Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleDoes Cast Immobilization Contribute to Posterior Stability After Posterior Cruciate Ligament Reconstruction?
Section snippets
Methods
This study was conducted after obtaining approval from the hospital ethics committee at our institution, and all the related information was explained to the patients in advance. The inclusion criterion for this study was chronic PCL injury that showed grade III instability by the posterior drawer test. Exclusion criteria were patients with fractures, associated ligament injury, multiple ligament injury, associated meniscus tear or meniscus transplantation on the affected side; patients who had
Results
The selected characteristics of the 44 patients are described in Table 2.
Discussion
This study aimed at suggesting a rehabilitation program that prevents excessive tension and relaxation of a tendon graft through long leg cast immobilization to restore stability and function of the knee after PCL reconstruction.4, 6, 7 We expected that applying long leg cast immobilization with the patient in a prone position would prevent posterior tibial sagging and that full weight bearing would shift the tibia anteriorly, reducing stress on the tendon graft and further limiting ROM. This
Conclusions
Immobilization with long leg casts until 5 weeks after PCL reconstruction yielded significantly better results in Telos posterior stress radiographs and distribution of IKDC grades 2 years postoperatively and did not show limited ROM when compared with the patients who wore braces only. However, IKDC subjective scores were not found to be different between the 2 groups.
References (29)
- et al.
Single-bundle versus double-bundle posterior cruciate ligament reconstruction. arthroscopy
Arthroscopy
(2009) Rehabilitation of isolated and combined posterior cruciate ligament injuries
Clin Sports Med
(1994)Posterior cruciate ligament rehabilitation: How slow should we go?
Arthroscopy
(2008)- et al.
Clinical outcomes after isolated arthroscopic single-bundle posterior cruciate ligament reconstruction
Arthroscopy
(2005) - et al.
Cruciate ligament forces in the human knee during rehabilitation exercises
Clin Biomech (Bristol, Avon)
(2000) - et al.
Isolated posterior cruciate ligament reconstruction: Is non-aggressive rehabilitation the right protocol?
Orthop Traumatol Surg Res
(2010) - et al.
Arthroscopic double-bundle augmentation of posterior cruciate ligament using split Achilles allograft
Arthroscopy
(2005) - et al.
Biomechanical evaluation of double bundle augmentation of posterior cruciate ligament using finite element analysis
Clin Biomech (Bristol, Avon)
(2010) - et al.
Serial magnetic resonance imaging evaluation of the patellar tendon after posterior cruciate ligament reconstruction
Arthroscopy
(2002) - et al.
Dependence of cruciate-ligament loading on muscle forces and external load
J Biomech
(1997)
A musculoskeletal model of the knee for evaluating ligament forces during isometric contractions
J Biomech
Pattern of anterior cruciate ligament force in normal walking
J Biomech
Excessive compression of the human tibio-femoral joint causes ACL rupture
J Biomech
Rehabilitation of the multiple-ligament-injured knee
Clin Sports Med
Cited by (17)
The Clinical Outcome of Arthroscopic Versus Open Popliteal Tendon Reconstruction Combined With Posterior Cruciate Ligament Reconstruction in Patients With Type A Posterolateral Rotational Instability
2019, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :We have observed that several risk factors, such as early initiation and rapid progression of ROM, high flexion angle, and early full weightbearing, have disadvantageous effects on the PCL graft. As described by Yoon et al.,25 at 5 weeks postoperatively, the cast was removed and a 0° locking brace was applied until 12 weeks postoperatively. When the cast was removed, gradual ROM was performed, starting with closed-kinetic-chain squats to achieve 90° flexion at 8 weeks, 120° flexion at 3 months, and full flexion at 6 months.
Posterior Cruciate Ligament Injuries: Diagnosis, Operative Techniques, and Clinical Outcomes
2017, Noyes' Knee Disorders: Surgery, Rehabilitation, Clinical OutcomesBiomechanical evaluation of a novel dynamic posterior cruciate ligament brace
2016, Clinical BiomechanicsCitation Excerpt :To achieve this position, the recommended treatment algorithm uses a rigid brace or cast immobilization with a posterior tibial splint for the first 5–8 weeks (Edson et al., 2010; Jung et al., 2008; Kim et al., 2013), since applying an anteriorly directed force to the tibia during PCL healing has been reported to improve the clinical outcome (Strobel et al., 2002; Ahn et al., 2011; Jacobi et al., 2010). After this initial healing period, a 6- to 8-week period follows with a second brace that allows an adjustable range of motion (Edson et al., 2010; Jung et al., 2008; Yoon et al., 2013). Initial prolonged rigid brace or cast immobilization during the healing period can cause knee joint stiffness, reduce muscle strength, and result in impairment of knee joint function.
Comparison of single-bundle and double-bundle isolated posterior cruciate ligament reconstruction with allograft: A prospective, randomized study
2014, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :In deep flexion of the knee, the PM bundle is taut again.10 SB PCL reconstruction, in which only the AL bundle is reconstructed, has shown good results.11-13 Without the support of the PM bundle, reconstruction of the AL bundle is insufficient to reproduce the function of the native PCL, which is lengthened because of cyclic fatigue.
Congratulations and condemnations: Level i evidence prize for femoral tunnel position in acl reconstruction, and aaos clinical practice guidelines miss the mark-Again
2014, Arthroscopy - Journal of Arthroscopic and Related SurgeryClimbing the level of evidence ladder: Prospective, comparative- effectiveness knee ACL and PCL research
2013, Arthroscopy - Journal of Arthroscopic and Related Surgery
Supported by a research grant from Smith & Nephew, Andover, MA.
The authors report that they have no conflicts of interest in the authorship and publication of this article.