Tibial Slope Strongly Influences Knee Stability After Posterior Cruciate Ligament Reconstruction: A Prospective 5- to 15-Year Follow-up

2016 ◽  
Vol 45 (2) ◽  
pp. 355-361 ◽  
Author(s):  
Clemens Gwinner ◽  
Andreas Weiler ◽  
Manoussos Roider ◽  
Frederik M. Schaefer ◽  
Tobias M. Jung
Keyword(s):  
Posterior Cruciate Ligament ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Posterolateral Corner ◽  
Knee Stability ◽  
Pcl Reconstruction ◽  
The Mean ◽  
Tibial Translation

Background: The reported failure rate after posterior cruciate ligament (PCL) reconstruction remains high. Previous studies have shown that the tibial slope (TS) influences sagittal plane laxity. Consequently, alterations of TS might have an effect on postoperative knee stability after PCL reconstruction. Hypothesis: We hypothesized that flattening of TS is associated with increased posterior laxity after PCL reconstruction. Study Design: Cohort study; Level of evidence 3. Methods: This study consisted of 48 patients who underwent PCL reconstruction in a single-surgeon series. Eight patients underwent an isolated PCL reconstruction, 27 patients underwent an additional posterolateral corner reconstruction, and 13 patients underwent a combined reconstruction of the PCL, anterior cruciate ligament, and posterolateral corner. Three blinded observers measured TS and the side-to-side difference (SSD) of posterior tibial translation (PTT) before and after PCL reconstruction using standardized stress radiographs. The minimum follow-up was 5 years. Results: At a mean follow-up of 103 months (range, 65-187), the mean SSD of PTT was significantly reduced (10.9 ± 2.9 vs 4.9 ± 4.3 mm; P < .0001). The mean TS was 8.0° ± 3.7° (range, 1°-14.3°) for the operated knee and 7.9° ± 3.2° (range, 2°-15.3°) for the contralateral knee. There was a statistically significant correlation between TS and PTT ( r = −0.77 and R2 = 0.59; P < .0001). In addition, there was a significant correlation between TS and the postoperative reduction of PTT ( r = 0.74 and R2 = 0.55; P < .0001). Subgrouping according to the number of operated ligaments showed no significant differences regarding TS or the mean reduction of PTT. Conclusion: Flattening of TS is associated with a significantly higher remaining PTT as well as a lower reduction of PTT. Notably, these results are irrespective of sex and number of ligaments addressed. Thus, isolated soft tissue procedures in PCL deficiency may only incompletely address posterior knee instability in patients with flattening of the posterior slope.

Slope-Reducing Tibial Osteotomy Combined With Primary Anterior Cruciate Ligament Reconstruction Produces Improved Knee Stability in Patients With Steep Posterior Tibial Slope, Excessive Anterior Tibial Subluxation in Extension, and Chronic Meniscal Posterior Horn Tears

2020 ◽  
Vol 48 (14) ◽  
pp. 3486-3494
Author(s):  
Guan-yang Song ◽  
Qian-kun Ni ◽  
Tong Zheng ◽  
Zhi-jun Zhang ◽  
Hua Feng ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Tibial Osteotomy ◽  
Knee Stability ◽  
Anterior Tibial ◽  
Kt 1000 ◽  
The Mean ◽  
Anterior Cruciate

Background: Steep posterior tibial slope (PTS; >13°), excessive anterior tibial subluxation (ATS) in extension (>10 mm), and meniscus posterior horn tears (MPHTs) have been identified to be associated with primary anterior cruciate ligament (ACL) reconstruction (ACLR) failure. Recent studies have reported that steep PTS is directly correlated with excessive ATS in extension and concomitant MPHTs, especially for those patients with chronic (>6 months) ACL deficiency. There is increasing biomechanical evidence that slope-reducing tibial osteotomy decreases ATS in extension and protects the ACL graft. Hypothesis: Slope-reducing tibial osteotomy combined with primary ACLR is effective for producing improved knee stability in patients with steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months). Study Design: Case series; Level of evidence, 4. Methods: Between June 2016 and January 2018, 18 patients with ACL injuries who had steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months) underwent slope-reducing tibial osteotomy combined with primary ACLR. The PTS and anterior subluxation of the lateral and medial compartment (ASLC and ASMC) in extension before and after the index procedures were regarded as primary clinical outcomes. Moreover, Lysholm score, Tegner activity score, International Knee Documentation Committee (IKDC) objective grade, pivot-shift test, and KT-1000 side-to-side difference were evaluated preoperatively and at the minimum 2-year follow-up visit. Results: The mean PTS was 18.5° (range, 17°-20°) preoperatively and 8.1° (range, 7°-9°) postoperatively ( P < .01). The mean ASLC and ASMC in extension were 12.1 mm and 11.9 mm preoperatively, which reduced to 1.0 mm and 1.5 mm at the last follow-up visit ( P < .05). In addition, all of the following showed significant improvements (pre- vs postoperatively): mean Lysholm score (46.5 vs 89.5; P < .05), mean Tegner activity score (5.7 vs 7.3; P < .05), IKDC objective grading results (18 grade D vs 14 grade A and 4 grade B; P < .05), pivot-shift tests (15 grade 2+ and 3 grade 3+ vs 18 grade 0; P < .01), and KT-1000 side-to-side difference (13.0 mm vs 1.6 mm; P < .01). Moreover, no graft reruptures were found at the final follow-up visit. Conclusion: In this study, slope-reducing tibial osteotomy combined with primary ACLR effectively improved knee stability in patients with steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months).

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.

scholarly journals Evaluating the results of an all-inside arthroscopic posterior cruciate ligament reconstruction using hamstring tendon autograft

2021 ◽  
Vol 10 (4) ◽  
Author(s):  
Anh Tuan Nguyen ◽  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Posterior Cruciate Ligament Reconstruction ◽  
Cruciate Ligament Reconstruction ◽  
Hamstring Tendon Autograft ◽  
The Mean ◽  
Tendon Autograft

Abstract Introduction: The posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) are important to ensure the stability of the knee joint. Both PCL and ACL can be injured, but PCL injuries are much less common than ACL injuries. In order to summarize the experience and improve the quality of treatment, we conducted the research with the aim is to evaluate the results of arthroscopic all-inside posterior cruciate ligament reconstruction using hamstring tendon autograft. Materials and methods: From June 2018 to December 2019, all patients who had posterior cruciate ligament (PCL) rupture treated with all-inside arthroscopy PCL reconstructions using semitendinous and gracilis autograft at the Joint Surgery Department of 108 Military Central Hospital were enrolled. The results were evaluated according to the Lysholm - Gilquist and IKDC - 2000 score. Results: 28 patients were enrolled. The mean age was 34,1 years (range: 20 – 55 years old), the mean follow-up time was 15,8 months, good results accounted for 35,7%, fair: 57,1%, average: 7,2%. Conclusions: In patients with PCL rupture, who were treated with arthroscopy PCL reconstruction by all - inside technique, the results were good prospects. However, it needs to assess more patients and to follow-up for long term.

scholarly journals Clinical outcome of arthroscopic management of isolated posterior cruciate ligament injuries

2016 ◽  
Vol 2 (4) ◽  
pp. 411
Author(s):  
Suresh Perumal ◽  
Sadem Amer ◽  
Prakash Ayyadurai ◽  
Arumugam Sivaraman
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Hamstring Tendon ◽  
Lysholm Score ◽  
Radiographic Evaluation ◽  
Pcl Reconstruction ◽  
Avulsion Fractures ◽  
Arthroscopic Management

<p class="abstract"><strong>Background:</strong> Isolated posterior cruciate ligament<strong> (</strong>PCL) injuries are considered as benign and treated conservatively. But studies have shown the long term outcomes of these patients are poor. Aim of this study is to determine the functional outcomes, efficacy, and complication of isolated PCL injuries treated by arthroscopic PCL reconstruction or fixation.</p><p class="abstract"><strong>Methods:</strong> 24 patients, each with an isolated PCL injury, (17 with complete PCL tear and 7 with PCL avulsion fracture) were enrolled in this prospective study. Patients with complete tear underwent PCL reconstruction with hamstring tendon autograft and patients with displaced avulsion fractures underwent arthroscopic fixation with suture bridge technique. Average age at time of surgery was 33 years. Average time from injury to surgery was 1 month. Average follow-up period was 18 months. Patients underwent regular follow-up postoperatively with clinical and radiographic evaluation. Follow-up examinations comprised the Lysholm knee score, the International Knee Documentation Committee (IKDC) score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean preoperative Lysholm score for 24 knees was 41; mean postoperative Lysholm score was 90. Eighteen of 24 patients had excellent results, and 4 patients had good results and 2 patients have fare result at final assessment. IKDC ratings showed significant improvements on subsequent follow ups. In final IKDC ratings, 21 patients were assessed as normal or near normal (grade A or B).</p><p class="abstract"><strong>Conclusions:</strong> The short-term follow-up, analytical results showed good function after arthroscopic management in isolated PCL injuries. Hence we recommend surgical intervention in isolated PCL injuries.</p>

scholarly journals Arthroscopic Standard Anterior and Posteromedial Portal Posterior Cruciate Ligament Reconstruction With Remnant Preservation : 2-Year Follow-up

2020 ◽  
Vol 8 (B) ◽  
pp. 418-422
Author(s):  
Sholahuddin Rhatomy ◽  
Erwin Saspraditya ◽  
Riky Setyawan
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Pcl Reconstruction ◽  
Remnant Preservation ◽  
Lysholm Knee Score ◽  
Ikdc Score ◽  
Grade 3 ◽  
Pcl Injury

BACKGROUND: Grade 3 posterior cruciate ligament (PCL) injury needs surgical intervention, but there is no consensus on the optimal technique in PCL reconstruction. The old technique always removes the remnant for good visualization of tunnel replacement. Recently, many studies proposed the concept of preservation of PCL remnant with achieve good visualization. AIM: The aim of the study is to evaluate PCL reconstruction with remnant preservation using the standard anterior and posteromedial portal at 2-year follow-up. METHODS: We conducted a cohort retrospective study between January 2013 and December 2015. In this study, 25 patients underwent PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation. We used quadrupled hamstring autograft. The patients were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm Knee Score, Modified Cincinnati Score, and knee society score (KSS) at pre-operative and 2-year post-operative. Range of motion (ROM) and complications were evaluated postoperatively. RESULTS: The mean diameter of the quadruple hamstring graft was 8 mm. Clinical outcomes enhanced significantly (p < 0.05). The average of Lysholm activity scale improved from 65.12 ± 10.48 to 94.96 ± 4.80. The IKDC score improved from 60.50 ± 15.10 to 95.60 ± 3.44. Modified Cincinnati score improved from 62. 28 ± 13.6 to 96.04 ± 1.62. The KSS also improved from 60.12 ± 18.01 to 94.88 ± 6.36. Twenty-two patients had 0–135° full ROM and three patients had 0–110° ROM. Two patients had surgical site infection but recovered with local debridement. CONCLUSION: PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation at 2-year follow-up resulted in satisfactory clinical and functional outcomes.

scholarly journals Arthroscopic Reconstruction of the Posterior Cruciate Ligament With Ligament Advanced Reinforcement System and Hamstring Tendon Autograft :A Retrospective Study

2020 ◽  
Author(s):  
Yang Luo ◽  
Zhigang Wang ◽  
Zhijiang Li ◽  
Min Wei
Keyword(s):  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Knee Stability ◽  
Pcl Reconstruction ◽  
Hamstring Tendon Autograft ◽  
Functional Scores ◽  
The Difference ◽  
Ligament Advanced Reinforcement System ◽  
Tendon Autograft

Abstract Background Both Ligament Advanced Reinforcement System(LARS) and hamstring tendon autograft can serve as grafts for posterior cruciate ligament (PCL) reconstruction but few studies compared their differences.This study aimed to compare the clinical efficacy of arthroscopic reconstruction of PCL with LARS and hamstring tendon autograft. Methods 36 patients who had received PCL reconstruction under arthroscopy were retrospectively analyzed. 15 patients received reconstruction using LARS (LARS group) and 21 using hamstring tendon autograft (HT group). The pre- and post-operative subjective scores and knee stability were evaluated. Results 36 patients were followed up for a period of 2 to 10.5 years (4.11±2.0 years on average). The last follow-up showed that functional scores and knee stability were all significantly improved in both groups (P<0.05). Six months after operation, Lysholm scores and IKDC subjective scores were higher in LARS group than in HT group (P<0.05). Nonetheless, the last follow-up showed no statistically significant differences in the functional scores and the posterior drawer test between the two groups (P>0.05). In LARS group and HT group, 12 and 9 patients, respectively had KT1000 values less than 3 mm, with the difference being statistically significant (P<0.05). In HT group, the diameter of the four-strand hamstring tendon was positively correlated with height (P<0.05),which was 7.37±0.52mm in males and 6.50±0.77 mm in females, and the difference was statistically significant (P<0.05). Conclusion Both LARS and hamstring tendon could achieve good clinical efficacy for PCL reconstruction ，but patients in LARS group had faster functional recovery and better knee stability. LARS is especially suitable for those who hope to resume activities as early as possible.

Treatment of Tibial Avulsion Fracture of Posterior Cruciate Ligament by Open Reduction and Internal Fixation

2020 ◽  
Vol 9 (1) ◽  
pp. 17-21
Author(s):  
Ranjib Kumar Jha ◽  
Santosh Thapa
Keyword(s):  
Clinical Outcome ◽  
Internal Fixation ◽  
Functional Outcome ◽  
Posterior Cruciate Ligament ◽  
Open Reduction ◽  
Avulsion Fracture ◽  
Cruciate Ligament ◽  
Avulsion Injury ◽  
The Mean

Background: An avulsion fracture of posterior cruciate ligament from tibial attachment is more common in younger age group. It should be fixed otherwise it may lead to secondary changes in knee. Various techniques and approaches are available to fix posterior cruciate ligament avulsion. Different biomechanical studies have shown that, results both open and arthroscopic methods of fixation of posterior cruciate ligament avulsion by screws are comparable. The purpose of study is to evaluate functional and clinical outcome of open reduction and fixation of posterior cruciate ligament avulsion injury through posteromedial approach. Materials and Methods: The study enrolled 19 cases of isolated posterior cruciate ligament avulsion injury with mean age of 33.21±9.07 year. All cases were treated by open reduction and internal fixation through modified posterior approach. The patients having duration of injury more than 12 weeks were excluded. The minimum follow up duration was 12 months. Results were assessed clinically and radiologically. Final functional outcome was assessed using the Lysholm scoring for knee. Results: The mean duration of follow up was 14±1.85 months. All patients achieved union at 3months. At final follow up the mean range of motion was 125.42±6.37 degree (range 110 to 135 degree) without any extensor lag. The functional outcome assessed by Lysholm scoring system was excellent in 15 cases and good in 4 cases. Conclusion: Open reduction and internal fixation with early range of motion exercises provides good clinical outcome and stable knee.

Change in Posterior Tibial Slope in Skeletally Immature Patients With Anterior Cruciate Ligament Injury: A Case Series With a Mean 9 Years’ Follow-up

2021 ◽  
pp. 036354652199709
Author(s):  
R. Kyle Martin ◽  
Guri R. Ekås ◽  
JūratėŠaltytė Benth ◽  
Nicholas Kennedy ◽  
Gilbert Moatshe ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Case Series ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Skeletally Immature ◽  
Posterior Tibial ◽  
Lateral Posterior ◽  
The Mean ◽  
Injured Knee

Background: Increased lateral posterior tibial slope (LPTS) is associated with increased rates of anterior cruciate ligament (ACL) injury and failure of ACL reconstruction. It is unknown if ACL deficiency influences the developing proximal tibial physis and slope in skeletally immature patients through anterior tibial subluxation and abnormal force transmission. Purpose: To assess the natural history of LPTS in skeletally immature patients with an ACL-injured knee. Study Design: Case series; Level of evidence, 4. Methods: A total of 38 participants from a previous study on nonoperative management of ACL injury in skeletally immature patients were included. During the initial study, bilateral knee magnetic resonance imaging (MRI) was performed within 1 year of enrollment and again at final follow-up. All patients were younger than 13 years at the time of enrollment, and final follow-up occurred a mean 10 years after the injury. MRI scans were retrospectively reviewed by 2 reviewers to determine bilateral LPTS for each patient and each time point. Linear mixed models were used to assess LPTS differences between knees, change over time, and association with operational status. Subgroup analyses were performed for patients who remained nonoperated throughout the study. Results: A total of 22 patients had ACL reconstruction before final follow-up and 16 remained nonoperated. In the entire study population, the mean LPTS was higher in the injured knee than in the contralateral knee at final follow-up by 2.0° ( P < .001; 95% CI, 1.3°–2.6°). The mean LPTS increased significantly in the injured knee by 0.9° ( P = .042; 95% CI, 0.03°–1.7°), while the mean LPTS decreased in the contralateral knee by 0.4° ( P = .363; 95% CI, –0.8° to 0.4°). A significant difference in LPTS was also observed in the nonoperated subgroup. No significant association was observed between LPTS and operational status. Conclusion: Lateral posterior tibial slope increased more in the ACL-injured knee than in the contralateral uninjured knee in a group of skeletally immature patients. Lateral posterior tibial slope at baseline was not associated with the need for surgical reconstruction over the study period.

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.

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