scholarly journals The pushed quadriceps active test – A modification of the quadriceps active test to diagnose PCL deficiency

2021 ◽  
Vol 2 ◽  
pp. 128-130
Author(s):  
Srinivas B. S. Kambhampati ◽  
Bharat Guthikonda
Keyword(s):  
Posterior Cruciate Ligament ◽  
Proximal Tibia ◽  
Cruciate Ligament ◽  
Posterior Drawer

Quadriceps active (QA) test has been described and well known for the diagnosis of posterior cruciate ligament (PCL) deficiency. We describe a modification of the QA test to diagnose PCL deficiency. Pushed QA test consists of two components where the examiner pushes the proximal tibia posteriorly with the knee flexed <90° in the first part of the test translating the tibia posteriorly like in the posterior drawer test while the patient reduces the translation actively by contracting the quadriceps in the second part like in the QA test.

scholarly journals Arthroscopic Reconstruction of Chronic Isolated Posterior Cruciate Ligament Instability in a Professional Dancer

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0022 ◽  
Author(s):  
Neslihan Aksu ◽  
Burak Abay ◽  
Ramazan Soydan ◽  
Ertuğrul Ercan
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Lysholm Score ◽  
Single Bundle ◽  
Reconstruction Technique ◽  
Arthroscopic Reconstruction ◽  
Professional Career ◽  
Posterior Drawer

Objectives: Chronic isolated injuries of the posterior cruciate ligament (PCL) are very rare in the literature. PCL injuries are often presented undiagnosed because of the weak signs of the injury compared to the anterior cruciate ligament (ACL) injuries. We report the surgical outcome of arthroscopic reconstruction of the chronic isolated PCL rupture with ipsilateral autologous hamstring tendon in a professional Caucasian dancer. Methods: A 21-year-old male professional Caucasian dancer presented severe instability without any pain in his right knee lasting for one year. The patient did not describe any specific traumatic event but his both knees received repeatitive direct pretibial trauma during hyperflexion of the knee while landing to the floor. At the physical examination, posterior sagging of the tibia was observed on the affected side at 90o of knee flexion and step off test and posterior drawer test were positive preoperatively under general anesthesia. The Tegner Lysholm score was evaluated as 59 (poor). A magnetic resonance image (MRI) revealed the isolated total rupture of PCL. The treatment of choice was arthroscopic single bundle reconstruction of PCL with ipsilateral autologous hamstring tendon. A standard arthroscopic exploration of the joint was performed preoperatively and we didn't observe any meniscal, cartilage or ligamentous lesion. Anteromedial and anterolateral portals were made in order to visualize the posterior cortex of the tibia with a 70 degree scope. Intra-operative fluroscopy was used to confirm proper tunnel position. During postoperatively first week, the patient was allowed to mobilize nonweight bearing with the use of two crutches without functional knee brace. Quadriceps musculature and passive range of motion was trained. Results: At the 6 month- follow-up, the patient achieved full symmetric restoration of motion. He had returned to full daily activies. The Tegner Lysholm score was evaluated as 95 (excellent) postoperatively. Functional examination of the right knee reveled 140 of flexion, and full knee extension. No posterior sagging was observed and step off test and posterior drawer test was negative. The complaint of instability was disappeared. At 1-year follow-up, clinical findings were unremarkable, with no sign of re-rupture and he returned to his professional career. Conclusion: Surgical reconstruction technique of the PCL and associated rehabilitation protocols has not yet been fully standardized and much work still has be done optimizing correct treatment of PCL injuries. The arthroscopic reconstruction of chronic isolated PCL instability is a very difficult technique as well as its diagnosis. The reconstruction is very beneficial in the athletes and the patients who are not responding well to the conservative treatment.

scholarly journals AUGMENTATION POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING PERONEAL LONGUS TENDON ON AVULSION PCL : CASE SERIES

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0006
Author(s):  
Deri Mulyadi ◽  
Sholahudin Rhatomy ◽  
Dwikora Novembri Utama
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Arthroscopic Surgery ◽  
Functional Score ◽  
Pcl Reconstruction ◽  
Peroneus Longus Tendon ◽  
Longus Tendon ◽  
Posterior Drawer ◽  
Peroneus Longus ◽  
Pcl Avulsion

Posterior Cruciate Ligament (PCL) avulsion may mimics PCL rupture with positive posterior drawer test. Treatment of choice to PCL avulsion is vary from open surgery to arthroscopic surgery. This study aims is to evaluate the knee functional score using augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Presentation of Case: We report 3 cases, 1 male and 2 females. The result of physical examination, X-ray examination, and MRI of the knee showed a PCL avulsion. Posterior drawer test showed grade 2 result. We performed an augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Knee scoring (IKDC, Modified Cincinnati, TegnerLysholm) collected pre-operative and 2 years post-operative. The result of knee scoring was significant improved in post-operative compare to before surgery. Discussions: The use of conventional screw on thin, small, and comminuted fragments cannot fix the bone and may causes bone fragmentation. Fixation technique using sutures produces unstable results and does not provide maximum pressure to fix the bone. Augmented PCL reconstruction surgery gives excellent result based on knee scoring system. Conclusion: Augmented PCL reconstruction can be considered to be an alternative treatment of PCL avulsion because the procedure has excellent post-operative knee scoring result.

Posterior Cruciate Ligament Response to Proximal Tibia Impact

2019 ◽  
Author(s):  
Alexia Ciontea ◽  
Hannah Gustafson ◽  
Julie Mansfield ◽  
Joe McFadden ◽  
Bruce Donnelly ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Proximal Tibia ◽  
Cruciate Ligament

scholarly journals Arthroscopic Suture Fixation With Autograft Augmentation Reconstruction for Delayed Tibial Avulsion Fractures of the Posterior Cruciate Ligament

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094404
Author(s):  
Mingguang Bi ◽  
Chen Zhao ◽  
Jihang Chen ◽  
Zheping Hong ◽  
Zhen Wang ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Case Series ◽  
Suture Fixation ◽  
Level Of Evidence ◽  
Avulsion Fractures ◽  
Posterior Drawer ◽  
Kt 1000 ◽  
The Mean

Background: The optimal surgical treatment of delayed avulsion fractures of the posterior cruciate ligament (PCL) is still controversial. Purpose: To evaluate the clinical results of arthroscopic suture fixation of tibial avulsion fractures of the PCL with autograft augmentation reconstruction. Study Design: Case series; Level of evidence, 4. Methods: From January 2013 to February 2017, we treated 15 patients with delayed tibial avulsion fractures of the PCL arthroscopically through posteromedial and posterolateral portals. The PCL and avulsion bone fragment were fixed with No. 2 nonabsorbable FiberWire sutures that were pulled out through a single tibial bone tunnel and fixed on a small Endobutton. Concomitantly, anatomic PCL augmentation reconstruction was performed, and the graft was pulled out through the same tunnel and fixed with an interference screw. Knee stability was assessed using the posterior drawer test, and the side-to-side difference was determined using a KT-1000 arthrometer with 134 N of posterior force at 30° of knee flexion. The International Knee Documentation Committee (IKDC) 2000 subjective form and Lysholm scale were used to evaluate clinical outcomes at follow-up. Overall, 12 patients were enrolled for analysis. The mean follow-up period was 34.4 months (range, 26-49 months). Results: At the final follow-up, 2 patients encountered 10° terminal flexion limitations. All patients had negative posterior drawer test results. The KT-1000 arthrometer side-to-side difference was significantly decreased from 8.25 ± 1.96 mm preoperatively to 1.08 ± 0.86 mm at the last follow-up ( P < .001). The mean IKDC and Lysholm scores, respectively, increased from 54.67 ± 7.13 and 53.50 ± 7.90 preoperatively to 91.13 ± 3.78 and 94.25 ± 3.32 at the final follow-up ( P < .001 for both). Conclusion: Arthroscopic suture fixation with autograft augmentation reconstruction for delayed tibial avulsion fractures of the PCL showed good clinical stability and function in this study.

POSTERIOR CRUCIATE LIGAMENT (PCL) RECONSTRUCTION BY TRANSTIBIAL TUNNEL: SUGGESTIONS OF LENGTHENING AND SLIPPAGE RATIO

2010 ◽  
Vol 24 (15n16) ◽  
pp. 2579-2584
Author(s):  
JAY-JUNG KIM ◽  
CHEOL-WOONG KIM
Keyword(s):  
Soft Tissue ◽  
Achilles Tendon ◽  
Posterior Cruciate Ligament ◽  
Proximal Tibia ◽  
Fatigue Behavior ◽  
Cruciate Ligament ◽  
Total Elongation ◽  
Fixation Method ◽  
Tissue Fixation ◽  
Double Cross

This paper examined the biomechanical fatigue behavior of Achilles tendon autograft after posterior cruciate ligament (PLC) reconstructions. It experimented with various fixation devices and locations on the degree of initial lengthening and slippage to investigate the relationship between lengthening and slippage ratios among calcaneal and soft tissue fixation methods. Eight specimens of proximal tibia and Achilles tendon grafts were harvested from cadavers and classified into four groups according to the type of transtibial fixation technique. A cyclic load ranging from 50N to 250N was applied to each graft when fixed to the proximal tibia at 55 degrees. The soft tissue fixation method, which uses an interference screw, demonstrated a 56.4% ratio of slippage to total elongation. The use of a double cross-pin with the same method demonstrated a 45.4% slippage ratio. The former was associated with approximately 2 mm less total elongation and 13% more slippage than lengthening compared to the latter. This result was predominantly due to the poor standard of fixation compared to the same method using a double cross-pin.

scholarly journals ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN POSTERIOR CRUCIATE LIGAMENT DEFICIENT KNEES - WHAT CAN BE SAVED?

2015 ◽  
Vol 2 (4) ◽  
pp. 183-188
Author(s):  
T. C. Munteanu ◽  
Ana-Raluca Mihalcea ◽  
B. Nistor ◽  
G. Dinu
Keyword(s):  
Anterior Cruciate Ligament ◽  
Posterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Full Range ◽  
Rehabilitation Program ◽  
Irreversible Damage ◽  
Posterior Drawer ◽  
Acl Rehabilitation ◽  
Anterior Cruciate

The floppy Anterior Cruciate Ligament (ACL) sign is a well-established arthroscopic and MRI indicator of Posterior Cruciate Ligament (PCL) insufficiency. We explored the diagnostic and therapeutic options in such cases by retrospectively analyzing the management of a series of five consecutive cases of iatrogenic floppy ACL reconstructions which resulted in fixed posterior drawer. All patients were young athletes. Because their ACL rehabilitation program was failing they sought for a new medical expertise. In all cases arthroscopic PCL reconstruction was performed and the acquired injuries after the initial ACL reconstruction were treated. All patients regained full range of motion and stable knees. Confusion between a PCL and an ACL injury still seems to be high. If not addressed accordingly, the fixed posterior drawer may lead to irreversible damage of the knee joint.

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