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Knapik DM, Gopinatth V, Jackson GR, Chahla J, Smith MV, Matava MJ, Brophy RH. Global variation in isolated posterior cruciate ligament reconstruction. J Exp Orthop 2022; 9:104. [PMID: 36209443 PMCID: PMC9548455 DOI: 10.1186/s40634-022-00541-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/29/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose In the setting of persistent instability or failed non-operative management, surgical reconstruction is commonly recommended for isolated posterior cruciate ligament (PCL) tears. The purpose of this study was to systematically review published studies to evaluate regional variation in the epidemiology of and surgical approaches to primary, isolated PCL reconstruction. Methods A systematic review was performed in June 2022 to identify studies examining operative techniques during primary, isolated PCL reconstruction. Collected variables consisted of reconstruction technique, graft type, graft source, tibial reconstruction technique, femoral and tibial drilling and fixation methods, and whether the remnant PCL was preserved or debrided. Studies were classified into four global regions: Asia, Europe, North America, and South America. Results Forty-five studies, consisting of 1461 total patients, were identified. Most of the included studies were from Asia (69%, n = 31/45). Single bundle reconstruction was more commonly reported in studies out of Asia, Europe, and North America. Hamstring autografts were utilized in 51.7% (n = 611/1181) of patients from Asia and 60.8% (n = 124/204) of patients from Europe. Trans-tibial drilling and outside-in femoral drilling were commonly reported in all global regions. The PCL remnant was generally debrided, while remnant preservation was commonly reported in studies from Asia. Conclusion Surgical treatment of isolated PCL injuries varies by region, with the majority of published studies coming from Asia. Single-bundle reconstruction with hamstring autograft through a trans-tibial approach is the most commonly reported technique in the literature, with males reported to undergo isolated reconstruction more often than females. Level of Evidence Systematic review, Level IV. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00541-4.
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Bone fixation techniques for managing joint disorders and injuries: A review study. J Mech Behav Biomed Mater 2021; 126:104982. [PMID: 34852984 DOI: 10.1016/j.jmbbm.2021.104982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 01/14/2023]
Abstract
The majority of surgical procedures treating joint disorders require a technique to realize a firm implant-to-tissue and/or a tissue-to-tissue fixation. Fixation methods have direct effects on survival, performance and integration of orthopedic implants This review paper gives an overview of novel fixation techniques that have been evaluated and optimized for orthopaedic joint implants and could be alternatives for traditional implant fixation techniques or inspirations for future design of joint implantation procedures. METHOD The articles were selected using the Scopus search engine. Key words referring to traditional fixation methods have been excluded to find potential innovative fixation techniques. In order to review the recent anchorage systems, only articles that been published during the period of 2010-2020 have been included. RESULTS A total of 57 studies were analyzed. The result revealed that three main fixation principles are being employed: using mechanical interlockings, employing adhesives, and performing tissue-bonding strategies. CONCLUSION The development of fixation techniques demonstrates a transformation from the general anchoring tools like K-wires toward application-specific designs. Several new methods have been designed and evaluated, which highlight encouraging results as described in this review. It seems that mechanical fixations provide the strongest anchorage. Employing (bio)-adhesives as fixation tool could revolutionize the field of orthopedic surgery. However, the adhesives must be improved and optimized to meet the requirements of an anchorage system. Long-term fixation might be formed by tissue ingrowth approaches which showed promising results. In most cases further clinical studies are required to explore their outputs in clinical applications.
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Li HZ, Yu C, Zhang ZT, Yan S, Liao YJ, Lu DF. Arthroscopic Reconstruction of Posterior Cruciate Ligament with Embedded Tibial Tendon Bolt. Orthop Surg 2021; 13:592-598. [PMID: 33474839 PMCID: PMC7957385 DOI: 10.1111/os.12855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/18/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the effect of newly designed arthroscopic reconstruction of posterior cruciate ligament (PCL) using tibial tendon bolt. METHODS The effects of embedded tendon pin were observed by X-ray of knee joint. From October 2010 to September 2015, 51 PCL injury patients who met the inclusion criteria were enrolled in this retrospective study. The arthroscopically assisted reconstruction of the PCL with tibial tendon bolt was performed on all patients. Visual Analog Scale (VAS) pain score, Tegner activity score, Lysholm score, International Knee Documentation Committee (IKDC) assessment, posterior drawer test (PDT), and KT-1000 activity score were evaluated preoperatively and at 1-year postoperative and 3-year postoperative. RESULTS The preoperative, 1-year postoperative, and 3-year postoperative IKDC score (15.8% ± 14.8%, 89.6% ± 5.8%, and 86.8% ± 5.4%), Lysholm score (17.4 ± 10.7, 91.2 ± 2.8, and 88.2 ± 3.1), VAS score (5.8 ± 1.2, 1.3 ± 0.5, and 0.6 ± 0.5), Tegner activity score (1.2 ± 0.8, 8.1 ± 0.8, and 7.4 ± 0.8), and KT-1000 score (15.6 ± 3.6, 4.5 ± 2.4, and 5.4 ± 1.8) were obtained. There were significant differences in these outcomes among preoperative, 1-year postoperative, and 3-year postoperative (all P < 0.0001). After 1- and 3-year surgery, 31 (60.8%) and 26 (51.0%) patients had the negative PDT, indicating that the PCL injury was improved. There were no postoperative complications. CONCLUSION The application of tendon pin fixed by tibial inlay 8-shaped tibial tunnel to reconstruct PCL was an effective, simple, and safe surgical procedure for PCL injury.
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Affiliation(s)
- Hua-Zhe Li
- Department of Orthopaedics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.,Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Cong Yu
- Department of Orthopaedics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhi-Tao Zhang
- Department of Orthopaedics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.,Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Shi Yan
- Department of Orthopaedics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yun-Jian Liao
- Department of Orthopaedics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.,Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Dai-Feng Lu
- Department of Orthopaedics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.,Heilongjiang Academy of Medical Sciences, Harbin, China
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Lee SH, Kim DH, Lee JI, Kim JS, Kim TW, Lee YS. Outcomes of trans-tibial posterior cruciate ligament reconstruction using a fovea landmark technique in relation to tunnel position and serial tunnel configuration. Knee 2020; 27:1942-1952. [PMID: 33221692 DOI: 10.1016/j.knee.2020.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/24/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate (1) the outcome of PCL reconstruction with tibial suspensory fixation using a fovea landmark technique based on the tunnel position and serial change of the tunnel configuration after trans-tibial PCL reconstruction, and (2) whether suspensory fixation has any harmful effect on the outcome. METHODS A total of 48 knees that underwent PCL reconstruction were included. The tunnel position was analyzed using CT. To analyze the tunnel configuration, the tunnel diameter, area, and volume were measured. To evaluate the outcome, pre- and postoperative International Knee Documentation Committee (IKDC) and Lysholm scores were analyzed. To evaluate stability, a side-to-side difference was evaluated using Telos stress radiographs. RESULTS The greatest configurational change occurred at the mid-portion of tibial tunnel. There was a correlation between stability and tibial tunnel mid-portion configurational change (p < 0.01). Important correlations were found between the tunnel position and serial tunnel configuration between high femoral tunnel and widest site of femoral tunnel and tibia aperture (p < 0.01 and 0.04, respectively). The diameter of widest site of tibia tunnel increased when the tibia tunnel center moved toward the posterior margin of the tibia (p = 0.02) and the percentage of femoral tunnel volume enlargement increased when the tibia tunnel center moved toward the medial edge of the PCL fovea (p = 0.02). CONCLUSIONS A high femoral tunnel, medial tibial tunnel, and posterior tibial tunnel were related to the serial configurational change. A suspensory tibial fixation produced significant configurational change around the mid-portion of the tibial tunnel, and it induced a negative effect on stability. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Seung Hoon Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Department of Orthopaedic Surgery, Veterans Health Service Medical Center, South Korea
| | - Dong Hyun Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Department of Orthopedic Surgery, Gwangmyeong 21st Century Hospital, South Korea
| | - Jae Ik Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Joo Sung Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea.
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Graft sources do not affect to the outcome of transtibial posterior cruciate ligament reconstruction: a systematic review. Arch Orthop Trauma Surg 2018; 138:1103-1116. [PMID: 29728834 DOI: 10.1007/s00402-018-2946-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Despite numerous published reports on posterior cruciate ligament (PCL) reconstruction in the past 30 years, the ideal graft source remains unclear, and few objective scientific data have been published that thoroughly evaluate the long-term outcomes according to the graft source. We, therefore, conducted a systematic review of available high-quality comparative studies that evaluated clinical and objective stability testing to compare the different graft sources for PCL reconstruction. MATERIALS AND METHODS Eight articles were included in the final analysis. There were two level II and six level III studies. Autograft included 4-strand hamstring grafts (SHGs), 7-SHGs, quadriceps tendon, and patellar tendon. Allografts included Achilles tendon and tibialis anterior tendon. Hybrid graft and a ligament advanced reinforcement system (LARS) were used in one study each. Comparison was performed between autografts and allografts in three studies, between different autografts in two studies, between autograft and LARS in one study, among three different grafts in one study, and between 4 and 7-SHGs in one study. RESULTS Most studies reported no statistically significant differences in the clinical results, except for one study that compared 4- and 7-SHG. Stability was similar or superior in a comparison between autografts and allografts, and was not statistically different between different autografts or between 4-SHG and LARS. However, more-stranded HG showed better stability than that of the less-stranded HG. Complications were more frequent with autografts. CONCLUSION Using a comprehensive analysis of the current literature, the authors could not identify an individual graft source with clearly superior clinical results, compared with other graft sources. However, autografts, especially 4-SHGs, showed similar or superior stability to irradiated allografts. Therefore, the graft source has a minimal effect on the clinical outcome, but it could have some effects on stability in single bundle transtibial PCL reconstruction.
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Li J, Kong F, Gao X, Shen Y, Gao S. Prospective Randomized Comparison of Knee Stability and Proprioception for Posterior Cruciate Ligament Reconstruction With Autograft, Hybrid Graft, and γ-Irradiated Allograft. Arthroscopy 2016; 32:2548-2555. [PMID: 27282110 DOI: 10.1016/j.arthro.2016.04.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate posterior stability and proprioception after arthroscopic posterior cruciate ligament reconstruction with autograft, hybrid graft, and γ-irradiated allograft. METHODS This prospective, randomized controlled trial (with 5 years' follow-up) included 90 patients who underwent posterior cruciate ligament reconstruction with autograft (gracilis and semitendinosus tendons), hybrid graft (γ-irradiated tibialis anterior tendon allograft and semitendinosus tendon autograft), or γ-irradiated allograft (tibialis anterior tendons). All the γ-irradiated allografts (tibialis anterior tendons) received an irradiation dose of 2.5 Mrad before distribution. Patients in this study had undergone a preoperative magnetic resonance imaging scan and physical examination. Patients were excluded from the study if they had a concomitant injury to other knee ligaments, previous surgery on the injured knee, or articular cartilage lesions greater than Outerbridge grade II. Clinical and proprioceptive evaluation results were collected preoperatively and at 3, 6, 12, 24, 36, and 60 months after surgery. RESULTS The autograft, allograft, and hybrid graft groups were followed up for 5.5 ± 0.2 months (range, 5 to 6 years), 5.7 ± 0.3 months (range, 5 to 6 years), and 5.6 ± 0.5 months (range, 5 to 6 years), respectively. No statistically significant differences were found among the 3 groups regarding preoperative demographic factors (P > .05). The differences in physical examination findings and subjective evaluations among the 3 groups were not significant (P > .05). However, a significant difference was detected in instrumented anteroposterior measurements, with more laxity shown in the γ-irradiated allograft group than in the other 2 groups (P = .006). CONCLUSIONS The differences in proprioceptive and functional outcomes among the 3 groups were not significant. In contrast, a significant difference was detected in instrumented anteroposterior measurements, which showed more laxity in the γ-irradiated allograft group than in the other 2 groups. However, this may not be clinically significant. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Jia Li
- Department of Orthopaedic Surgery and Key Laboratory of Orthopedic Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Fanlong Kong
- Department of Orthopaedic Surgery and Key Laboratory of Orthopedic Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Xianda Gao
- Department of Orthopaedic Surgery and Key Laboratory of Orthopedic Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yong Shen
- Department of Orthopaedic Surgery and Key Laboratory of Orthopedic Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Shijun Gao
- Department of Orthopaedic Surgery and Key Laboratory of Orthopedic Biomechanics of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
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Ahn S, Lee YS, Song YD, Chang CB, Kang SB, Choi YS. Does surgical reconstruction produce better stability than conservative treatment in the isolated PCL injuries? Arch Orthop Trauma Surg 2016; 136:811-9. [PMID: 27084513 DOI: 10.1007/s00402-016-2454-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The purpose of this study was to conduct a systematic review to address the stability outcome from reconstruction and conservative treatments. MATERIALS AND METHODS Inclusion criteria were as follows: (1) English language, (2) human subject, (3) measures of stability outcomes, and (4) patients with isolated PCL injuries. We did not limit the type of study design (interventional or non-interventional study) and included all published systematic reviews. The following data were extracted: the number of study populations, year of publication, baseline characteristics of patients, follow-up period, and outcome data. The primary outcome variable was side-to-side difference (STSD). RESULTS In the conservative treatment, the average STSD ranged from 3.5 to 5.3 mm on Telos™ (range 0.7-12.0 mm) and from 3.0 to 5.2 mm on KT-1000™ (range 0.5-10 mm). Among reconstructive treatment, the average STSD ranged from 2.0 to 3.7 mm on Telos™ (range 0-7 mm) and 0.7-5.9 mm on KT-1000™ (range -1 to 11.8 mm). In the conservative treatment, the estimated weighted mean STSD difference was 3.49 [95 % confidence interval (CI): 0.95-6.03] on Telos™ and 2.64 (95 % CI 0.76-4.51) on KT-1000™. On the other hand, in the reconstructive treatment, the estimated mean STSD difference was 8.09 (95 % CI 7.11-9.07) on Telos™ and 8.45 (95 % CI 6.44-10.47) on KT-1000™. CONCLUSIONS This systematic review noted more satisfactory and consistent stability in the reconstructive treatment group. However, more complications and small differences of stability between groups should be also considered.
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Affiliation(s)
- Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi, 463-707, South Korea.
| | - Young Dong Song
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi, 463-707, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Boramae Hospital, Seoul, South Korea
| | - Seung Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Boramae Hospital, Seoul, South Korea
| | - Yun Seong Choi
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi, 463-707, South Korea
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Lee YS, Ko TS, Ahn JH, Kang SG, Choi UH, Elazab A, Lee HR. Comparison of Tibial Tunnel Techniques in Posterior Cruciate Ligament Reconstruction: C-Arm Versus Anatomic Fovea Landmark. Arthroscopy 2016; 32:487-92. [PMID: 26597550 DOI: 10.1016/j.arthro.2015.08.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 07/27/2015] [Accepted: 08/25/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the accuracy of the posterior cruciate ligament (PCL) fovea landmark against conventional fluoroscopic pin placement retrospectively using 3-dimensional computed tomography (3D CT). METHODS This retrospective comparison focused on the tibial tunnel locations determined in consecutive 26 patients using the fluoroscopic imaging technique (group I) and in consecutive 23 patients using the PCL fovea landmark technique without the help of the fluoroscopy (group II) for tibial tunnel formation. The 3D surface-modeled CT images that appropriately located the position of the PCL fovea on the tibial plateau were used. Ratios between total length of the fovea and length of the tunnel center from the medial border (coronal) and posterior edge (sagittal) were evaluated. RESULTS The ratios between sagittal tunnel length and total sagittal length for groups I and II were 35.4% ± 12.2% and 44.1% ± 23.1%, respectively (P = .07). The ratios between the coronal tunnel lengths and total coronal lengths for groups I and II were 47.3% ± 9.2% and 57.3% ± 18.1%, respectively: group II showed a more laterally positioned tibial tunnel than did group I (P = .03). CONCLUSIONS A more laterally located tibial tunnel was produced using the PCL fovea landmark technique. However, the differences in centers were small and probably not clinically relevant. Therefore, the PCL fovea landmark technique might be an alternative method to the fluoroscopic imaging technique for locating the anatomic tibial tunnel during transtibial PCL reconstruction. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Yong Seuk Lee
- Department of Orthopaedic Surgery, Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Taeg Su Ko
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seou, Republic of Korea
| | - Jin Hwan Ahn
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seou, Republic of Korea
| | - Seo Goo Kang
- Department of Orthopaedic Surgery, Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Uk Hyun Choi
- Department of Orthopaedic Surgery, Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ashraf Elazab
- Department of Orthopaedic Surgery, Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung Rae Lee
- Department of Orthopaedic Surgery, Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Heinrichs CH, Schmoelz W, Mayr R, Keiler A, Schöttle PB, Attal R. Biomechanical evaluation of a novel dynamic posterior cruciate ligament brace. Clin Biomech (Bristol, Avon) 2016; 33:20-25. [PMID: 26896691 DOI: 10.1016/j.clinbiomech.2016.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Use of a rigid brace or cast immobilization is recommended in conservative treatment or postoperative rehabilitation after a posterior cruciate ligament injury. To prevent the loss of knee joint function and muscle activity often associated with this, a flexible knee brace has been developed that allows an adjustable anteriorly directed force to be applied to the calf in order to prevent posterior tibial translation. The purpose of this biomechanical study was to evaluate the impact of this novel dynamic brace on posterior tibial translation after posterior cruciate ligament injury and reconstruction. METHODS A Telos stress device was used to provoke posterior tibial translation in seven human lower limb specimens, and stress radiographs were taken at 90° of knee flexion. Posterior tibial translation was measured in the native knees with an intact posterior cruciate ligament; after arthroscopic posterior cruciate ligament dissection with and without a brace; and after posterior cruciate ligament reconstruction with and without a brace. The force applied with the brace was measured using a pressure sensor. FINDINGS Posterior tibial translation was significantly reduced (P=0.032) after application of the brace with an anteriorly directed force of 50N to the knees with the dissected posterior cruciate ligament. The brace also significantly reduced posterior tibial translation after posterior cruciate ligament reconstruction in comparison with reconstructed knees without a brace (P=0.005). INTERPRETATION Posterior tibial translation was reduced to physiological values using this dynamic brace system that allows an anteriorly directed force to be applied to the calf.
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Affiliation(s)
- Christian H Heinrichs
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Werner Schmoelz
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Raul Mayr
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Alexander Keiler
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Philip B Schöttle
- Department of Orthopaedic and Trauma Surgery, Isar Medical Center, Sonnenstrasse 24, 80331 Munich, Germany.
| | - René Attal
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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Elazab A, Lee YS, Kang SG. Suspensory Anterior Tibial Fixation in the Anatomic Transtibial Posterior Cruciate Ligament Reconstruction. Arthrosc Tech 2016; 5:e71-7. [PMID: 27073781 PMCID: PMC4811054 DOI: 10.1016/j.eats.2015.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/26/2015] [Indexed: 02/03/2023] Open
Abstract
The transtibial technique is the most relevant among many surgical techniques for posterior cruciate ligament reconstruction, and many types of fixation devices are used for tibial fixation according to the technique and the length of the graft. However, bone density in the fixation areas should be taken into consideration when choosing the fixation device to achieve rigid and stable fixation. However, density is not a substantial issue for anteromedial cortical fixation using a cortical suspension device. We describe tibial fixation with a TightRope RT (Arthrex, Naples, FL), which is a cortical suspension device, in anatomic transtibial posterior cruciate ligament reconstruction.
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Affiliation(s)
| | - Yong Seuk Lee
- Address correspondence to Yong Seuk Lee, M.D., Ph.D., Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.Department of Orthopaedic SurgerySeoul National University College of MedicineBundang Hospital166 Gumi-roBundang-guSeongnam-siGyeonggi-do463-707Republic of Korea
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Ihle C, Ateschrang A, Albrecht D, Mueller J, Stöckle U, Schröter S. Occupational consequences after isolated reconstruction of the insufficient posterior cruciate ligament. BMC Res Notes 2014; 7:201. [PMID: 24684773 PMCID: PMC3994232 DOI: 10.1186/1756-0500-7-201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/19/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND With incorrect or even without treatment, acute injuries of the posterior cruciate ligament (PCL) can lead to chronic instability of the knee joint. After delayed treatment, negative occupational changes and reduced quality of life can occur. These aspects have not yet been investigated. The purpose of this study was to evaluate occupational consequences after isolated reconstruction in cases of chronic PCL insufficiency. FINDINGS 12 patients treated with PCL reconstruction in a single bundle technique, using hamstring tendon grafts, were evaluated. All patients were operated upon at least 3 months after injury. Mean time of follow-up was 51 ± 18.2 months (14-75). Radiological assessment (Telos stress device) showed a side comparison of total translation of 4.5 ± 2.6 mm. Occupational consequences have been evaluated by the classification system "REFA". Median time incapacity for work was 8 weeks. Nearly all patients achieved the mental status of the normal population (SF-36), but physical status was still restricted. A pre- to postoperative improvement of the clinical scores could be seen: Lysholm-Score: 46.4 ± 17.3 to 84.7 ± 14.1, HSS-Score: 74.3 ± 10.5 to 88.3 ± 10.7. Postoperative evaluated scores were: Tegner score: 4.8 ± 1.2, IKDC score: 80.0 ± 16.2, VPS: 3.4 ± 2.7. Patients with low physical load in their workplace described significantly better clinical results in every clinical score (p < .05) and less pain than patients with high physical load prior to the accident (VPS: REFA < 2: 2.4 ± 2.6, REFA ≥ 2: 5.5 ± 1.7; p < 0.05). CONCLUSIONS Operative treated patients with a chronic PCL insufficiency achieve an improvement of the clinical result. Patients with low physical load at their workplace achieve less restrictions.
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Affiliation(s)
- Christoph Ihle
- Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Schnarrrenbergstr. 95, 72076 Tübingen, Germany
| | - Atesch Ateschrang
- Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Schnarrrenbergstr. 95, 72076 Tübingen, Germany
| | - Dirk Albrecht
- Group practice, Traumatology and Reconstructive Surgery, Listplatz 1, 72764 Reutlingen, Germany
| | - Johannes Mueller
- Department of Gastroenterology, Klinikum Ludwigsburg, Posilipostraße 4, 71640 Ludwigsburg, Germany
| | - Ulrich Stöckle
- Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Schnarrrenbergstr. 95, 72076 Tübingen, Germany
| | - Steffen Schröter
- Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Schnarrrenbergstr. 95, 72076 Tübingen, Germany
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Montgomery SR, Johnson JS, McAllister DR, Petrigliano FA. Surgical management of PCL injuries: indications, techniques, and outcomes. Curr Rev Musculoskelet Med 2013; 6:115-23. [PMID: 23430587 DOI: 10.1007/s12178-013-9162-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The ideal treatment for posterior cruciate ligament (PCL) injuries is controversial and remains an active area of orthopedic research. The indications for surgery and the ideal method of reconstruction continue to be evaluated in biomechanical and clinical studies. Recent research has provided information on the anatomy and biomechanics of the PCL, and the merits and drawbacks of the transtibial compared with the tibial inlay technique, the use of single vs double-bundle reconstruction, and different graft options for reconstruction. This review discusses important factors in the surgical treatment of PCL injuries, with attention to the most current literature on these topics.
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Affiliation(s)
- Scott R Montgomery
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA, USA,
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Lee GW, Jang SJ, Choi Y, Son JH. Accessory anterolateral portal in arthroscopic PCL reconstruction. Knee Surg Sports Traumatol Arthrosc 2013; 21:1043-9. [PMID: 22777540 DOI: 10.1007/s00167-012-2130-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the clinical and radiological results of arthroscopic PCL reconstruction using an accessory anterolateral portal for femoral tunneling and to compare these results with those of the conventional technique. METHODS We retrospectively reviewed the clinical and radiological results for 57 patients who underwent PCL reconstruction, including 31 patients who underwent arthroscopic PCL reconstruction with an accessory anterolateral portal (group A) and 26 patients who underwent conventional arthroscopic PCL reconstruction (group B). Lysholm score, IKDC score, simple radiographs (AP and lateral), and posterior drawer test results were evaluated preoperatively and at 3 years postoperatively. RESULTS No major complication was observed in group A. However, posterior cortical disruption due to improper placement of the femoral tunnel was observed in one patient in group B. The mean Lysholm knee scores increased from 41.5 ± 4.8 preoperatively to 92.5 ± 6.2 at final follow-up in group A (P < 0.001), and from 43.5 ± 3.4 preoperatively to 88.5 points ± 3.7 in group B (P = 0.002). Posterior stress radiographs with a KT-1000 showed that the mean side-to-side differences improved from 13.79 ± 5.1 mm preoperatively to 3.1 ± 0.7 mm postoperatively in group A and from 12.68 ± 6.3 mm preoperatively to 3.5 ± 0.5 mm postoperatively in group B. The sensitivity and specificity of the placement and direction of the femoral tunnel were significantly higher in group A than group B (P = 0.002). CONCLUSION Arthroscopic PCL reconstruction with an accessory anterolateral portal can provide a better surgical view than the conventional technique, and this can minimize the problems associated with femoral tunneling, such as inappropriate and inconsistent placement of the tunnel, abnormal angulation, and sliding of the guide tip. Moreover, this approach may have a shorter operative time and a better functional recovery than the conventional technique. LEVEL OF EVIDENCE Retrospective comparative study, Level IV.
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Affiliation(s)
- Gun Woo Lee
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, 34 Amnam-Dong, Seo-gu, Busan, 602-702, Republic of Korea
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Arøen A, Verdonk P. Posterior cruciate ligament, exploring the unknown. Knee Surg Sports Traumatol Arthrosc 2013; 21:996-7. [PMID: 23404513 DOI: 10.1007/s00167-013-2440-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
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