CLINICS 2012;67(6):597-602 Table 3 - The posterolateral drawer test. Posterolateral rotation Before surgery 6 to 10 degrees .10 degrees Total n % n % n % 40 35.1 65 57.0 105 92.1 normal 3 to 5 degrees 6 to 10 degrees .10 degrees 1 0.9 4 3.5 5 4.4 After surgery 1 0.9 2 1.7 3 2.6 0 0.0 1 0.9 1 0.9 Total 42 36.9 72 63.1 114.0 100.0 New autografts in PLC lesions Oliveira MG et al. the anterior aspect of the fibular head is isometric to the posterior aspect of the lateral femoral epicondyle (26). Sigward et al. (27) determined the ideal isometric location for the grafts of the fibular collateral ligament, popliteus tendon and popliteofibular ligament in the lateral femoral condyle using the foot-print of the fibular collateral ligament and popliteus tendon, in accordance with the studies of Fanelli and Larson (26). We therefore believe that the anatomical reconstruction agrees with the concepts of isometry, and together, these ideas can provide the best results in reconstructions of the posterolateral corner of the knee. The treatment of injuries in the posterolateral corner of the knee has generated much controversy, especially in the past. Most authors agree that the surgical treatment should be performed during the acute phase of the disease, up to three weeks after the trauma that caused the injury (7,8), and should be aimed at repairing the damaged poster- olateral structures. Several recent studies (28,29) also indicate that the results of surgical reconstruction in the acute phase of injury are better. This consensus is likely due to the difficulty in identifying the precise injury sites as time passes, as there is swelling and bruising during the acute phase of injury that may confuse the surgeons at the time of the repair of the lesions. Posterolateral corner injuries are typically associated with other ligament injuries, and there is a general consensus in the literature that the best surgical results are obtained when all ligament injuries are corrected during the same surgery (5,15), which we also affirm. Accordingly, all of our patients had their lesions reconstructed during the same surgery. In our study, we found that 100% of the injuries to the posterolateral corner were associated with other ligament injuries. There is no consensus in the literature regarding the best surgical technique. In cases of structural carus, there is consensus that a high tibial osteotomy should be performed as an initial procedure to prevent excessive loads on the posterolateral structures that were rebuilt (2,15,28,30,31). We also agree with this consensus, and in our study, the patients who had structural varus (4.6% of patients) under- went high tibial osteotomy in the same surgical procedure during which the posterolateral structures were rebuilt; thus, we obtained good results. LaPrade et al. (11) proposed an anatomical reconstruction technique based on a biomechanical study in vitro, in which they rebuild the three main structures of the posterolateral corner of the knee (fibular collateral ligament, popliteus tendon and popliteofibular ligament). The authors recon- struct the popliteofibular ligament from the tibia to the fibula. LaPrade et al. (32) demonstrated the results of this technique with allografts of the Achilles tendon in a series of cases, and they concluded that the technique has increased the stability in patients with chronic injuries of the posterolateral corner. 601 We also reconstructed the three main structures, but in our study, we reconstructed the popliteofibular ligament from the femur to the fibula and not from the tibia to the fibula as did LaPrade (11,32). Moreover, our results demonstrated improved stability of the posterolateral corner with 12 months of follow-up. Jakobsen et al. (13) proposed a technique for the anatomical reconstruction of the posterolateral corner of the knee with the use of autografts of the semitendinosus and gracilis tendons. Their study was conducted in patients with isolated injuries of the posterolateral corner of the knee. The authors recreated the fibular collateral ligament, popliteus tendon and popliteofibular ligament. They used transtibial and transfibular tunnels with good results. In contrast, in our study, all of the patients had lesions associated with at least one of the cruciate ligament injuries, and the results achieved were excellent. Patients with instability in more than one plane have a highly dysfunctional knee. They cannot play sports, and many experience difficulty in performing daily activities (33). This scenario is exactly what we found in our study, but our results were very encouraging, and we have provided to 92% of the patients the state of functionality they had before the injury. There is no consensus in academia regarding how to perform the anatomical reconstruction of the posterolateral corner of the knee. There are disagreements over the use of autografts versus allografts, as well as over whether the popliteofibular ligament should pass from the femur to the fibula (11,32,34) or from the tibia to the fibula. We believe that the popliteofibular ligament has to proceed from the femur to the fibula, but only with additional biomechanical and surgical results, with long-term follow-ups, will we be able to reach a conclusion regarding which of these methods is the best surgical technique. In the technique we use (34), the anatomical reconstruction of the posterolateral corner of the knee recreates the fibular collateral ligament, popliteus tendon, and popliteofibular ligament. The isometric, biomechanical and anatomical descriptions of previous studies (9,14,23,25,35,36) are used as references for the reconstruction of the three main poster- olateral structures. The results were very good in general, as demonstrated by the Lysholm score and item 4 of the IKDC. Because this study contains only complex lesions associated with at least one injury to the cruciate ligaments, and because autografts of the semitendinosus and gracilis tendons were used, we had no other option but to use the biceps femoris tendon and fascia lata in the reconstruction of the damaged posterolateral structures. However, allografts are not as easily accessible in our country, and when that option becomes widespread, we believe that this same technique will be performed with allografts, resulting in less morbidity.