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Abstract Introduction: Careful clinical examination is the gold standard for diagnosis of PCL/PLC injuries with very good reliability in both acute and chronic settings. X-rays to rule out associated fractures and to quantify the degree of instability is very important to monitor the degree of improvement in the knee instability. Single bundle PCL reconstruction is a good surgical option for the management of the posterior cruciate ligament injuries, which improves the posterior instability and, the functional score of the patient of at least one grade. Using the hamstring tendon is a low morbidity graft with good midterm follow up results. Posterolateral corner injuries are a common association with PCL and must be addressed at the time of surgery to protect the PCL reconstruction and decrease the graft stress. Repair is a good option provided it is done in the acute stage within first 2 weeks before scarring of the tissue. Although the results of repair were inferior to that of reconstruction, the repair if done properly with good identification of the structures can give a predictable good clinical result. Especially if the repair is strong enough to allow for early knee mobilization. Aim of work: To management combined posterior cruciate ligament and posterolateral corner injuries of the knee. Patients and methods: Between March 2007 and June 2011; 52 patients with posterior cruciate ligament and posterolateral corner injuries of the knee were operated only 48 patients meeting our inclusion criteria and completed the follow up were included in this study. The inclusion criteria for the study were; the presence of GIII PCL and posterolateral corner insufficiency diagnosed by, clinical examination and confirmed by MRI. Symptoms of pain and instability were considered before planning for surgery. The exclusion criteria from our study were presence of knee stiffness and/or presence of grade III osteoarthritis of the knee were also excluded from this study. Results: Repair of the posterolateral capsule together with the popletius tendon and the LCL is the most important structures to be addressed intraoperatively. Posterolateral reconstruction with Larson technique is a minimal invasive surgery that had a very good midterm results with a very low rate of complications. One stage surgery had better results than 2 stages surgery and if 2-stage surgery is indicated as in acute setting the period between the first and second stage should be within 6 weeks. Surgical intervention in acute stage was not associated with arthrofibrosis or decrease in the range of motion provided it is followed with a good rehabilitation with early knee mobility. Conclusions: Rehabilitation program adapted in this study is a balanced protocol with good care of the range of motion and muscle power with proprioception training that put a minimal tension on the graft. One year follow up results was a good indicator to the midterm results in this study with minimal decrease in the mean score at 4 years. |