- SPECIALIST ORTHOPAEDIC SURGEON | MELBOURNE, VIC | ALBURY, NSW | MORNINGTON, VIC |
- 03 9421 6133
- Melbourne & Mornington VIC |
- Albury, NSW
PFL Reconstruction
Restoring stability and protecting knee function after posterolateral corner injury
The posterolateral corner (PLC) of the knee is a complex network of ligaments, tendons, and joint capsule structures that work together to stabilise the outer (lateral) side of your knee. One of these key stabilisers is the posterolateral femoral ligament (PFL), which plays an important role in resisting external rotation, varus (inward angling) forces, and preventing hyperextension.
Injuries to the PLC, often due to trauma, sports injury, or dislocation, can lead to significant instability, difficulty walking, and an increased risk of further joint damage if left untreated. When non-operative treatments fail or when there is a complete tear of key PLC structures, surgical reconstruction may be recommended.
PFL reconstruction is a procedure performed to restore stability to the lateral side of the knee by reconstructing the damaged ligament using a tendon graft. In many cases, PFL reconstruction is part of a broader posterolateral corner reconstruction, which may also involve repairing or reconstructing the lateral collateral ligament (LCL) and popliteus tendon.
Dr Jason Hockings performs this procedure arthroscopically or through a small open incision, using modern anatomical reconstruction techniques designed to restore your knee’s natural biomechanics, improve function, and prevent long-term degeneration.Â
What does PFL reconstruction surgery involve?
PFL reconstruction is typically performed under general or spinal anaesthesia. The surgical technique depends on the extent of the injury and whether other ligament structures (such as the ACL, PCL, or LCL) are also involved.
Key steps may include:
- Thorough evaluation under anaesthesia to confirm instability and identify associated injuries
- Arthroscopic assessment of the knee to assess internal structures and cartilage
- Harvesting a graft, often from your hamstring tendon or using a donor (allograft) tendon
- Drilling bone tunnels in the femur and tibia to recreate the anatomical path of the damaged ligament
- Securing the graft with screws or fixation devices in precise alignment to restore normal stability
If other ligaments are also torn, such as in multi-ligament knee injuries, Dr Hockings may perform a staged or combined procedure to address all damaged structures. In some cases, repair of torn tissue may be possible instead of full reconstruction.
The procedure usually takes around 90 minutes to 2 hours, depending on the complexity, and is performed as an inpatient surgery with an overnight hospital stay.
Recovery and rehabilitation after PFL reconstruction
Recovery following PFL reconstruction is a carefully structured process. Ligaments need time to heal and integrate, and rehabilitation must be tailored to protect the repair while gradually restoring movement, strength, and function.
Typical recovery involves:
First 6 weeks:
- Use of a hinged knee brace locked in extension
- Crutches with partial or non-weight bearing
- Early physiotherapy focused on pain control, gentle range of motion, and reducing swelling
Weeks 6–12:
- Gradual increase in weight-bearing
- Progression of range of motion under physiotherapy supervision
- Muscle strengthening begins, focusing on quadriceps and hamstrings
6–9+ months:
- Sport-specific training
- Return to running and pivoting activities may be allowed after clinical and functional assessment
Your exact timeline may vary depending on injury severity, associated ligament reconstructions, and your overall health. Dr Hockings works closely with your physiotherapist to ensure a safe and effective return to function.
Benefits of PFL reconstruction
PFL reconstruction is often essential for restoring knee stability when conservative management is unsuccessful. Potential benefits include:
- Restoration of normal lateral knee stability
- Reduced sensation of the knee ‘giving way’ during movement
- Improved walking mechanics and confidence in daily activities
- Protection of other knee ligaments (such as ACL or PCL) from secondary strain
- Reduced long-term risk of cartilage damage and osteoarthritis
When performed as part of a comprehensive knee reconstruction plan, PFL reconstruction helps to re-establish a stable, functional joint that supports active lifestyles.
Risks and considerations
All surgical procedures carry some risk. For PFL reconstruction, potential complications may include:
- Infection or wound complications
- Knee stiffness or reduced range of motion
- Graft failure or loosening
- Blood clots (deep vein thrombosis)
- Ongoing instability if associated injuries are not fully addressed
Outcomes are generally favourable when surgery is performed using anatomical techniques by a surgeon experienced in multi-ligament knee reconstruction. Compliance with post-operative rehabilitation is critical to long-term success.
Is PFL reconstruction right for you?
Dr Hockings may recommend PFL reconstruction if you have:
- A confirmed PLC injury on imaging and clinical examination
- Persistent instability, especially with pivoting or twisting
- Associated injuries to the ACL, PCL, or LCL
- Failed non-operative management or chronic instability
During your consultation, Dr Hockings will thoroughly assess your knee stability, review MRI findings, and discuss your goals. If surgical reconstruction is the most appropriate path, you’ll receive a detailed, personalised treatment and recovery plan.
If you’re experiencing ongoing pain, stiffness, or reduced movement that is affecting your daily activities or quality of life, a thorough orthopaedic assessment can help determine the cause and guide the most appropriate treatment options for your situation.