Clinical Outcomes After Isolated Arthroscopic Single-Bundle Posterior Cruciate Ligament Reconstruction

doi:10.1016/j.arthro.2005.05.023

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 21, Issue 9, September 2005, Pages 1042-1050

https://doi.org/10.1016/j.arthro.2005.05.023 Get rights and content

Purpose: The purpose of this study was to evaluate the clinical outcomes after arthroscopic single-bundle posterior cruciate ligament (PCL) reconstruction in patients with isolated grade III PCL injuries. Type of Study: Retrospective review. Methods: Twenty-one patients who underwent an isolated arthroscopic single-bundle PCL reconstruction for the treatment of a grade III PCL injury between 1989 and 1998 were included in the study. There were 15 male and 6 female patients with an average age of 38 years (range, 20 to 62 years). The length of follow-up was 5.9 years (range, 2.6 to 11 years), and the average time from injury to surgery was 4.5 years (median, 1.3 years; range, 2 weeks to 25 years). All patients completed a subjective evaluation and 14 patients returned for a physical examination and radiographs. One patient underwent an acute reconstruction (<3 weeks), 4 had a subacute (<3 months), and 16 underwent a chronic (>3 months) reconstruction. The anterolateral bundle of the PCL was reconstructed using an Achilles tendon allograft passed through femoral and tibial bone tunnels. Results: The overall average Activities of Daily Living Scale (ADLS), Sports Activities Scale (SAS), and SF-36 scores were 79.3, 71.6, and 98 points, respectively. There was a significant difference identified when the ADLS (91.3 v 75.6) and the SAS (90.4 v 65.8) scores of the subacute/acute group were compared with those of the chronic reconstruction group. Using the International Knee Documentation Committee (IKDC) subjective assessment, 57% of the patients had normal/near normal knee function, and 62% had a normal/near normal activity level. The average extension and flexion losses were 1° and 5°, respectively. Instrumented laxity examination revealed that 62% had less than a 3-mm and 31% had a 3- to 5-mm side-to-side difference in corrected posterior displacement. Radiographs at follow-up showed that 75% had normal/near normal findings according to IKDC guidelines. Conclusions: The clinical outcomes after arthroscopic single-bundle PCL reconstruction in this study produced a satisfactory return of function and improvement in symptoms. All patients in this study had improved laxity of at least 1 grade. When compared with chronic reconstructions, acute reconstructions had statistically significant better ADLS and SAS scores. Level of Evidence: IV, case series.

Section snippets

Methods

Twenty-five patients underwent isolated arthroscopic single-bundle PCL reconstruction for the treatment of a grade III PCL injury between 1989 and 1998 at our institution. All patients selected for surgery were felt to represent isolated PCL injuries. A grade III PCL was defined according to the International Knee Documentation Committee (IKDC) score of greater than 10 mm of posterior tibial translation compared with the contralateral knee at 90° of flexion, which corresponds clinically to the

IKDC Subjective Assessment

The IKDC subjective evaluation was based on patient-reported self-assessments of their knee function and activity level (Table 1). In terms of knee function, 57% of patients stated that they were normal or nearly normal, whereas 43% were abnormal or severely abnormal. In terms of activity level, 62% of patients described a normal or nearly normal level of activity and 38% who reported abnormal or severely abnormal activity level.

In the acute/subacute group, all patients reported normal or

Discussion

The management of PCL injuries remains a challenging clinical problem. Numerous studies have described the anatomy and the biomechanical properties of the PCL.39, 40, 41, 42 Studies have also provided a scientific rationale for PCL reconstruction (single- v double-bundle), graft selection, tunnel placement, and fixation.43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 However, no single PCL reconstruction technique has emerged as the one that is consistently accepted

Conclusions

The clinical outcomes after arthroscopic single-bundle PCL reconstruction produced a satisfactory return of function and improvement in symptoms. All patients had improved laxity of at least 1 grade. Based on our data, acute/subacute reconstructions had statistically significant better subjective outcomes than did chronic reconstructions. Other differences may exist, but our sample size was not sufficient to detect them.

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No difference in subjective and objective clinical outcomes between arthroscopic transtibial and open inlay posterior cruciate ligament reconstruction techniques in the treatment of multi-ligamentous knee injuries
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Citation Excerpt :
Many authors have discovered that PCL injury is usually associated with PLC injury [17–19]. Some authors have attributed PCL reconstruction failures to neglected PLC injury [6,20,21]. Seon and Song [7] performed an isolated PCL reconstruction for patients with Grade II (5 mm < SSD of PTT < 10 mm) and III (SSD of PTT > 10 mm) PCL injury.
There is controversy regarding the optimal treatment of posterior cruciate ligament (PCL) -based multi-ligamentous injuries. The purpose of this study was to compare the subjective and objective clinical outcomes of arthroscopic transtibial reconstruction and tibial inlay reconstruction.
From 2005 to 2013, a total of 135 patients with PCL-based multi-ligamentous injuries were consecutively identified. Patients were operated with the arthroscopic transtibial technique or the open tibial inlay technique group. Other injured structures were reconstructed or repaired simultaneously. All of the patients underwent a preoperative and postoperative physical examination, KT-1000 measurement, stress radiography under anesthesia and subjective evaluations including Tegner score, Lysholm score, American Academy of Orthopedic Surgeons (AAOS) score.
Fifty-seven patients (64.8%) underwent arthroscopic transtibial PCL reconstruction, and 31 patients (35.2%) underwent PCL reconstruction with the tibial inlay technique. The average follow up period was 45.9 ± 17.0 months (24–77 months). At the final follow up, for the arthroscopic transtibial group, the side-to-side difference of KT-1000 decreased from 13.5 ± 4.8 mm to 2.4 ± 3.4 mm (P < 0.001); the tibial posterior translation by stress radiograph decreased from 14.9 ± 7.1 mm to 4.6 ± 4.0 mm (P < 0.001). For the open inlay group, the side-to-side difference of KT-1000 decreased from 13.7 ± 5.2 mm to 2.2 ± 3.6 mm (P < 0.001) and the posterior translation by stress radiograph decreased from 14.9 ± 5.9 mm to 4.3 ± 3.9 mm (P < 0.001) at the final follow up. The inter-group clinical outcomes pre- and postoperatively were not significantly different at any time point.
There was no statistically significant difference in objective and subjective outcome between the arthroscopic transtibial and open inlay PCL reconstruction in patients with multi-ligamentous injuries.
Similar functional outcomes of arthroscopic reconstruction in patients with isolated Posterior Cruciate Ligament (PCL) and combined Anterior Cruciate Ligament (ACL) and PCL tears
2021, Journal of Clinical Orthopaedics and Trauma
Posterior Cruciate Ligament (PCL) injuries seldom occur in isolation and majority occurs in conjugation with other ligament injuries. Posterior Cruciate Ligament (PCL) reconstruction continues to be taken into consideration as a complicated surgical procedure, with heterogeneity in literature regarding clinical and functional outcomes in isolated PCL and combined ACL and PCL injuries.
The retrospective evaluation of patients with isolated PCL reconstruction (group 1) and combined Anterior Cruciate Ligament (ACL) and PCL reconstruction (group 2) was performed. A total of 66 patients with either isolated PCL or combined ACL and PCL reconstruction surgeries that met the inclusion criteria, were included in the study. These patients were assessed for functional outcome scores including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Lysholm score, International Knee Documentation Committee (IKDC) and Tegner activity score at a minimum follow-up of 5 years.
The mean follow-up of patients was 82.09 ± 12.43 months in group 1 and 79.36 ± 11.24 months in group 2, with a total of 29 patients in group 1 and 21 patients in group 2. Both the groups were found to be comparable in terms of age, gender, duration of injury and pre-injury Tegner activity level. Post-surgical functional outcome scores (WOMAC score, Lysholm score and Tegner score) were found to be comparable between 2 groups at a mean follow-up of 5 years. Further, 22 patients in group 1 and 16 patients in group 2 had normal or near normal objective IKDC outcome scores at a mean follow-up of 5 years.
No differences were observed in functional outcome scores (WOMAC score, Lysholm score, Tegner score and IKDC score) between isolated reconstructed PCL and combined ACL and PCL reconstructed patients.
Anatomic Double Bundle Posterior Cruciate Ligament Reconstruction Using an Internal Splint
2020, Arthroscopy Techniques
Techniques for reconstruction of posterior cruciate ligament (PCL) tears are rapidly evolving. One problem with current techniques is that laxity may develop early in the postoperative period, leading to relapsed posterior translation of the tibia. Therefore, maintaining tibial reduction during graft incorporation is a target for improvement. We describe using an internal splint to optimize the 4-tunnel, double-bundle allograft PCL reconstruction.
All-inside Posterior Cruciate Ligament Reconstruction: Surgical Technique and Outcome
2019, Clinics in Sports Medicine
Citation Excerpt :
Despite advances in knowledge about posterior cruciate ligament (PCL) anatomy and function, the optimal surgical approach, graft choice, and reconstruction technique remain controversial. Double-bundle (DB), single-bundle (SB), transtibial, and tibial inlay techniques have been described for PCL reconstruction (PCLR) and all are associated with successful clinical outcomes.1–9 Additional studies have demonstrated satisfactory subjective and objective clinical outcomes after PCLR using either autograft or allograft tissue.10,11
Influence of Graft Source on Postoperative Activity and Joint Laxity in Posterior Cruciate Ligament Reconstruction: A Systematic Review
2019, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
Most noncomparative studies reported a reduction in posterior laxity after autograft22,24,25,29-31,37-39 and allograft35,41,44 PCL reconstruction. Among studies examining change in posterior joint laxity using the KT-1000 or KT-2000 arthrometer, 12 studies (9 using autograft22,25,28-31,37,42,45 and 3 using allograft36,40,41) provided postoperative side-to-side differences. Among studies using stress radiography, 7 studies (5 using autograft22,29,31,37,39 and 2 using allograft35,44) report postoperative side-to-side differences.
To compare the clinical and functional outcomes of allograft and autograft reconstruction in patients with posterior cruciate ligament (PCL) deficiency.
The MEDLINE, Embase, and Cochrane Library databases were used to identify all relevant articles. Clinical outcomes including International Knee Documentation Committee, Tegner, and Lysholm scores; joint laxity; and posterior tibial displacement were evaluated.
Among the 145 unique articles identified during the title screening, 25 studies published between 2002 and 2016 with a combined population of 900 patients were deemed eligible for inclusion in the review. Of the 900 patients, 603 were treated with autograft and 297 were treated with allograft PCL reconstruction. Five of the included studies directly compared autograft and allograft PCL reconstruction. Most studies found postoperative functional outcomes and joint laxity to improve postoperatively regardless of graft source. With only 1 exception, the included comparative studies found no significant postoperative difference in any of the functional outcome scores between patients treated with allograft and those treated with autograft. Two comparative studies found autograft reconstruction to result in significantly less posterior laxity than in the allograft group, whereas 2 comparative studies found no significant difference in posterior laxity between the 2 groups.
PCL reconstruction results in improved functional outcome scores and joint laxity regardless of graft source. Current studies suggest there is no significant difference in postoperative functional outcomes between patients treated with autograft and those treated with allograft. Patients treated with autograft have donor-site morbidity that is not associated with allograft reconstruction. Some evidence suggests that autograft reconstruction may result in reduced posterior laxity relative to allograft reconstruction. The magnitude of this finding, however, may not be clinically significant. Our review found that decision making based on the current literature is at high risk of potential bias.
Level IV, systematic review of Level I to IV studies.
Delayed multiligament PCL reconstruction is associated with a higher prevalence of intraarticular injury and may influence treatment
2023, BMC Musculoskeletal Disorders

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Original articleClinical Outcomes After Isolated Arthroscopic Single-Bundle Posterior Cruciate Ligament Reconstruction

Section snippets

Methods

IKDC Subjective Assessment

Discussion

Conclusions

J Biomech

Arthroscopy

Arthroscopy

J Biomech

Oper Tech Sports Med

Oper Tech Sports Med

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

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Original article
Clinical Outcomes After Isolated Arthroscopic Single-Bundle Posterior Cruciate Ligament Reconstruction