Editorial Commentary: Those Who Don't Know History Are Condemned to Repeat It-What Are the Next Steps to Improve Posterolateral Knee Outcomes?

Two decades ago, it was not uncommon to call the posterolateral corner of the knee the "dark side of the knee." This was because there were few quantitative anatomic data, no anatomic-based reconstructions, and a high rate of clinical outcome failures. Most nonanatomic posterolateral reconstruction procedures at the time commonly resulted in significant recurrent increases in varus gapping and significant overconstraint in external rotation. Postoperative protocols for treating these injuries were designed to often either cast or immobilize the operative knee for 2 to 6 weeks, which resulted in a higher incidence of arthrofibrosis. In addition, missed or neglected posterolateral corner injuries were frequently the cause of failed anterior and posterior cruciate ligament reconstruction graft failures. Anatomic-based posterolateral corner reconstructions have now been validated clinically to significantly improve patient outcomes. The next steps in improving patient outcomes would be to further refine these anatomic-based techniques, improve postoperative rehabilitation protocols, and ensure that future outcome studies have both patient-reported outcomes and objective data with stress radiographs to confirm that we are building a better mousetrap to treat this pathology.