Reconstructions of the Knee Following Combined Injury to the Posterior Cruciate Ligament and the Posterior Lateral Structures

2004 ◽  
Author(s):  
Michael J. Askew ◽  
William B. Wiley ◽  
Arne Melby ◽  
Donald A. Noe
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Cartilage Degeneration ◽  
Surgical Reconstruction ◽  
Combined Injury ◽  
Rotary Instability ◽  
Lateral Structures ◽  
Tibial Translation ◽  
Combined Injuries

The posterior cruciate ligament (PCL) provides primary restraint to posterior tibial translation (1). Knee injuries involving only the PCL usually result in minimal disability, and are commonly treated non-surgically (2). However, combined injuries of the PCL and the posterior lateral structures (PLS) in the knee can result in considerable abnormal posterior laxity and posterolateral rotary instability leading to rapid cartilage degeneration (3). There is consensus that, in most cases, knees with this combined injury require surgical reconstruction.

Posterior Cruciate Ligament Reconstruction in the Multiple Ligament Injured Knee

2020 ◽  
Vol 33 (05) ◽  
pp. 421-430
Author(s):  
Michelle E. Kew ◽  
Mark D. Miller
Keyword(s):  
Posterior Cruciate Ligament ◽  
Knee Injury ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Surgical Reconstruction ◽  
Nonsurgical Management ◽  
Injured Knee ◽  
Tibial Inlay ◽  
Low Activity

AbstractMultiligamentous knee injuries are challenging to treat and diagnose. Posterior cruciate ligament (PCL) injuries are commonly found in the constellation of injuries included in a multiligamentous knee injury and are caused by a posteriorly directed force on the proximal tibia with relation to the femoral condyles. A thorough history and physical examination should be performed to evaluate for associated neurovascular injuries and associated ligamentous, chondral, or bony injuries. Nonsurgical management is reserved for patients who are critically ill or have very low activity demands. Surgical reconstruction is recommended for most patients with multiligamentous knee injuries. The PCL reconstruction can be undertaken with several different graft options and reconstruction techniques, including the transtibial, arthroscopic tibial inlay, and open tibial inlay approach. The literature has a paucity of data regarding outcomes among the various reconstructive options, so the optimal surgical technique has not been established.

scholarly journals Arthroscopic Primary Repair of the Posterior Cruciate Ligament

2021 ◽  
Author(s):  
Harmen D. Vermeijden ◽  
Jelle P. van der List ◽  
Gregory S. DiFelice
Keyword(s):  
Posterior Cruciate Ligament ◽  
Primary Repair ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Knee Injuries ◽  
Surgical Techniques ◽  
Treatment Strategies ◽  
Early Mobilization ◽  
Invasive Approach ◽  
Tibial Translation

AbstractThe posterior cruciate ligament (PCL) is one of the four major stabilizers of the knee joint and functions as the primary restraint to posterior tibial translation. PCL tears rarely occur in isolation and most commonly presents in the setting of multiligamentous knee injuries. Several treatment strategies for these injuries have been proposed over the last decades, including ligament reconstruction and primary repair. Arthroscopic primary PCL repair has the potential to preserve native tissue using a more minimally invasive approach, thereby avoiding donor-site morbidity and allowing early mobilization. While arthroscopic PCL repair is certainly not an effective surgical approach for all patients, this procedure may be a reasonable and less morbid alternative to PCL reconstruction in selected patients treated for proximal or distal avulsion tears, with low failure rates, good knee stability, and good to excellent subjective outcomes. The surgical indications, surgical techniques, postoperative management, and outcomes for arthroscopic primary repair of proximal and distal PCL tears will be discussed in this review.

Posterior Cruciate Ligament Femoral Insertion Site Characteristics: Importance for Reconstructive Procedures

2002 ◽  
Vol 30 (5) ◽  
pp. 643-651 ◽  
Author(s):  
Etienne A. Mejia ◽  
Frank R. Noyes ◽  
Edward S. Grood
Keyword(s):  
Articular Cartilage ◽  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Femoral Shaft ◽  
Surgical Reconstruction ◽  
Anatomic Study ◽  
Reconstructive Procedures ◽  
Femoral Attachment ◽  
Site Characteristics

Background: Previous descriptions of the insertion site of the posterior cruciate ligament are inadequate. Hypothesis: More than one reference system is required to adequately represent the anatomy of the femoral attachment. Study Design: Descriptive anatomic study. Methods: Twelve cadaveric specimens were evaluated by using two measurement methods relative to the femoral articular cartilage margin and two methods relative to the intercondylar femoral roof. Results: Reference lines perpendicular to the articular cartilage best defined the 12- and 1-o'clock positions, and those perpendicular to the articular cartilage or parallel to the femoral shaft best defined the 2-, 3-, and 4-o'clock positions. The angle of the proximal attachment to the roof was 88° ± 5.5°. The posterior cruciate ligament was a continuum of fibers rather than two distinct bundles, and its attachment showed variability in shape and thickness, extending past the midline in the notch (11:21 ± 15 minutes to 4:12 ± 20 minutes, right knee). Conclusions: More than one measurement system is required to accurately describe the femoral origin of the posterior cruciate ligament. Clinical Relevance: Accurate assessment of the anatomy is crucial for successful surgical reconstruction of the posterior cruciate ligament femoral attachment.

scholarly journals Single-Stage Arthroscopic Anterior and Posterior Cruciate Ligament Repairs and Open Medial Collateral Ligament Repair for Acute Knee Dislocation

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ryo Murakami ◽  
Eisaburo Honda ◽  
Atsushi Fukai ◽  
Hiroki Yoshitomi ◽  
Takaki Sanada ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Knee Dislocation ◽  
Single Stage ◽  
Lateral Condyle ◽  
Ligament Repair ◽  
Collateral Ligament ◽  
Medial Condyle

Till date, there are no clear guidelines regarding the treatment of multiple ligament knee injuries. Ligament repair is advantageous as it preserves proprioception and does not involve grafting. Many studies have reported the use of open repair and reconstruction for multiple ligament knee injuries; however, reports on arthroscopic-combined single-stage anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) repairs are scarce. In this report, we describe a case of type III knee dislocation (ACL, PCL, and medial collateral ligament (MCL) injuries) in a 43-year-old man, caused by contact while playing futsal. On the sixth day after injury, arthroscopic ACL and PCL repairs were performed with open MCL repair. The proximal lesions in the three ligaments that were injured were sutured using no. 2 strong surgical sutures. The ACL was pulled out to the lateral condyle of the femur and fixed using a suspensory fixation device. The PCL was pulled out to the medial condyle of the femur, and the MCL was pulled towards the proximal end of the femur; both were fixed using suture anchors. Early mobilization was performed, and both, clinical and imaging outcomes, were good two years after surgery.

Kinematics of the Posterolateral Corner of the Knee: A Cadaveric Study

2010 ◽  
Author(s):  
Ryan J. Quigley ◽  
Hideya Ishigooka ◽  
Michelle H. McGarry ◽  
Yu J. Chen ◽  
Akash Gupta ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Posterolateral Corner ◽  
Cadaveric Study ◽  
Knee Ligaments ◽  
Rotatory Instability ◽  
Posterolateral Rotatory Instability ◽  
Combined Injuries

Combined injuries of the posterior cruciate ligament (PCL) and the posterolateral corner (PLC) of the knee results in posterolateral rotatory instability. The detailed anatomy and kinematics of the PCL is well described in the literature as well as the anatomy of the PLC; however, the detailed kinematics of the posterolateral corner ligaments and tendons are not well understood. This information on the posterolateral corner is important for developing a strategy for accurate anatomical reconstructions. Therefore, the purpose of this study was to quantify the detailed kinematics of the posterolateral corner of the knee ligaments and tendons.

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