**3. Current surgical treatment options**

Numbers of surgical techniques have been developed for treatment of PLC injuries what outlines that it is a very complex problem and no simple solution does exist [7, 9, 14–20]. Among them one can differentiate 3 types of procedures: tightening of injured structures, PLT bypass and anatomic reconstructions [9, 21]. Anatomic reconstructions, in turn, involve fibular-based and tibio-fibular based techniques [4]. Most anatomic techniques focus on reconstruction of three main stabilizers of the PLC: FCL, PLT and PFL. However, it has been emphasized that concerning surgical techniques, individual PLC structures should be reconstructed only if injured, avoiding reconstruction of that are not damaged [10]. Thus, a proper diagnosis of injured structures is a key to success in surgical treatment and Fanelli and Larson classification mentioned above may be a helpful tool in considering surgical approach. It is worth noting that in case of chronic PLC injury the success rate of surgical management is about 90% [21]. However, detailed description of each available technique for PLC tears treatment is far beyond the scope of this chapter. Interested readers we send to positions from literature [14–20].

When last two decades have provided a comprehensive knowledge about anatomy and anatomical reconstructions of PLC, especially due to studies of dr Laprade and his groups, last years brought a great development in arthroscopic surgery and shift from open to arthroscopic procedures based on previous assumptions [20]. The reasons of these changes were that open PLC reconstructions, despite their effectiveness, are very invasive procedures. They require a broad surgical approach with poor esthetic results, which some patients do not accept, and enforce less aggressive rehabilitation protocol. It causes a longer recovery after surgery. Moreover, common peroneal nerve neurolysis is obligatory [15]. Arthroscopic surgeries have many advantages including better visualization of anatomical landmarks, lower infection rates, lesser amount of scar tissue, less post-operative pain, faster rehabilitation, better protection of common peroneal nerve without obligatory neurolysis [21]. Another advantage of arthroscopic surgery for PLC injury is its proved reproducibility and high accuracy in tunnel placement during reconstructions [7]. However, most arthroscopic techniques require maneuvering in popliteal fossa and trans-septal portal placement, what puts at risk popliteal neuro-vascular bundle. Thus, these techniques are reserved for very experienced arthroscopic surgeons.

Following sections of these chapter will present arthroscopic popliteus tenodesis and minimally invasive arthroscopic-assisted PLC reconstructions which are techniques for PLC injuries developed and used with success for many years by senior authors (K.H, P.J) [22, 23]. Indications, contraindications, advantages, disadvantages and surgical details will be explained.
