scholarly journals Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 2: surgical techniques, outcomes and rehabilitation

2020 ◽  
Author(s):  
Philipp W. Winkler ◽  
Bálint Zsidai ◽  
Nyaluma N. Wagala ◽  
Jonathan D. Hughes ◽  
Alexandra Horvath ◽  
...  
Keyword(s):  
Risk Factors ◽  
Posterior Cruciate Ligament ◽  
Operative Treatment ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Knee Laxity ◽  
The Body ◽  
Single Bundle ◽  
Pcl Reconstruction ◽  
Level Of Evidence

Abstract Isolated and combined posterior cruciate ligament (PCL) injuries are associated with severe limitations in daily, professional, and sports activities as well as with devastating long-term effects for the knee joint. As the number of primary and recurrent PCL injuries increases, so does the body of literature, with high-quality evidence evolving in recent years. However, the debate about the ideal treatment approach such as; operative vs. non-operative; single-bundle vs. double-bundle reconstruction; transtibial vs. tibial inlay technique, continues. Ultimately, the goal in the treatment of PCL injuries is restoring native knee kinematics and preventing residual posterior and combined rotatory knee laxity through an individualized approach. Certain demographic, anatomical, and surgical risk factors for failures in operative treatment have been identified. Failures after PCL reconstruction are increasing, confronting the treating surgeon with challenges including the need for revision PCL reconstruction. Part 2 of the evidence-based update on the management of primary and recurrent PCL injuries will summarize the outcomes of operative and non-operative treatment including indications, surgical techniques, complications, and risk factors for recurrent PCL deficiency. This paper aims to support surgeons in decision-making for the treatment of PCL injuries by systematically evaluating underlying risk factors, thus preventing postoperative complications and recurrent knee laxity. Level of evidence V.

scholarly journals The Posterior Cruciate Ligament: Anatomy, Biomechanics, and Double-Bundle Reconstruction

2021 ◽  
Vol 0 ◽  
pp. 1-14
Author(s):  
Robert F. LaPrade ◽  
Edward R. Floyd ◽  
Kari L. Falaas ◽  
Nicholas J. Ebert ◽  
Griffin D. Struyk ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Treatment Options ◽  
Knee Laxity ◽  
International Knee Documentation Committee ◽  
Double Bundle ◽  
Anatomic Reconstruction ◽  
Single Bundle ◽  
Pcl Reconstruction ◽  
Tibial Translation

The posterior cruciate ligament (PCL) is the largest intra-articular ligament in the knee and is the primary stabilizer to posterior tibial translation. Historically, the PCL’s functional dynamics and appropriate management after injury have been controversial. However, recent biomechanical and anatomic studies have elucidated a better understanding of PCL function, which has led to development of more anatomic reconstruction techniques. The larger anterolateral bundle and the smaller posteromedial bundle of the PCL exhibit a codominant relationship and have a wide femoral attachment footprint. For these reasons, the native kinematics of the knee is better restored with a double-bundle PCL reconstruction (DB-PCLR) technique than with a single-bundle PCL reconstruction (SB-PCLR). Likewise, clinical studies have demonstrated excellent outcomes for DB-PCLR compared to SB-PCLR, with decreased posterior knee laxity on stress radiography and improved International Knee Documentation Committee scores. This review will provide a detailed overview of the clinically relevant anatomy, biomechanics, injury evaluation, and treatment options, with an emphasis on arthroscopic DB-PCLR.

scholarly journals Evaluation of Deep Vein Thrombosis Risk Factors After Arthroscopic Posterior Cruciate Ligament Reconstruction: A Retrospective Observational Study

2021 ◽  
Vol 27 ◽  
pp. 107602962110305
Author(s):  
Pu Ying ◽  
Wenge Ding ◽  
Xiaowei Jiang ◽  
Yue Xu ◽  
Yi Xue ◽  
...  
Keyword(s):  
Risk Factors ◽  
Posterior Cruciate Ligament ◽  
Color Doppler ◽  
Cruciate Ligament ◽  
Color Doppler Ultrasound ◽  
Pcl Reconstruction ◽  
Vein Thrombosis ◽  
Post Surgery ◽  
Pcl Injury ◽  
D Dimer

We evaluated the risk factors of deep venous thrombosis (DVT) after knee arthroscopic posterior cruciate ligament (PCL) reconstruction in patients with only PCL injury. From August 2014 to December 2020, a total of 172 patients who had accepted knee arthroscopic PCL reconstruction underwent the color Doppler ultrasound of bilateral lower-extremities deep veins on 3 days postoperatively. Based on the inspection results, patients were divided into DVT group (18 males and 8 females, mean age 43.62 years) and non-DVT group (108 males and 38 females, mean age 33.96 years). The potential associations of DVT risk and age, gender, body mass index (BMI), diabetes, hypertension, smoking and other factors were analyzed. An old age (OR = 1.090; 95% CI = 1.025-1.158; P = 0.006), a high BMI (OR = 1.509; 95% CI = 1.181-1.929; P = 0.001) and an increased post-surgery D-dimer (OR = 5.034; 95% CI = 2.091-12,117; P ≤ 0.001) value were significantly associated with an elevated DVT risk after knee arthroscopic PCL reconstruction. Increased age, BMI, and postoperative D-dimer were risk factors of DVT following knee arthroscopic PCL reconstruction in patients with only PCL injury.

scholarly journals Long-term outcomes after arthroscopic single-bundle reconstruction of the posterior cruciate ligament: A 7-year follow-up study

2017 ◽  
Vol 46 (2) ◽  
pp. 865-872 ◽  
Author(s):  
Rui Wang ◽  
Bin Xu ◽  
Lei Wu ◽  
Honggang Xu
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Single Bundle ◽  
Long Term Outcomes ◽  
Pcl Reconstruction ◽  
Lysholm Knee Score ◽  
The Stability ◽  
Tegner Score

Objective Arthroscopy is the most popular technique in posterior cruciate ligament (PCL) reconstruction surgery. However, no consensus on long-term outcomes after arthroscopic PCL reconstruction has been reached. This study was performed to evaluate the long-term outcomes after arthroscopic autologous hamstring or allogeneic tendon single-bundle reconstruction of the PCL. Methods Fifty-eight patients who underwent arthroscopic PCL reconstruction in Anhui, China from 2007 to 2009 were included. The follow-up period ranged from 56 to 83 months. During the follow-up, the Lysholm knee score and Tegner activity score were used to assess knee function. The KT-2000 arthrometer (MEDmetric Corp., San Diego, CA, USA) was used to assess the stability of the reconstructed PCL. Results The mean Lysholm score, mean Tegner score, and mean forward and backward displacements were not significantly different between the final follow-up and 1 year after the surgery. Additionally, no significant differences were observed in any of the above-mentioned parameters between autologous and allogeneic reconstruction at the final follow-up. Conclusion Both autologous and allogeneic reconstruction had few complications and satisfactory long-term outcomes.

Common risk factors of deep vein thrombosis after arthroscopic posterior cruciate ligament reconstruction: a 5-year retrospective study

2020 ◽  
Author(s):  
Dai Xiaoyu ◽  
Ding Wenge ◽  
Li Huan ◽  
Peng Xu ◽  
Wang Kejie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Posterior Cruciate Ligament ◽  
Color Doppler ◽  
Cruciate Ligament ◽  
Color Doppler Ultrasound ◽  
Pcl Reconstruction ◽  
Post Surgery ◽  
Common Risk Factors ◽  
Pcl Injury ◽  
D Dimer

Abstract Background To analyse the common risk factors of deep venous thrombosis (DVT) after knee arthroscopic posterior cruciate ligament (PCL) reconstruction in patients with PCL injury. Methods From August 2014 to December 2019, a total of 86 patients who had accepted knee arthroscopic PCL reconstruction underwent the color Doppler ultrasound of bilateral lower-extremities deep veins on 3 days postoperatively. Based on the inspection results, patients were divided into DVT group (9 males and 4 females, mean age 43.62 years) and non-DVT group (54 males and 19 females, mean age 33.96 years). The potential associations of DVT risk and age, gender, body mass index (BMI), diabetes, hypertension, smoking and other factors were analysed. Results High BMI and post-surgery D-dimer values were significantly associated with DVT risk. Conclusions Increased BMI and postoperative D-dimer levels are risk factors of DVT following knee arthroscopic PCL reconstruction in patients with PCL injury.

scholarly journals Posterior Cruciate Ligament Reconstruction With Independent Suture Tape Reinforcement: An In Vitro Biomechanical Full Construct Study

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098187
Author(s):  
Bruce A. Levy ◽  
Marina Piepenbrink ◽  
Michael J. Stuart ◽  
Coen A. Wijdicks
Keyword(s):  
Posterior Cruciate Ligament ◽  
Ultimate Strength ◽  
Cruciate Ligament ◽  
Full Range ◽  
Knee Laxity ◽  
Total Elongation ◽  
Joint Stability ◽  
Pcl Reconstruction ◽  
Tibial Translation ◽  
Suture Tape

Background: Posterior cruciate ligament (PCL) reconstruction is commonly performed to restore joint stability and prevent posterior tibial translation at higher flexion angles. However, persistent knee laxity after reconstruction is often reported. Purpose: To biomechanically evaluate the effect of independent suture tape (ST) reinforcement on different PCL reconstruction techniques. Study Design: Controlled laboratory study. Methods: PCL reconstruction using porcine bones and quadrupled bovine tendons was performed using 2 techniques: (1) an all-inside method using suspensory adjustable loop devices (ALDs) in the tibia and femur and (2) a method using an interference screw on the tibial and an ALD on the femoral site. Both were tested with and without an additional ST for 4 groups (n = 8 per group). Each construct underwent biomechanical testing involving 3000 loading cycles in 3 stages. After position-controlled cycles simulating full range of motion, force-controlled loading from 10 to 250 N and then from 10 to 500 N were performed before pull-to-failure testing. Elongation, stiffness, and ultimate strength were evaluated. Results: The highest ultimate load (1505 ± 87 N), a small total elongation (2.60 ± 0.97 mm), and stiffness closest to the native human ligament (156.3 ± 16.1 compared with 198.9 ± 33.5 N/mm; P = .192) was seen in the all-inside technique using ST. Intragroup comparison revealed that reinforcement with ST produced a smaller total elongation for the screw fixation (Screw-ALD, 6.06 ± 3.60 vs Screw-ALD ST, 2.50 ± 1.28 mm; P = .018) and all-inside techniques (ALD-ALD, 4.77 ± 1.43 vs ALD-ALD ST, 2.60 ± 0.97 mm; P = .077), albeit the latter was not significantly different. Elongation for constructs without ST increased more rapidly at higher loads compared with elongation for ST constructs. The ultimate strength was significantly increased only for constructs using the all-inside technique using ST (ALD-ALD, 1167 ± 125 vs ALD-ALD ST, 1505 ± 87 N; P = .010). Conclusion: Adding an independent ST to PCL reconstruction led to improvement in the studied metrics by reducing the total elongation and increasing the ultimate strength, independent of the technique used. Clinical Relevance: PCL reconstruction using additional ST reinforcement was biomechanically favorable in this study. ST reinforcement in the clinical setting could decrease knee laxity after PCL reconstruction, providing better joint stability and improved functional outcomes.

Biomechanical Comparison of Five Posterior Cruciate Ligament Reconstruction Techniques

2016 ◽  
Vol 30 (06) ◽  
pp. 523-531 ◽  
Author(s):  
Jeffrey Milles ◽  
Ferris Pfeiffer ◽  
James Stannard ◽  
Patrick Smith ◽  
Mauricio Kfuri ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Single Bundle ◽  
Reconstruction Technique ◽  
Pcl Reconstruction ◽  
Hydraulic Load ◽  
Suspensory Fixation ◽  
Maximal Displacement ◽  
Biomechanical Comparison

AbstractNo surgical technique recreates native posterior cruciate ligament (PCL) biomechanics. We compared the biomechanics of five different PCL reconstruction techniques versus the native PCL. Cadaveric knees (n = 20) were randomly assigned to one of five reconstruction techniques: Single bundle all-inside arthroscopic inlay, single bundle all-inside suspensory fixation, single bundle arthroscopic-assisted open onlay (SB-ONL), double bundle arthroscopic-assisted open inlay (DB-INL), and double bundle all-inside suspensory fixation (DB-SUSP). Each specimen was potted and connected to a servo-hydraulic load frame for testing in three conditions: PCL intact, PCL deficient, and PCL reconstructed. Testing consisted of a posterior force up to 100 N at a rate of 1 N/s at four knee flexion angles: 10, 30, 60, and 90 degrees. Three material properties were measured under each condition: load to 5 mm displacement, maximal displacement, and stiffness. Data were normalized to the native PCL, compared across techniques, compared with all PCL-intact knees and to all PCL-deficient knees using one-way analysis of variance. For load to 5 mm displacement, intact knees required significantly (p < 0.03) more load at 30 degrees of flexion than all reconstructions except the DB-SUSP. At 60 degrees of flexion, intact required significantly (p < 0.01) more load than all others except the SB-ONL. At 90 degrees, intact, SB-ONL, DB-INL, and DB-SUSP required significantly more load (p < 0.05). Maximal displacement testing showed the intact to have significantly (p < 0.02) less laxity than all others except the DB-INL and DB-SUSP at 60 degrees. At 90 degrees the intact showed significantly (p < 0.01) less laxity than all others except the DB-SUSP. The intact was significantly stiffer than all others at 30 degrees (p < 0.03) and 60 degrees (p < 0.01). Finally, the intact was significantly (p < 0.05) stiffer than all others except the DB-SUSP at 90 degrees. No technique matched the exact properties of the native PCL, but the double bundle reconstructions more closely recreated the native biomechanics immediately after implantation, with the DB-SUSP coming closest to the native ligament. This study contributes new data for consideration in PCL reconstruction technique choice.

scholarly journals Developing Trends and Core Knowledge in Posterior Cruciate Ligament Research: A Bibliometric and Visualized Analysis

2021 ◽  
Author(s):  
Jinfei Li ◽  
Shuangyi Chen ◽  
Michael A. DiNenna ◽  
Shuyi Chen ◽  
Qi Chen ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Sports Medicine ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Tibial Slope ◽  
The United States ◽  
Postoperative Recovery ◽  
Research Trend ◽  
Future Research ◽  
Pcl Reconstruction

Abstract Background: The Posterior Cruciate Ligament (PCL) has important research value and broad application prospects in sports medicine. This study provides information on the present status, worldwide trends, evolutionary path and frontier research hotspots in this field. Methods: Publications from 1971 to 2021 were obtained from the Web of Science database and analyzed using VOSviewer and CiteSpace software. Results: there is an increasing trend in the relative research interests and the number of publications per year globally. The research institution with the highest documents and citations was the University of Pittsburgh. The United States showed a dominant position in publication outputs, followed by China and South Korea. Leading researchers, their cooperative relationships, and their scientific masterpieces have been identified. Arthroscopy has published the most papers in this field, followed by Knee Surgery Sports Traumatology Arthroscopy and American Journal of Sports Medicine. The publications can be divided into eight clusters: “Total knee arthroplasty”, “PCL reconstruction”, “Injury and rehabilitation”, “Anatomy and diagnosis” and “Functional assessment and etiology”. A cluster of citation keywords showed that “tibial slope” is the new research focus in the field. Conclusions: The publications about PCL research would remain in a high level of relevance for the future, based on the current global trends. Double bundle PCL reconstruction is the preferred surgical method for most PCL complex injuries. Its surgical techniques and postoperative management are making continuous progress, with doctors paying more attention to rapid postoperative recovery and improvement of patient satisfaction. Bibliometrics analysis enables us to accurately identify scholars, institutions, and journals with great academic influence in the vast and miscellaneous literature. This helps us quickly understand the current development and future research trend of the field.

THE BIOMECHANICAL STUDY OF DIFFERENT POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION TECHNIQUES

2018 ◽  
Vol 18 (08) ◽  
pp. 1840025
Author(s):  
NA GUO ◽  
YANSONG QI ◽  
BIAO YANG ◽  
ZHONGHAO HAN ◽  
LEI HU ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Single Bundle ◽  
Pcl Reconstruction ◽  
Rotational Angle ◽  
Reconstruction Methods ◽  
Fresh Cadaver ◽  
Varus Angle

The main purpose of our study was to evaluate the biomechanics of different posterior cruciate ligament (PCL) reconstruction techniques. Seven fresh cadaver knees were collected. A 6-DOF robot arm was used to test the biomechanical parameters, including the posterior stability, the lateral stability and the rotation stability of different PCL reconstruction techniques. Each group was tested at the knee flexion of 0, 30[Formula: see text], 60[Formula: see text], 90[Formula: see text] and 120[Formula: see text], under the following conditions respectively: a posterior force of 134[Formula: see text]N, an internal and external rotation torque of 5[Formula: see text][Formula: see text], a varus and valgus torque of 10[Formula: see text][Formula: see text], and a combination of 100[Formula: see text]N posterior force and 5[Formula: see text][Formula: see text] external rotation torque. The posterior tibia translation and the rotational angle of the 4-tunnel double-bundle PCL reconstruction group were significantly lower than that of 3-tunnel double-bundle group and the single-bundle group; the posterior tibia translation valgus–varus-angle were lower at some specified flexion angle. No statistical difference was found between the anatomic 4-tunnel bundle group and the intact knee group concerning the posterior tibia translation, the rotational angle, and the valgus–varus-angle. This study showed that the biomechanics of PCL of 4-tunnel double-bundle reconstruction was closer to the intact knees than the other two reconstruction methods.

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