Reconstruction for chronic grade-II posterior cruciate ligament deficiency in Malaysian military personnel (original) (raw)
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PLOS ONE, 2018
Background There is increasing interest in the long-term outcomes of patients with posterior cruciate ligament (PCL) tears following conservative treatment or reconstruction. However, limited information is available regarding these results because of the relative rarity of cases and lack of long-term follow-up. Purpose The goals of this study are to (1) compare the occurrence of secondary meniscal tears, osteoarthritis (OA) or subsequent total knee replacement (TKR) in patients with or without PCL injury, and (2) evaluate the potential protective effect of PCL reconstruction against longterm sequela in patients with PCL deficiency. Study design Cohort study; Level of evidence, 3 Methods This retrospective cohort study evaluated the long-term results of PCL deficiency with or without reconstruction in Taiwan based on data from the National Health Insurance Research Database (NHIRD) from 2000 to 2015. The cumulative incidence rates of meniscus tear, OA and TKR were analyzed using the Kaplan-Meier estimator. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
Malaysian Orthopaedic Journal, 2020
Introduction: This study was conducted to evaluate the demographics, causes and outcomes of patients who underwent Posterior Cruciate Ligament (PCL) reconstruction and/or Posterolateral Corner (PLC) reconstruction performed at our institution over the last three years. Sub-analysis was performed to assess the impact of delay from injury to surgery and how this affected outcomes. Materials and Methods: From an initial number of 10 patients, seven were contactable and available for analysis. All patients underwent PCL and/or PLC reconstruction (modified Larson's procedure) between 2017 and 2019. The mean age of our cohort was 31.4±9.6 years (range, 21 to 46). Assessment of functional outcomes pre-and postoperatively were done using the Lysholm knee scoring scale, the Knee injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS). The mean follow-up from operation at time of reporting was seven months (range, 2 to 12 months). Results: There were four combined PCL and PLCs, two isolated PLCs and one patient who underwent an isolated PCL reconstruction. There were significant improvements between pre-operative and post-operative in all functional outcome scores utilised following PCL reconstruction and/or modified Larson's reconstruction. Lysholm knee scoring scale improved from pre-operative to post-operative at 41.14±12.32 to 74.86±13.52 (p=0.0001), KOOS from 49.71±11.19 to 71.43±13.84 (p=0.001), and VAS from 5.71±2.06 to 2.86±2.48 (p=0.001). Our sub-analysis showed that higher functional outcomes were present when surgery was done less than six months from the time of index injury. There were no complications (eg. Infections, revisions) in this cohort at the time of reporting. Conclusion: Reconstructive surgery for PCL and/or PLC injury is successful in increasing the functional outcomes of patients post-operatively. Delays from injury to surgery remains a problem in the public setting as patients may need to await appropriate imaging and approval of funding. Increased awareness for early surgical intervention may improve overall outcomes of PCL and/or PLC reconstruction in Malaysia.
Orthopaedics & traumatology, surgery & research : OTSR, 2010
Isolated posterior laxity is most often cared for with conservative functional treatment. However, when there is pain or instability, surgical treatment can legitimately be proposed. The objective of this study was to assess the results of surgical treatment for chronic isolated posterior laxity. Surgical treatment of direct posterior laxity re-establishes sufficient anatomical integrity to stabilize and provide good function to the knee. This was a retrospective, continuous, single-operator study. Eleven operated patients were retained for this study, all followed up a mean 20.9 months, with a minimum follow-up of 1 year. Subjective and clinical assessments were carried out using the International Knee Documentation Score (IKDC) score. Surgical correction of posterior laxity was measured clinically and radiologically. The subjective IKDC score increased from 53 preoperatively to 68.5 at the last follow-up (P=0.006). For the objective IKDC score, all knees were classified C or D pre...
Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2006
Purpose: This study prospectively evaluated 20 patients treated consecutively to determine patient outcomes, efficacy, and complication potential of arthroscopically assisted posterior cruciate ligament (PCL) reconstruction performed with hamstring tendon grafts. Methods: Twenty patients (15 men and 5 women), each with an isolated PCL injury, underwent PCL reconstruction with hamstring tendon autograft and were enrolled in this prospective study. Average age at time of surgery was 29 years (range, 20 to 57 years). Average time from injury to surgery was 4 months (range, 3 to 12 months). Average follow-up period was 40 months (range, 36 to 50 months). Patients underwent regular follow-up after clinical and radiographic preoperative and postoperative evaluation. Follow-up examinations comprised the Lysholm Knee Score, the Tegner Activity Score, the International Knee Documentation Committee (IKDC) score, thigh muscle assessment, and radiographic evaluation. Results: Mean preoperative Lysholm score for 20 knees was 63 Ϯ 10 (range, 48-73); mean postoperative Lysholm score was 93 Ϯ 9 (range, 77-100). Eighteen of 20 patients (90%) showed good or excellent results at final assessment. Mean preinjury and preoperative Tegner scores were 7 Ϯ 1.5 (range, 5-9) and 3 Ϯ 1.9 (range, 2-5), respectively; mean postoperative Tegner score for 20 knees was 6.3 Ϯ 2.4 (range, 4-9). In final IKDC ratings, 85% of patients (17 of 20) were assessed as normal or near normal (grade A or B). A statistically significant improvement was seen in thigh girth difference, extensor strength ratio, and flexor strength ratio before and after reconstruction at a minimum of 3 years of follow-up. Conclusions: After follow-up for longer than 36 months, analytical results showed satisfactory function after PCL reconstruction with the use of hamstring tendon autografts. We suggest that the hamstring tendon autograft is a safe, effective, and acceptable choice for PCL reconstruction, and that it affords good ligament reconstruction. Level of Evidence: IV, therapeutic case series.
An evaluation of posterior cruciate ligament reconstruction surgery
BMC Musculoskeletal Disorders
Background: The nature of posterior cruciate ligament (PCL) injuries and the scarcity of data on this issue have made reports on clinical and epidemiological features of PCL injuries valuable. We aimed to report our experiences with PCL injuries in our region. Methods: Any patient who referred with a diagnosis of PCL rupture from 2004 to 2018 to our center, was included in this report. We evaluated pre-and postoperative outcomes and compared patients with isolated and combined (multi-ligament) PCL injuries. Results: Overall, 55 patients were included in our study. Majority of patients were men (87.2%). Mean age of patients was 28.12 ± 8.53 years old. Average follow-up period was 28.83 ± 20.62 months and mean duration between trauma and surgery was 27.8 ± 38.0 months. Most common cause of PCL injury was traffic accidents (70.9%) followed by sports injuries (5.5%). Majority of patients (69.1%) had combined PCL injuries. Majority of patients underwent single tibial-double femoral tunnel reconstruction (56.4%), followed by single tibialsingle femoral tunnel (34.5%) reconstruction. Allografts were used in 60% of patient. Average Cincinnati knee rating scale (CKRC) was 35.87 ± 11.4, which improved significantly after PCL reconstruction (79.45 ± 11.90, p < 0.001). Full range of motion only existed in 29.1% of patient prior to surgery, which improved after surgery (92.7%, p < 0.001). Three patients had postoperative arthrofibrosis and motion stiffness, 1 had deep vein thrombosis and 3 patients had infections. Those with isolated PCL injuries had higher pre-operative CKRS (42.05 ± 8.96 vs. 33.10 ± 11.45, p = 0.006) and lower pre-operative posterior drawer test (2.76 ± 0.43 vs. 3.1 ± 0.6, p = 0.042) compared to those with combined injuries. Conclusion: Today with advances in surgical techniques, considering treatment of collateral ligament injuries, use of stronger allografts and more secure fixation methods, better rehabilitation programs and early range of motion, results of reconstruction of the PCL has become very promising. Accordingly we recommend surgical treatment even for isolated PCL tears, with the goal to prevent functional deficit and to prevent degenerative arthritis.
La Clinica terapeutica
To evaluate the functional outcomes of a delayed (>6 months post-injury) and combined reconstruction of grade III posterior cruciate ligament (PCL) and grade III posterolateral corner (PLC) deficiencies. Between March 2006 and October 2009, a delayed surgery consisting of arthroscopically-assisted PCL reconstruction and open reconstruction of the PLC was performed on 19 men and 2 women (average age, 29 years). The mean time-to-surgery was 18 months (range, 7-51 months) and duration of follow-up was 22 months (range, 12-48 months). Postoperatively, patients were evaluated using Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) subjective and objective scores. At the final follow-up, majority of the knees (61.9%) achieved either normal or nearly normal rating objective IKDC score. The means of IKDC subjective score, Lysholm score and Tegner activity level were 62.09, 74.35 and 5.14 respectively. One patient was able to participate in compet...
Emerging Updates on the Posterior Cruciate Ligament: A Review of the Current Literature
The American Journal of Sports Medicine, 2015
The posterior cruciate ligament (PCL) is recognized as an essential stabilizer of the knee. However, the complexity of the ligament has generated controversy about its definitive role and the recommended treatment after injury. A proper understanding of the functional role of the PCL is necessary to minimize residual instability, osteoarthritic progression, and failure of additional concomitant ligament graft reconstructions or meniscal repairs after treatment. Recent anatomic and biomechanical studies have elucidated the surgically relevant quantitative anatomy and confirmed the codominant role of the anterolateral and posteromedial bundles of the PCL. Although nonoperative treatment has historically been the initial treatment of choice for isolated PCL injury, possibly biased by the historically poorer objective outcomes postoperatively compared with anterior cruciate ligament reconstructions, surgical intervention has been increasingly used for isolated and combined PCL injuries. Recent studies have more clearly elucidated the biomechanical and clinical effects after PCL tears and resultant treatments. This article presents a thorough review of updates on the clinically relevant anatomy, epidemiology, biomechanical function, diagnosis, and current treatments for the PCL, with an emphasis on the emerging clinical and biomechanical evidence regarding each of the treatment choices for PCL reconstruction surgery. It is recommended that future outcomes studies use PCL stress radiographs to determine objective outcomes and that evidence level 1 and 2 studies be performed to assess outcomes between transtibial and tibial inlay reconstructions and also between single-and double-bundle PCL reconstructions.
Folia Morphologica, 2017
The aim of the study was to determine the degree of posterior cruciate ligament (PCL) degeneration and the reduction in the number of its mechanoreceptors, in patients with advanced degenerative joint disease. PCLs taken from study group of 50 patients in the mean age of 70.7 (53-84) years with a diagnosis of advanced idiopathic osteoarthritis undergoing condylar total knee arthroplasty were compared to those taken form the control group of 10 knee joints of cadavers. Groups were matched with regard to sex and age. Histological examination of PCLs of the study group showed changes of an inflammatory process and no significant signs of osteoarthritis in the control group. A close correlation was found between the severity of degenerative changes on the X-ray images according to the Ahlbäck scale, and the increased mucoid degeneration (p < 0.0001), the severity of the degeneration of the collagen structure (p < 0.0001) and the presence of proprioceptors of PCLs (p < 0.0001). Conserving the PCL by the use of type cruciate retaining knee arthroplasty does not guarantee the preservation of correct proprioceptive sensation.