scholarly journals Experimental validation of a new technique for the assessment of posterior tibial translation (ABC angle) after posterior cruciate ligament rupture

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
M. Severyns ◽  
M.-E. Rollet ◽  
T. Vendeuvre ◽  
S. Pesenti ◽  
A. Benzakour ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Reference Method ◽  
New Technique ◽  
Radiographic Measurement ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Significant Difference ◽  
Posterior Translation ◽  
A New Technique ◽  
Tibial Translation

Abstract Background The aim of this cadaver study was to evaluate an original technique for measuring posterior tibial translation based on an angle value instead of a distance value, with and without posterior stress application. It was hypothesized that an angle measurement of the posterior tibial translation would confirm the presence of a PCL tear with the knee flexed and completely extended. Method Using fresh cadavers, a set of strict lateral views were taken by fluoroscopy with the knee at 0°, 45° and 90° flexion on the intact knee and after transecting the PCL. The primary endpoint was the change in the posterior translation measured using a new technique, the ABC angle. This measurement was compared to the conventional posterior translation distance measurement with and without a posterior stress placed on the knee. Results Application of a posterior stress revealed clear changes in posterior translation after PCL transection with the knee at 0° for the angle technique and at 45° and 90° for the two techniques (p < 0.05). Contrary to the reference method, the ABC angle method found a statistically significant difference in posterior translation with the knee in extension. Conclusion Our technique provides a reliable radiographic measurement of posterior translation with the knee in extension, which should make it easier to acquire radiographs in patients who have pain with knee flexion. This angular measurement also has the advantage of not needing length calibration contrary to the reference technique. Level of evidence IV

Two-Bundle Posterior Cruciate Ligament Reconstruction: An In Vitro Analysis of Graft Placement and Tension

1999 ◽  
Author(s):  
Jason T. Shearn ◽  
Dana A. Mannor ◽  
Edward S. Grood ◽  
Martin S. Levy ◽  
Frank R. Noyes
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Load Sharing ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Posterior Translation ◽  
Vitro Analysis ◽  
Tibial Translation ◽  
Loss Of Strength

Abstract The posterior cruciate ligament (PCL) provides over 90% of the forces that resist posterior tibial translation (Butler et al., 1980). When the PCL is ruptured the resulting change in joint kinematics and kinetics can lead to patello femoral pain and joint arthritic. These changes can effect daily activity requiring reconstruction (Satku et al, 1984). Although the goal of PCL reconstruction is to restore the normal limit of posterior tibial translation (Andrews et al., 1994), there is a frequent recurrence of posterior translation (Markolf et al Part I, 1997). The recurrence is believed to be caused by graft elongation/failure. The failure is probably due to non-uniform load sharing among graft fibers combined with large forces and the loss of strength during remodeling (Markolf et al Part II, 1997). The governing hypothesis of this study is that improving load sharing among graft fibers can reduce graft failures. We are pursuing a technique that divides the graft into two bundles so that the bundles have separate attachments and can be separately tensioned. The purpose of this study was to determine the ability of one and two bundle reconstructions to control posterior translation, and to determine how femoral attachment location affected bundle tension.

The Effects of a Popliteus Muscle Load on In Situ Forces in the Posterior Cruciate Ligament and on Knee Kinematics

1998 ◽  
Vol 26 (5) ◽  
pp. 669-673 ◽  
Author(s):  
Christopher D. Harner ◽  
Jürgen Höher ◽  
Tracy M. Vogrin ◽  
Gregory J. Carlin ◽  
Savio L-Y. Woo
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Tibial Rotation ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Tibial Translation ◽  
Intact Knee ◽  
Popliteus Muscle

To investigate the effect of simulated contraction of the popliteus muscle on the in situ forces in the posterior cruciate ligament and on changes in knee kinematics, we studied 10 human cadaveric knees (donor age, 58 to 89 years) using a robotic manipulator/universal force moment sensor system. Under a 110-N posterior tibial load (simulated posterior drawer test), the kinematics of the intact knee and the in situ forces in the ligament were determined. The test was repeated with the addition of a 44-N load to the popliteus muscle. The posterior cruciate ligament was then sectioned and the knee was subjected to the same tests. The additional popliteus muscle load significantly reduced the in situ forces in the ligament by 9% to 36% at 90° and 30° of flexion, respectively. No significant effects on posterior tibial translation of the intact knee were found. However, in the ligament-deficient knee, posterior tibial translation was reduced by up to 36% of the translation caused by ligament transection. A coupled internal tibial rotation of 2° to 4° at 60° to 90° of knee flexion was observed in both the intact and ligament-deficient knees when the popliteus muscle load was added. Our results indicate that the popliteus muscle shares the function of the posterior cruciate ligament in resisting posterior tibial loads and can contribute to knee stability when the ligament is absent.

Anatomy and Biomechanics of the Posterior Cruciate Ligament

2021 ◽  
Vol 34 (05) ◽  
pp. 499-508
Author(s):  
Thomas B. Lynch ◽  
Jorge Chahla ◽  
Clayton W. Nuelle
Keyword(s):  
Posterior Cruciate Ligament ◽  
Clinical Decision Making ◽  
Cruciate Ligament ◽  
Primary Role ◽  
X Rays ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Knee Pathology ◽  
Tibial Translation

AbstractPosterior cruciate ligament (PCL) injuries are often encountered in the setting of other knee pathology and sometimes in isolation. A thorough understanding of the native PCL anatomy is crucial in the successful treatment of these injuries. The PCL consists of two independent bundles that function in a codominant relationship to perform the primary role of resisting posterior tibial translation relative to the femur. A secondary role of the PCL is to provide rotatory stability. The anterolateral (AL) bundle has a more vertical orientation when compared with the posteromedial (PM) bundle. The AL bundle has a more anterior origin than the PM bundle on the lateral wall of the medial femoral condyle. The tibial insertion of AL bundle on the PCL facet is medial and anterior to the PM bundle. The AL and PM bundles are 12-mm apart at the center of the femoral origins, while the tibial insertions are more tightly grouped. The different spatial orientation of the two bundles and large distance between the femoral centers is responsible for the codominance of the PCL bundles. The AL bundle is the dominant restraint to posterior tibial translation throughout midrange flexion, while the PM bundle is the primary restraint in extension and deep flexion. Biomechanical testing has shown independent reconstruction of the two bundles that better reproduces native knee biomechanics, while significant differences in clinical outcomes remain to be seen. Stress X-rays may play an important role in clinical decision-making process for operative versus nonoperative management of isolated PCL injuries. Strong understanding of PCL anatomy and biomechanics can aid surgical management.

Measurement of Posterior Tibial Translation in the Posterior Cruciate Ligament-Reconstructed Knee

2003 ◽  
Vol 31 (6) ◽  
pp. 843-848 ◽  
Author(s):  
C. Benjamin Ma ◽  
Akihiro Kanamori ◽  
Tracy M. Vogrin ◽  
Savio L-Y. Woo ◽  
Christopher D. Harner
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Tibial Translation ◽  
Reconstructed Knee

scholarly journals Vascular Complications in Arthroscopic Repair Of Posterior Cruciate Ligament

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0001
Author(s):  
Juan Ignacio Agotegaray ◽  
Ignacio Comba ◽  
Luciana Bisiach ◽  
María Emilia Grignaffini
Keyword(s):  
Vascular Surgery ◽  
Posterior Cruciate Ligament ◽  
Popliteal Artery ◽  
Cruciate Ligament ◽  
Vascular Complications ◽  
Arthroscopic Repair ◽  
Vascular Lesions ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Tibial Translation

Introduction: Posterior cruciate ligament is the primary stabilizer of the knee. Among the potential complications in arthroscopic repair of this ligament, there are vascular lesions, due to laceration, thrombosis and injury of the intima of the popliteal artery. We used one case to show the vascular complications that may arise in arthroscopic repair of the posterior cruciate ligament, how to handle it and the results. Methods: One patient, 33 years old, with a history of traffic accident. In a physical exam the patient shows pain and swelling of the knee, positive posterior drawer test and positive Godfrey test. X-rays on the knee show posterior tibial translation and MRI a complete fibers rupture at the middle third of the posterior cruciate ligament. An arthroscopic repair surgery was scheduled three weeks after trauma, with PCL reconstruction using simple band technique.After surgical intervention, hemostatic cuff was released, no peripheral pulse, paleness and coldness of the member was confirmed. An arteriography was carried out, which confirmed absences of distal vascular filling in the popliteal artery. An urgent referral was carried out with Vascular Surgery Services, who had been informed of the surgery previously (a notification that is part of our routine for this kind of interventions). Arteriorrhaphy and venorrhaphy of the popliteal arteries was fulfilled 12 hours later, with a leg fasciotomy. Daily monitoring was performed, and after 72 hours, muscle necrosis is seen with wound drainage, analysis shows presence of gram-negative bacilli, Proteus Mirabilis-Pseudomonas spp and the lab results showed leukocytes: 8.700/ml, ESR: 58, CRP: 48. A new surgery is performed with complete resection of the anterior external compartment of the leg, and a system of continuous cleansing is applied with physiological saline solution and boric acid for 14 days until drainage is eliminated. Vancomycin and ceftazidime EV was indicated for 14 days and, after a good evolution of the wounds, patient is discharged from hospital with Sulfamethoxazole/trimethoprim 160mg/800mg to be taken orally for 14 days. Results: After treatment with oral antibiotic is completed, wounds progress positively. Foot in equinus position, has positive distal pulses with distal sensibility. Use of a thermoforming brace is indicated for movement. Vascular Surgery Services are currently following patient’s evolution. An ankle arthrodesis surgery is evaluated for the future. Conclusion: Combined injuries that result in a posterior tibial translation over 15 mm and, those that come along with injuries in the anterior cruciate ligament or posterior lateral structures of the knee, should be repaired through surgery. Vascular lesion caused by laceration, thrombosis or injury of the intima of the popliteal artery, mainly during perforation and preparation of tibial tunnel, is a serious lesion. Although these vascular lesions during arthroscopy are complications relatively rare, a potential risk should be considered, with consequences that could be fatal for the extremity and for patient’s life when bleeding is involved. In those cases, urgent treatment is imperative, that is the reason we believe it is safe to coordinate with Vascular Surgery Services before the surgery is carried out.

scholarly journals Sequential Changes in Posterior Tibial Translation After Posterior Cruciate Ligament Reconstruction: Risk Factors for Residual Posterior Sagging

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110098
Author(s):  
Yuta Tachibana ◽  
Yoshinari Tanaka ◽  
Kazutaka Kinugasa ◽  
Masayuki Hamada ◽  
Shuji Horibe
Keyword(s):  
Risk Factors ◽  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Multivariate Logistic Regression Analysis ◽  
Radiographic Findings ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Grade 3 ◽  
Tibial Translation

Background: Residual posterior sagging may occur after posterior cruciate ligament (PCL) reconstruction (PCLR), yet when it mainly occurs is not fully understood. Purpose: To elucidate sequential changes in radiographic posterior tibial translation (PTT) after PCLR. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively investigated the radiographic findings from 22 patients who underwent bisocket double-bundle PCLR for isolated PCL injury with at least 2 years of follow-up (mean, 4.5 years; range, 2-10 years). Injury severity was assessed using PTT on lateral radiographs with gravity sag views and was stratified according to side-to-side difference in the tibial-femoral stepoff: grade 1 (<5 mm), grade 2 (5 to <10 mm), or grade 3 (≥10 mm). Measurements were taken preoperatively and then immediately, 3 months, 6 months, 1 year, and ≥2 years postoperatively. The authors also investigated the risk factors for residual posterior sagging, indicated when PTT was ≥5 mm (grade ≥2) at the minimum 2-year follow-up. Results: Preoperatively, 13 patients had a grade 2 injury, and 9 had grade 3 injury. The PTT, restored immediately after PCLR, significantly increased at 3 months ( P < .001) but remained unchanged thereafter ≥2 years. There were 7 cases of postoperative PTT ≥5 mm on radiographs. Patients with residual posterior sagging had significantly larger mean PTT than did those without residual posterior sagging at all time points except for immediately postoperatively (preoperatively, 9.1 ± 1.6 vs 12.2 ± 2.3 mm; 3-month follow-up, 2.7 ± 1.6 vs 7.0 ± 1.8 mm; ≥2-year follow-up, 3.4 ± 1.0 vs 6.5 ± 1.4 mm; P < .001 for all). Multivariate logistic regression analysis showed that preoperative grade 3 injury was independently associated with residual posterior sagging (OR, 26.809; 95% CI, 1.257-571.963; P < .001). Conclusion: The initially reduced postoperative PTT significantly increased within 3 months using conventional rehabilitation protocols, but no progression was observed up to 4.5 years after PCLR. Preoperative grade 3 injury was independently associated with residual posterior sagging.

scholarly journals Passive Posterior Tibial Subluxation on Routine Knee MRI as a Secondary Sign of PCL Tear

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Andrew J. Degnan ◽  
Catherine Maldjian ◽  
Richard J. Adam ◽  
Christopher D. Harner
Keyword(s):  
Interobserver Agreement ◽  
Weight Bearing ◽  
Intraclass Correlation ◽  
Ligament Injury ◽  
Clinical Test ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Knee Mri ◽  
Significant Difference ◽  
Tibial Translation

The posterior drawer test is an accurate clinical test to diagnose posterior cruciate ligament (PCL), indicating laxity of the PCL that allows posterior tibial translation. This study aimed to determine whether posterior tibial translation relative to the femur on routine MRI could serve as an additional sign of PCL tear. Routine knee MRI in eleven patients (7 males, 4 females) with arthroscopically confirmed isolated PCL tears were reviewed independently by two musculoskeletal radiologists. Measurements of tibial translation were made in the medial and lateral compartments of patients and controls (10 males, 12 females) without clinical or MRI evidence of ligament injury. Significant medial compartment posterior tibial translation was present in patients with PCL tear compared to controls (+2.93 mm versus +0.03 mm,P=0.002) with excellent interobserver agreement (intraclass correlation coefficient (ICC) = 0.94). No significant difference in lateral compartment tibial translation was observed (+0.17 mm versus −0.57 mm,P=0.366) despite excellent interobserver agreement (ICC = 0.96). Posterior tibial translation in the midmedial compartment may be a secondary sign of isolated PCL tear on routine knee MRI with passive extension without manipulation or weight bearing. Additional work in a larger cohort may better address the accuracy of this finding.

Sign in / Sign up

Export Citation Format

Share Document