Posterolateral reconstruction of the knee using capsular procedures for evaluation and treatment of posterolateral instability of the knee.

Posterolateral rotatory instability of the knee causes significant morbidity if unrecognized and left untreated. With both acute and chronic injuries, restoration of the normal anatomy is crucial for a good outcome. During capsular repairs, detailed knowledge of the anatomy will help the surgeon repair the pathoanatomy. To complement the direct approach, an osteotomy of the lateral femoral condyle that includes the attachments of the fibular collateral ligament and popliteal tendon allows superior visualization of the lateral meniscus and its attachments, as well as the associated deep structures. The osteotomy also permits placement of posterior capsular sutures that allow the capsular shift to tighten the injured structures. Fine-tuning the tension of these structures may be accomplished by slightly adjusting the position of the bone block as it is reattached without significantly affecting isometry. The osteotomy is not required for all reconstructions; however, it provides excellent access to the deep structures of the posterolateral corner. The capsular shift can complement the direct repair of structures and may be done as an isolated or staged procedure or in combination with other reconstructive treatment options.