DOI:10.6061/clinics/2012(06)09 CLINICS 2012;67(6):597-602 CLINICAL SCIENCE Reconstruction of chronic lesions in the posterolateral corner of the knee with autologous biceps femoralis and fascia lata grafts Marcus Guilherme de Oliveira,I Nilson Roberto Severino,I Cezar Teruyuki KawanoII I Santa Casa de Miseric o´rdia de S a˜o Paulo, S a˜o Paulo/SP, Brazil. II Centro M e´dico Kawano, S a˜o Paulo/SP, Brasil. OBJECTIVE: The aim of this study was to evaluate the treatment of patients with chronic lesions in the posterolateral corner of the knee with reconstruction of the fibular collateral ligament, popliteus tendon and popliteofibular ligament and with autografts of the biceps femoris and fascia lata. METHOD: A total of 129 patients with injuries of the posterolateral corner of the knee that lasted for more than three weeks and were associated with the lesion of at least one of the cruciate ligaments were included. All of the patients were operated on consecutively in the same hospital between March 2004 and April 2009. Clinical evaluation using the Lyshom scale and the International Knee Documentation Committee (IKDC, item 4, assessment ligament) protocol was performed in 114 patients for whom there were complete data available. RESULTS: There was significant improvement in the Lyshom score and improved stability according to the IKDC protocol in the pre- compared to postoperative varus stress test at 30 degrees and the posterolateral rotation test. CONCLUSIONS: Surgical reconstruction of the posterolateral corner of the knee with biceps femoris tendon and fascia lata autografts is effective in stabilizing the posterolateral corner of the knee. KEYWORDS: Knee Injuries/Surgery; Joint Instability/Surgery; Autologous Transplantation; Reconstructive Surgical Procedures. Oliveira MG, Severino NR, Kawano CT. Reconstruction of chronic lesions in the posterolateral corner of the knee with autologous biceps femoralis and fascia lata grafts. Clinics. 2012;67(6):597-602. Received for publication on January 20, 2012; First review completed on February 27, 2012; Accepted for publication on February 27, 2012 E-mail: mguio@ig.com.br Tel.: 55 11 5579-3272 INTRODUCTION The posterolateral corner of the knee has received relatively little attention because there is no consensus regarding the exact structures that are damaged in the case of injuries in this region (1,2). The involvement of these complex structures can lead to instabilities or to a severe derangement of the joint (3-6). The treatment is controver- sial in the literature, and various surgical techniques have been proposed (7,8), ranging from a surgical repair in the acute phase to a complete reconstruction of injured structures. Currently, the anatomical reconstruction of the posterolateral corner of the knee is advocated (2,9-13). Lesions of the posterolateral structures of the knee are still underdiagnosed, and they are often neglected due to the difficulty of verifying which of the multiple structures are affected and with what intensity. It is known that the loss of opportunity to treat the posterolateral corner of the knee Copyright 2012 CLINICS – This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. No potential conflict of interest was reported. 597 leads to failure in the primary reconstruction of the cruciate ligaments (3-6). Previous studies (9,14) argue that the main posterolateral structures to be rebuilt are the fibular collateral ligament, the popliteus tendon and the popliteo- fibular ligament. The objective of this study was to evaluate the surgical outcome of the anatomical reconstruction of the fibular collateral ligament, popliteus tendon and popliteofibular ligament with biceps femoris tendon and fascia lata autografts in patients with chronic lesions (lesions lasting more than three weeks) (15) in the posterolateral corner of the knee. MATERIALS AND METHODS This work is a retrospective cohort study. Between March 2004 and April 2009, 129 patients with chronic injuries of the posterolateral corner of the knee associated with at least one injury of the cruciate ligaments were consecutively admitted and operated on at Hospital Nossa Senhora do Rosa´rio (Sa˜o Paulo) by the surgery service CEMKA (Centro Me´dico Kawano), in conjunction with the Orthopedics and Traum- atology Department of Santa Casa de Miserico´ rdia de Sa˜o Paulo (SCMSP), Pavilha˜o ‘‘Fernandinho Simonsen’’. We defined chronic injuries as those that occurred more than