged), the outer side structures may be overloaded. In selected cases, an osteotomy to correct alignment may be recommended to protect a PLC reconstruction and improve long-term stability.

Similarly, if ACL or PCL injuries coexist, the sequence and combination of procedures are planned carefully to restore balanced stability.

Recovery and rehabilitation

Rehabilitation after LCL/PLC surgery is structured and protective early on, because the reconstructed structures are under stress during rotation and side-to-side movements.

Typical rehab priorities include:

Swelling control and restoring safe range of motion
Protected weight-bearing with bracing as advised
Progressive strengthening of quadriceps, hamstrings, hips and core
Neuromuscular training to restore control in cutting, pivoting and deceleration
Return-to-running and sport progression based on milestones and testing

Recovery timelines vary, especially in multiligament cases. The plan is individualised to your reconstruction, associated injuries (meniscus/cartilage), and goals.

Risks and considerations

All surgery carries risks. For LCL/PLC reconstruction, considerations can include:

Infection, blood clots, wound healing problems
Stiffness or prolonged swelling
Persistent instability or graft failure (particularly if alignment drivers are not addressed)
Nerve irritation or injury (the common peroneal nerve lies close to the PLC region)
Ongoing pain or difficulty returning to high-demand pivoting sport

A personalised discussion covers expected benefits, alternatives, and the rehabilitation commitment required for a successful outcome.

Frequently asked questions

Are LCL and PLC injuries the same thing?

No. The LCL is one ligament. The PLC is a group of stabilising structures at the back-outside of the knee. They are often injured together, and PLC injury is particularly important because it strongly influences rotational stability.

Can a PLC injury heal without surgery?

Lower-grade sprains may improve with bracing and rehabilitation. High-grade PLC injuries often do not heal reliably and may require reconstruction to restore stability, especially in active patients or when combined ligament injuries are present.

Why does PLC injury matter if I’m having ACL or PCL surgery?

Untreated PLC laxity can place extra strain on ACL or PCL grafts and increase the risk of persistent instability or graft failure. Identifying and treating PLC injury is a key part of a durable reconstruction plan.

Can I be assessed for LCL/PLC injury in Bath or Bristol?

Yes. Mr Simon Abram offers specialist assessment and treatment planning for LCL and posterolateral corner injuries in Bath and Bristol, including rehabilitation-led care where appropriate and reconstruction strategies (including Arciero-type and LaPrade-type PLC reconstruction techniques) for high-grade instability.