Paper 278: Accuracy of Different Methods Indicating Femoral Insertion of Posterior Cruciate Ligament of the Knee Using Double-Bundle Reconstruction Technique: An Anatomical Study

2012 ◽  
Vol 28 (9) ◽  
pp. e502-e503
Author(s):  
Luo Hao ◽  
Yu Jia-Kuo ◽  
Changlong Yu ◽  
Yingfang AO ◽  
Jiying Zhang
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Anatomical Study ◽  
Double Bundle ◽  
Reconstruction Technique ◽  
Femoral Insertion ◽  
Double Bundle Reconstruction

Avoiding tibia physeal injury during double-bundle posterior cruciate ligament reconstruction

2018 ◽  
Vol 3 (1) ◽  
pp. 21-25
Author(s):  
Stockton Troyer ◽  
Nicolas G Anchustegui ◽  
Connor G Richmond ◽  
Peter C Cannamela ◽  
Aleksei Dingel ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Double Bundle ◽  
Reconstruction Technique ◽  
Pcl Reconstruction ◽  
Turn Angle ◽  
Physeal Injury ◽  
The Impact ◽  
Killer Turn

BackgroundAnatomic studies of the paediatric posterior cruciate ligament (PCL) demonstrate that the tibial attachment spans the epiphysis, physis and metaphysis. To better reproduce the anatomy of the PCL and avoid direct physeal injury, a double-bundle PCL reconstruction technique that includes both an all-epiphysial and an all-metaphyseal tibial tunnel has been proposed. The purpose of this study was to evaluate tibial tunnel placement in a paediatric double-bundle PCL reconstruction technique that avoids direct physeal injury using a 3-D computer model.MethodsTen skeletally immature cadaveric knee specimens (ages 5–11) were used to create 3-D model reconstructions from CT scans. All-metaphyseal and all-epiphysial tibial tunnels were simulated with the goal of maintaining adequate spacing (≥2 mm) between the tibial physis and tunnels to avoid injury. The all-metaphyseal tunnel, simulated at sizes of 5, 6 and 7 mm, entered anteriorly, below the tibial tubercle (apophysis) and exited posteriorly in the metaphyseal PCL footprint, distal to the proximal tibial physis. Four-millimetre all-epiphysial proximal tibial tunnels were simulated to enter the epiphysis anteromedially and exit posteriorly at the central epiphysial region of the PCL footprint, proximal to the physis. The distance was measured from the all-metaphyseal tunnels to the physis posteriorly and from the all-epiphysial tunnels to the physis, both anteriorly and posteriorly.ResultsIn all specimens, the 4 mm all-epiphysial tunnel and the 5, 6 and 7 mm all-metaphyseal tunnels maintained adequate spacing, ≥2 mm from the physis. In the specimens aged 5–7 years, the 5, 6 and 7 mm all-metaphyseal tunnels measured a mean distance of 3.5, 2.8 and 2.5 mm from the physis, respectively. In the specimens aged 8–11 years, the 5, 6 and 7 mm all-metaphyseal tunnels measured a mean distance of 3.4, 2.9 and 2.6 mm from the physis. In the specimens aged 5–7 years, the all-epiphysial tunnel measured a mean of 2.1 mm to the physis anteriorly and a mean of 2.8 mm posteriorly. In the specimens aged 8–11 years, the all-epiphysial tunnel measured a mean of 2.2 mm to the physis anteriorly and 2.4 mm posteriorly.ConclusionThese computer-aided 3-D models of paediatric knees illustrate that 5, 6 and 7 mm all-metaphyseal tunnels as well as 4 mm all-epiphysial tunnels can be placed without direct injury to the proximal tibial physis. The margin of error for direct physeal injury is small, especially for the all-epiphysial tunnel. Further, the all-epiphysial tunnel, while reproducing the anatomy of the PCL epiphysial attachment, may also produce a more extreme ‘killer turn’ of the graft. Modifications to the all-epiphysial tunnel may be considered to reduce the impact of the high ‘killer turn’ angle on the tibia.Level of evidenceIV.

scholarly journals Differences of Intra-Articular Graft Length between Sandwich-Style Reconstruction and Zhao-Style Non-Remnant-Preserving Double-Bundle Reconstruction of Posterior Cruciate Ligament

PLoS ONE ◽  
2016 ◽  
Vol 11 (5) ◽  
pp. e0155678
Author(s):  
Peng Shen ◽  
Xiaoxi Li ◽  
Caiqi Xu ◽  
Song Zhao ◽  
Shikui Dong ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Double Bundle Reconstruction ◽  
Graft Length

Trantibial anterior cruciate ligament double bundle reconstruction technique: two tibial bundle in one tibial tunnel

2007 ◽  
Vol 128 (11) ◽  
pp. 1245-1250 ◽  
Author(s):  
Haeng Kee Noh ◽  
Joon Ho Wang ◽  
Leela P. Bada ◽  
Jin Hwan Ahn ◽  
Jae Chul Yoo ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Double Bundle ◽  
Reconstruction Technique ◽  
Double Bundle Reconstruction ◽  
Anterior Cruciate

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 FEMORAL INSERTION OF THE POSTERIOR CRUCIATE LIGAMENT: AN ANATOMICAL STUDY

2011 ◽  
Vol 46 (5) ◽  
pp. 591-595
Author(s):  
Ricardo de Paula Leite Cury ◽  
Nilson Roberto Severino ◽  
Osmar Pedro Arbix Camargo ◽  
Tatsuo Aihara ◽  
Leopoldo Viana Batista Neto ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Anatomical Study ◽  
Femoral Insertion

scholarly journals Postoperative Evaluation of Knees With Posterior Cruciate Ligament Injury Using Patient-Oriented Evaluation Method: Comparison of Single-Bundle and Anatomic Double-Bundle Techniques

2021 ◽  
Author(s):  
Satoshi Ochiai ◽  
Tetsuo Hagino ◽  
Shinya Senga ◽  
Naoto Furuya ◽  
Naofumi Taniguchi ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Double Bundle ◽  
National Standard ◽  
Single Bundle ◽  
Reconstruction Technique ◽  
Double Bundle Reconstruction ◽  
Post Surgery ◽  
Sf 36 ◽  
Standard Values ◽  
Group D

Abstract Introduction Using the patient-based QOL evaluation scale SF-36 and conventional assessment methods, we evaluated the postoperative outcome of patients with posterior cruciate ligament (PCL) injury who underwent single-bundle or double-bundle reconstruction, and compared the two reconstruction techniques. Methods 37 male patients with isolated PCL injury who underwent reconstruction were randomized to receive single-bundle reconstruction (group S: n=20) or double-bundle reconstruction (group D: n=17). Before surgery and 6 and 24 months after surgery, patients were evaluated by SF-36 scores, Lysholm score, visual analog scale (VAS), posterior tibial displacement rate, and knee range of motion (ROM). Results For SF-36 evaluation at 6 months post-surgery, the scores of all the subscales improved to above the national standard values in group D, whereas none of the subscale scores reached the national standard values in group S, and three subscale scores were inferior in group S compared to group D. At 24 months post-surgery, improvement of all subscale scores to above the national standard values was achieved in both groups. Lysholm score, VAS score, and posterior tibial displacement rate improved after surgery in both groups, but no significant intergroup differences were observed in all evaluation methods. For knee ROM, residual limitation of flexion was significantly more frequent in group S than in group D at 6 and 24 months post-surgery.Conclusion Arthroscopy-assisted single-bundle PCL reconstruction technique is considered to be a safe procedure with low invasiveness, but despite its widespread use, surgical result is not consistently good. This was attributed to the low reproducibility of the unique course and anatomy of PCL, and the anatomic double-bundle reconstruction technique was proposed aiming to improve treatment outcome. According to the present results, double-bundle reconstruction tended to achieve better restoration at an early stage compared to single-bundle reconstruction, with fewer patients having residual limitation of knee flexion after surgery. Trial registration number of our hospital’s IRB: 27-8.Registered 14 September 2015, retrospectively registered.

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