Isolated posterior cruciate ligament reconstruction: Long-term results (original) (raw)
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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.
Posterior cruciate ligament tears: functional and postoperative rehabilitation
Purpose Historically, the results of posterior cruciate ligament (PCL) reconstructions are not as favourable as anterior cruciate ligament (ACL) reconstructions, and it is well recognized that nonoperative treatment and postoperative rehabilitation for PCL injuries must be altered compared to those for ACL injuries. The purpose of this article was to review current peer-reviewed PCL rehabilitation programmes and to recommend a nonoperative and postoperative programme based on basic science and published outcomes studies.
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...
Revision Reconstruction of the Posterior Cruciate Ligament
Techniques in Knee Surgery, 2007
There has been significant improvement in the development of reconstructive techniques for tears of the posterior cruciate ligament. Despite these advances, this is still a relatively uncommon procedure with even less known about the optimal method for revision of a failed primary reconstruction. This article will review the pertinent preoperative evaluation and surgical technique for a revision posterior cruciate ligament reconstruction. Complications of this procedure and the limited data regarding outcome will also be addressed.
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).
Posterior Cruciate Ligament Reconstruction
1996
We studied posterior cruciate ligament reconstruction in a cadaveric model using two substitutes: a 1-mm diameter flexible cable and an 11-mm diameter Achilles tendon autograft. The thin cable allowed us to study five femoral and five tibial attachments in each knee. A nearly isometric attachment was located after cutting the posterior cruciate ligament while the tibia was reduced with a 100 N anterior force. The five femoral locations studied were the isometric location and four locations centered around this isometric point. The Achilles tendon reconstruction was used with both an isometric and a nonisometric femoral site, allowing us to confirm the results with the wire cable. Posterior motion limits were measured under a 100 N posterior force in the intact, posterior cruciate ligament-deficient, and posterior cruciate ligament-reconstructed knees. We found that the restoration of knee stability in flexion depended strongly on the femoral attachment location. A femoral attachment that was nonisometric by intraoperative measurement, but within the posterior cruciate ligament anatomic footprint, most closely reproduced the intact knee's posterior motion limits. Variations in the tibial attachment site produced only minor changes in the posterior motion limits. We concluded that the proximal-distal location selected for the femoral attachment of a posterior cruciate ligament substitute was particularly important in the restoration of normal posterior motion limits. The results of PCL reconstruction, as reported in the litera
Posterior Cruciate Ligament : Injury , Diagnosis , and Management
2017
Posterior cruciate ligament (PCL) injuries represent a minority of isolated ligamentous injuries to the knee. However the sequelae of these injuries can have a significant negative impact on function leading to instability, pain, and arthritis. A thorough understanding of the anatomy, mechanism of injury, and, pathophysiological changes that can occur with impaired PCL function can help the clinician formulate a specific treatment algorithm.Up to this point, there has been no consensus on optimal treatment for these injuries. The vast majority of isolated PCL injuries are treated conservatively including grade I, grade II, and even some grade III tears. However, a myriad of operative options exist in grade III tears and concomitant knee ligamentous injuries. These include single-bundle (SB), doublebundle (DB), tibial inlay, and anteriomedial or anteriolateraltranstibial reconstruction techniques. This review will provide an introduction to PCL injuries, how they are diagnosed both o...
Orthopaedics & Traumatology: Surgery & Research, 2010
Introduction: Reconstruction Surgery of the posterior cruciate ligament (PCL) has not yet been fully standardized, and associated rehabilitation protocols have not been clearly defined. The aim of this study is to report the results of a consecutive series of patients who underwent the same surgical technique for isolated PCL reconstruction and were submitted to the same specific rehabilitation protocol. A non-aggressive rehabilitation protocol which protects the graft from excess mechanical stress produces satisfying and reproducible clinical and laxity results in the knee. Materials and methods: Our series included 17 patients who underwent single bundle arthroscopic reconstruction of the PCL with an autologous quadriceps tendon graft and who followed the same non-aggressive rehabilitation protocol. All patients were followed up for an average of 30 months (range 12-60 months). The preoperative evaluation and the last follow-up included objective and subjective IKDC scores as well as the Tegner & Lysholm knee scales. The side to side laxity was measured radiologocially with the Telos stress testing device. A statistical analysis was performed to compare preoperative and postoperative results. Results: Preoperatively, no patients were classified as A or B on the IKDC objective score. At last follow-up visit, 88.2% of patients were classified as A or B. Average side to side anteroposterior laxity was 11.9 mm (range 8-18) in the preoperative evaluation and 3.8 mm (range 1-7) in the final follow-up (p = 0.01) The average subjective IKDC score was 37.7 before surgery and 74.7 at last follow-up (p < 0.01). The Tegner & Lysholm scores were significantly improved by surgery.
Outcome analysis of posterior cruciate ligament injuries
F1000Research
Background - The posterior cruciate ligament (PCL), a major stabiliser of the knee, restrains the posterior translation of tibia over femur. Injury to the two bundles of this ligament is usually seen in a motor vehicle accident, followed by dashboard injury. Methods - Non-operative management post posterior cruciate ligament tears includes non-steroidal anti-inflammatory drugs and rehabilitation. Common surgical procedures include trans-tibial tunnel or tibial inlay technique of graft reconstruction, single bundle or double bundle reconstruction. Literature on outcomes of posterior cruciate ligament injuries managed with either of the methods is sparse; we therefore aim to conduct an interventional study to analyse the patients’ functional status and satisfaction post treatment. Conclusions - Lysholm knee scoring scale and IKDC knee scoring system will be used as outcome measures. The follow up scores are taken 6, 12, 15 and 24 months after the treatment. CTRI registration: REF/2023...
Posterior Cruciate Ligament: Current Concepts Review
The archives of bone and joint surgery, 2018
The posterior cruciate ligament (PCL) is the largest and strongest ligament in the human knee, and the primary posterior stabilizer. Recent anatomy and biomechanical studies have provided an improved understanding of PCL function. PCL injuries are typically combined with other ligamentous, meniscal and chondral injuries. Stress radiography has become an important and validated objective measure in surgical decision making and post-operative assessment. Isolated grade I or II PCL injuries can usually be treated non-operatively. However, when acute grade III PCL ruptures occur together with other ligamentous injury and/or repairable meniscal body/root tears, surgery is indicated. Anatomic single-bundle PCL reconstruction (SB-PCLR) typically restores the larger anterolateral bundle (ALB) and represents the most commonly performed procedure. Unfortunately, residual posterior and rotational tibial instability after SB-PCLR has led to the development of an anatomic double-bundle (DB) PCLR...