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Bingol I, Oktem U, Kaymakoglu M, Kolac UC, Birinci S, Kamaci S. PCL injury following high energy trauma: associated injuries and postoperative complications "insights from a national registry study". J Orthop Surg Res 2024; 19:490. [PMID: 39155388 PMCID: PMC11330600 DOI: 10.1186/s13018-024-04927-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
PURPOSE The posterior cruciate ligament (PCL) is a vital knee stabilizer. While PCL injuries are rare, high-energy traumas can lead to total ruptures, with accompanying injuries requiring surgery. This study aims to investigate the demographics, concomitant injuries, and postoperative complications of patients who underwent PCL reconstruction due to high-energy trauma in a large patient sample. METHODS Patients who underwent PCL reconstruction from 2016 to 2022 were retrospectively evaluated using data from a nationwide personal health recording system. Patient demographics, injury mechanisms, associated fractures, soft tissue injuries, and postoperative complications were collected from patient notes, clinical visits, and surgical notes. Individuals with a PCL injury following high-energy trauma (car accident, falls from height, motorcycle accident) with a minimum follow-up of 1 year were included in the study. RESULTS The study included 416 patients with a mean age of 32.4 years. Isolated PCL injuries (n = 97, 23.3%) were observed less frequently than multiple-ligament injuries (n = 319, 76.7%). Most cases were treated with single-stage surgery (86.8%), while staged surgeries were performed in a minority of cases (13.2%). There was no relationship between trauma mechanisms and multiple-ligament involvement, accompanying injuries, or postoperative complications. Surgeries following car accidents were more likely to occur as staged surgeries (p = 0.014). Additionally, the complication rates for staged surgeries and younger patients (≤ 18 years) were significantly higher (p = 0.009). CONCLUSION High-energy trauma-induced PCL injuries are often associated with severe concurrent knee injuries with multiple ligament involvement. PCL reconstructions following car accidents are more likely to be staged. These findings highlight the importance of careful consideration in managing these cases to minimize complications, particularly in younger age groups. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Izzet Bingol
- Department of Orthopaedics and Traumatology, Ankara Yildirim Beyazit University, Ankara, Turkey.
| | - Umut Oktem
- Department of Orthopaedics and Traumatology, Bilkent City Hospital, Ankara, Turkey
| | - Mehmet Kaymakoglu
- Department of Orthopaedics and Traumatology, Izmir University of Economics, Izmir, Turkey
| | - Ulas Can Kolac
- Department of Orthopaedics and Traumatology, Hacettepe University, Ankara, Turkey
| | | | - Saygin Kamaci
- Department of Orthopaedics and Traumatology, Hacettepe University, Ankara, Turkey
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Niu Y, Li Z, Chen Z, Zheng Y, Zhang Z, Zhang Z, Ma J, Dong J. The tibial capsular reflection and septum in posterior compartment are safe and reliable soft-tissue landmark for tibial tunnel drilling in posterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2024; 32:1682-1689. [PMID: 38651571 DOI: 10.1002/ksa.12202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To investigate the validity of using tibial capsular reflection and septum in the posterior compartment as landmark during posterior cruciate ligament (PCL) reconstruction (PCLR). METHODS Anatomic measurements were obtained for 12 fresh human cadaveric knee specimens to observe the spatial position of the tibial insertion of the PCL in relation to the posterior septum and the capsular reflection in the posterior compartment. Sixty patients who underwent reconstruction of the PCL between 2020 and 2023 were also retrospectively investigated. The tibial tunnel was replaced in all patients using the same method (with reference to the tibial capsular reflection and the posterior septum). The placement of the tibial tunnel was assessed using X-ray fluoroscopy intraoperatively and computed tomography and three-dimensional reconstruction postoperatively. RESULTS All fibres in the tibial insertion of the PCL in the 12 cadaveric specimens were located in the posteromedial compartment, adjacent to the posterior septum. The inferior border of the PCL insertion is adjacent to the tibial capsular reflection, which is attached at the champagne glass drop-off of the posterior tibia. In our previous cases, none of the patients experienced postoperative or intraoperative complications such as neurovascular injury, and the angle between the pin and the PCL facet was 93.1 ± 3.9° as measured on intraoperative radiographs. The mean distance from the centre of the tibial tunnel outlet to the inferior border of the PCL insertion was 5.6 ± 1.1 mm, and the distance from the centre of the tibial tunnel outlet to the outer border of the PCL insertion as a percentage of the length of the inferior border of PCL insertion was 42.2 ± 6.3%. CONCLUSION The tibial capsular reflection and septum in the posterior compartment are safe and reliable soft-tissue landmark for tibial tunnel drilling in PCLR. LEVEL OF EVIDENCE Level Ⅳ.
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Affiliation(s)
- Yingzhen Niu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhikuan Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhen Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yi Zheng
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenfeng Zhang
- Department of Orthopaedic Surgery, Tiemenguan People's Hospital, Xinjiang, China
| | - Zhuangdai Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jun Ma
- Department of Hebei Medical University, Shijiazhuang, China
| | - Jiangtao Dong
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Korthaus A, Hansen S, Krause M, Frosch KH. [Treatment of Injuries to the Posterior Cruciate Ligament]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:316-328. [PMID: 38834079 DOI: 10.1055/a-2091-4681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Compared to the anterior cruciate ligament injury, the rupture of the posterior cruciate Ligament (PCL) is the rarer condition. A high healing potential is attributed to the PCL in the literature, which is why conservative therapy is also considered important in addition to surgical treatment 1. Posterior cruciate ligament rupture is often associated with concomitant injuries. Among other things, up to 70% of cases are associated with accompanying injuries to the posterolateral corner 2. The detection of concomitant injuries has a significant influence on the outcome, as isolated surgical PCL stabilization does not lead to satisfactory results in these cases.
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Abed Ali A, Pettinari F, Alayane A, Barosso M, Osório TF, Vieira TD, Patt T, Sonnery-Cottet B. Arthroscopic Confirmation of Femoral Button Deployment During Posterior Cruciate Ligament Reconstruction. Arthrosc Tech 2024; 13:102978. [PMID: 39036411 PMCID: PMC11258917 DOI: 10.1016/j.eats.2024.102978] [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: 11/14/2023] [Accepted: 02/03/2024] [Indexed: 07/23/2024] Open
Abstract
Posterior cruciate ligament (PCL) ruptures are uncommonly seen in knee ligament injuries. Cconservative treatment is often suitable for isolated tears with mild-to-moderate posterior knee laxity (grades I or II). However, surgical intervention is indicated for symptomatic grade III or multiligament knee injuries. PCL reconstruction has experienced continuous development due to the progress made in arthroscopic techniques and instruments. Abnormal positioning and tensioning of the femoral button result in multiple complications such as residual laxity, loss of quadriceps muscle strength, and joint stiffness. In this Technical Note, we describe direct arthroscopic visualization of the femoral button deployment in PCL reconstruction technique, and we discuss its importance to prevent complications related to button malposition.
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Affiliation(s)
- Ahmad Abed Ali
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay Générale de Santé, Lyon, France
| | - Francesco Pettinari
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay Générale de Santé, Lyon, France
| | - Ali Alayane
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay Générale de Santé, Lyon, France
| | - Marta Barosso
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay Générale de Santé, Lyon, France
| | - Tomás Freitas Osório
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay Générale de Santé, Lyon, France
| | - Thais Dutra Vieira
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay Générale de Santé, Lyon, France
| | | | - Bertrand Sonnery-Cottet
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay Générale de Santé, Lyon, France
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Temperato J, Rucinski K, Cook JL, Meers A, Albuquerque JBD, Stannard JP. Outcomes after Anatomic Double-Bundle Posterior Cruciate Ligament Reconstructions Using Transtibial and Tibial Inlay Techniques. J Knee Surg 2024; 37:183-192. [PMID: 36507661 DOI: 10.1055/a-1996-1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Surgical reconstruction is recommended for symptomatic posterior cruciate ligament (PCL) deficiency. While anatomic double-bundle PCL reconstruction (PCLR) has been reported to be associated with biomechanical and clinical advantages over other methods, there is still debate regarding the optimal technique for tibial positioning and fixation. Based on reported advantages and disadvantages, we employed two tibial fixation techniques, transtibial (TT) and tibial inlay (TI) for anatomic double-bundle PCLR with technique selection based on body mass index, comorbidities, and primary versus revision surgery. This study aimed to compare clinical outcomes following PCLR utilizing either TT or TI techniques to validate relative advantages, disadvantages, and indications for each based on the review of prospectively collected registry data. For 37 patients meeting inclusion criteria, 26 underwent arthroscopic TT PCLR using all-soft- tissue allograft with suspensory fixation in the tibia and 11 patients underwent open TI PCLR using an allograft with calcaneal bone block and screw fixation in the tibia. There were no significant preoperative differences between cohorts. Success rates were 96% for TT and 91% for TI with all successful cases documented to be associated with good-to-excellent posterior stability and range of motion in the knee at the final follow-up. In addition, patient-reported outcome scores were within clinically meaningful ranges for pain, function, and mental health after PCLR in both cohorts, suggesting similarly favorable functional, social, and psychological outcomes. Patient-reported pain scores at 6 months postoperatively were significantly (p = 0.042) lower in the TT cohort, which was the only statistically significant difference in outcomes noted. The results of this study support the use of TT and TI techniques for double-bundle anatomic PCLR in restoring knee stability and patient function when used for the treatment of isolated and multiligamentous PCL injuries. The choice between tibial fixation methods for PCLR can be appropriately based on patient and injury characteristics that optimize respective advantages for each technique.
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Affiliation(s)
- Joseph Temperato
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Aaron Meers
- School of Medicine, University of Missouri System Ringgold Standard Institution, Columbia, Missouri
| | - João Bourbon de Albuquerque
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
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Nusia J, Xu JC, Knälmann J, Sjöblom R, Kleiven S. Injury risk functions for the four primary knee ligaments. Front Bioeng Biotechnol 2023; 11:1228922. [PMID: 37860626 PMCID: PMC10582698 DOI: 10.3389/fbioe.2023.1228922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023] Open
Abstract
The purpose of this study was to develop injury risk functions (IRFs) for the anterior and posterior cruciate ligaments (ACL and PCL, respectively) and the medial and lateral collateral ligaments (MCL and LCL, respectively) in the knee joint. The IRFs were based on post-mortem human subjects (PMHSs). Available specimen-specific failure strains were supplemented with statistically generated failure strains (virtual values) to accommodate for unprovided detailed experimental data in the literature. The virtual values were derived from the reported mean and standard deviation in the experimental studies. All virtual and specimen-specific values were thereafter categorized into groups of static and dynamic rates, respectively, and tested for the best fitting theoretical distribution to derive a ligament-specific IRF. A total of 10 IRFs were derived (three for ACL, two for PCL, two for MCL, and three for LCL). ACL, MCL, and LCL received IRFs in both dynamic and static tensile rates, while a sufficient dataset was achieved only for dynamic rates of the PCL. The log-logistic and Weibull distributions had the best fit (p-values: >0.9, RMSE: 2.3%-4.7%) to the empirical datasets for all the ligaments. These IRFs are, to the best of the authors' knowledge, the first attempt to generate injury prediction tools based on PMHS data for the four knee ligaments. The study has summarized all the relevant literature on PHMS experimental tensile tests on the knee ligaments and utilized the available empirical data to create the IRFs. Future improvements require upcoming experiments to provide comparable testing and strain measurements. Furthermore, emphasis on a clear definition of failure and transparent reporting of each specimen-specific result is necessary.
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Affiliation(s)
- Jiota Nusia
- Department of Traffic Safety and Traffic Systems, The Swedish National Road and Transport Research Institute (VTI), Stockholm, Sweden
| | - Jia-Cheng Xu
- Department of Traffic Safety and Traffic Systems, The Swedish National Road and Transport Research Institute (VTI), Stockholm, Sweden
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Johan Knälmann
- Department of Strength and Crash Analysis, Scania CV AB, Södertälje, Sweden
| | - Reimert Sjöblom
- Department of Strength and Crash Analysis, Scania CV AB, Södertälje, Sweden
| | - Svein Kleiven
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
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Li L, Li J, Zhou P, He Y, Li Y, Deng X, Jiang H, Liu J, Li Z. Decreased medial posterior tibial slope is associated with an increased risk of posterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc 2023; 31:2966-2973. [PMID: 36622419 DOI: 10.1007/s00167-023-07308-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
PURPOSE It remains unclear whether there is an association between posterior cruciate ligament (PCL) rupture and the medial posterior tibial slope (MTS) or lateral posterior tibial slope (LTS). The present case-control study aimed to investigate a possible association between primary PCL rupture and MTS or LTS measured by magnetic resonance imaging (MRI). METHODS A retrospective case-control study was conducted. Patients with primary PCL ruptures but not with anterior cruciate ligament injuries, were 1:1 matched by age and sex to a control group with no evidence of knee ligament injuries. Knee MRI was used to measure the MTS and LTS. In addition, the receiver operating characteristic (ROC) analysis was performed to identify an optimal cut-off value of the MTS and/or LTS. RESULTS In total, 46 patients with PCL ruptures (32 males, 14 females) and 46 controls (32 males, 14 females) were included in this study. The MTS was significantly lower in the patients with PCL ruptures (3.0° ± 2.2°) than in the control group (5.1° ± 2.3°, p < 0.001). The mean LTS/MTS ratio was significantly higher in patients with PCL ruptures (2.6 ± 2.5) than in the control group (1.3 ± 1.3, p = 0.001). However, the LTS was not significantly different between patients with PCL ruptures and the controls (4.4° ± 2.3° vs. 5.3° ± 2.6°, n.s.). After the MTS was determined to be a significant predictor, the ROC analysis was performed. The ROC analysis revealed the most accurate MTS cut-off of < 3.9°, with a sensitivity of 76.1% and a specificity of 73.9%. CONCLUSION A decreased MTS and an increased LTS/MTS ratio are associated with an increased risk of primary PCL rupture. People with MTS < 3.9° are particularly at risk for PCL ruptures, and prevention and intervention programs for PCL ruptures should be developed and targeted towards them. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Lingzhi Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China
| | - Jun Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China
| | - Peng Zhou
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China
| | - Yanwei He
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China
| | - Yuan Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China
| | - Xiangtian Deng
- Orthopedic Research Institution, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hao Jiang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China
| | - Juncai Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China.
| | - Zhong Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China.
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Zsidai B, Engler ID, Narup E, Lin RT, Nazzal EM, Winkler PW, Samuelsson K, Irrgang JJ, Musahl V. Delayed multiligament PCL reconstruction is associated with a higher prevalence of intraarticular injury and may influence treatment. BMC Musculoskelet Disord 2023; 24:502. [PMID: 37337235 DOI: 10.1186/s12891-023-06638-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/15/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate differences in concomitant injury patterns and their treatment in patients undergoing early (≤ 12 weeks) and delayed (> 12 weeks) primary multiligament posterior cruciate ligament (PCL) reconstruction (PCL-R). METHODS This study was a retrospective chart review of patients undergoing primary multiligament PCL-R at a single institution between 2008 and 2020. Multiligament PCL-R was defined as PCL-R and concurrent surgical treatment of one or more additional knee ligament(s). Exclusion criteria included isolated PCL-R, PCL repair, and missing data for any variable. Patients were dichotomized into early (≤ 12 weeks) and delayed (> 12 weeks) PCL-R groups based on the time elapsed between injury and surgery. Between-group comparison of variables were conducted with the Chi-square, Fisher's exact, and independent samples t-tests. RESULTS A total of 148 patients were eligible for analysis, with 57 (38.5%) patients in the early and 91 (61.1%) patients in the delayed multiligament PCL-R groups. Concomitant LCL/PLC reconstruction (LCL-R/PLC-R) was performed in 55 (60%) of delayed multiligament PCL-Rs and 23 (40%) of early PCL-Rs (p = 0.02). Despite similar rates of meniscus injury, concomitant meniscus surgery was significantly more prevalent in the early (n = 25, 44%) versus delayed (n = 19, 21%) multiligament PCL-R group (p = 0.003), with a significantly greater proportion of medial meniscus surgeries performed in the early (n = 16, 28%) compared to delayed (n = 13, 14%) PCL-R group (p = 0.04). The prevalence of knee cartilage injury was significantly different between the early (n = 12, 24%) and delayed (n = 41, 46%) multiligament PCL-R groups (p = 0.01), with more frequent involvement of the lateral (n = 17, 19% vs. n = 3, 5%, respectively; p = 0.04) and medial (n = 31, 34% vs. n = 6, 11%, respectively; p = 0.005) femoral condyles in the delayed compared to the early PCL-R group. CONCLUSIONS Given higher rates of chondral pathology and medial meniscus surgery seen in delayed multiligament PCL-R, early management of PCL-based multiligament knee injury is recommended to restore knee stability and potentially prevent the development of further intraarticular injury. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Bálint Zsidai
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA.
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ian D Engler
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA
- Central Maine Healthcare Orthopedics, Central Maine Medical Center, Auburn, USA
| | - Eric Narup
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ryan T Lin
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA
| | - Ehab M Nazzal
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA
| | - Philipp W Winkler
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Linz, Austria
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - James J Irrgang
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Green JS, Yalcin S, Moran J, Vasavada K, Kahan JB, Li ZI, Alaia MJ, Medvecky MJ. Examining the Schenck KD I Classification in Patients With Documented Tibiofemoral Knee Dislocations: A Multicenter Retrospective Case Series. Orthop J Sports Med 2023; 11:23259671231168892. [PMID: 37378278 PMCID: PMC10291419 DOI: 10.1177/23259671231168892] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/06/2023] [Indexed: 06/29/2023] Open
Abstract
Background Acute tibiofemoral knee dislocations (KDs) with a single cruciate ligament remaining intact are rare and can be classified as Schenck KD I. The inclusion of multiligament knee injuries (MLKIs) has contributed to a recent surge in Schenck KD I prevalence and has convoluted the original definition of the classification. Purpose To (1) report on a series of true Schenck KD I injuries with radiologically confirmed tibiofemoral dislocation and (2) introduce suffix modifications to further subclassify these injuries based on the reported cases. Study Design Case series; Level of evidence, 4. Methods A retrospective chart review identified all Schenck KD I MLKIs at 2 separate institutions between January 2001 and June 2022. Single-cruciate tears were included if a concomitant complete disruption of a collateral injury was present or injuries to the posterolateral corner, posteromedial corner, or extensor mechanism. All knee radiographs and magnetic resonance imaging scans were retrospectively reviewed by 2 board-certified orthopaedic sports medicine fellowship-trained surgeons. Only documented cases consistent with a complete tibiofemoral dislocation were included. Results Of the 227 MLKIs, 63 (27.8%) were classified as KD I, and 12 (19.0%) of the 63 KD I injuries had a radiologically confirmed tibiofemoral dislocation. These 12 injuries were subclassified based on the following proposed suffix modifications: KD I-DA (anterior cruciate ligament [ACL] only; n = 3), KD I-DAM (ACL + medial collateral ligament [MCL]; n = 3), KD I-DPM (posterior cruciate ligament [PCL] + MCL; n = 2), KD I-DAL (ACL + lateral collateral ligament [LCL]; n = 1), and KD I-DPL (PCL + LCL; n = 3). Conclusion The Schenck classification system should only be used to describe dislocations with bicruciate injuries or with single-cruciate injuries that have clinical and/or radiological evidence of tibiofemoral dislocation. Based on the presented cases, the authors recommend the suffix modifications for subclassifying Schenck KD I injuries with the goal of improving communication, surgical management, and the design of future outcome studies.
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Affiliation(s)
- Joshua S. Green
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
| | - Sercan Yalcin
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jay Moran
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kinjal Vasavada
- Division of Sports Medicine, Department of Orthopaedic Surgery, New York University Langone Orthopedic Center, New York, New York, USA
| | - Joseph B. Kahan
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Zachary I. Li
- Division of Sports Medicine, Department of Orthopaedic Surgery, New York University Langone Orthopedic Center, New York, New York, USA
| | - Michael J. Alaia
- Division of Sports Medicine, Department of Orthopaedic Surgery, New York University Langone Orthopedic Center, New York, New York, USA
| | - Michael J. Medvecky
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
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Huang WT, Kang K, Wang J, Li T, Dong JT, Gao SJ. Morphological Risk Factors for Posterior Cruciate Ligament Tear and Tibial Avulsion Injuries of the Tibial Plateau and Femoral Condyle. Am J Sports Med 2023; 51:129-140. [PMID: 36476119 DOI: 10.1177/03635465221131295] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Identification of morphological risk factors associated with the knee that threaten ligaments is important for understanding injury mechanisms and prevention. However, the morphological risk factors for posterior cruciate ligament (PCL) lesions are not clearly understood. PURPOSE To investigate whether the medial tibial depth (MTD), medial and lateral posterior tibial slope, asymmetry of the medial and lateral slopes, radius of the sagittal plane medial femoral condyle, coronal tibial slope, and notch width index (NWI) were risk factors for PCL intrasubstance tearing (PCLIT) and tibial avulsion fractures (PCLAF). STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Between January 2015 and March 2022, 82 patients with isolated PCLIT, 68 patients with isolated PCLAF, and 82 controls without any ligamentous or meniscal pathologic findings as determined via physical examination and magnetic resonance imaging were included. Values were compared among the 3 groups. Logistic regression analysis was performed to confirm the risk factors. Receiver operating characteristic curves were defined for the morphological indicators and combination of risk factors. RESULTS Logistic regression analysis revealed (1) MTD, lateral minus medial posterior tibial slope, radius of the posterior circle of the medial femoral condyle, and NWI as significant independent predictors for PCLIT and (2) MTD and NWI for PCLAF. The areas under the curve combining the 4 indicators for PCLIT and noncontact PCLIT were 0.79 (95% CI, 0.72-0.86) and 0.90 (95% CI, 0.85-0.96), respectively. The area under the curve for the combination of MTD and NWI for PCLAF was 0.78 (95% CI, 0.70-0.86). CONCLUSION Decreased MTD and NWI were associated with an increased incidence of PCLIT and PCLAF. Increased asymmetry of the medial and lateral slopes and the radius of the posterior circle of the medial femoral condyle were associated with the presence of PCLIT. In addition, the model of a combination of risk factors showed good predictive ability for noncontact PCLIT. These findings may aid clinicians in identifying patients at risk for PCL lesions. Further studies are warranted for identifying the effect of these factors on biomechanical mechanisms.
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Affiliation(s)
- Wen-Tao Huang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Kai Kang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Juan Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Hebei Institute of Orthopaedic Research, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tong Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiang-Tao Dong
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shi-Jun Gao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Hebei Institute of Orthopaedic Research, Shijiazhuang, China
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Intercondylar notch volume in patients with posterior cruciate ligament tears and tibial avulsion injuries: a study applying computed tomography. J Orthop Surg Res 2022; 17:560. [PMID: 36550563 PMCID: PMC9784257 DOI: 10.1186/s13018-022-03451-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Two relatively common forms of injury exist in the posterior cruciate ligament (PCL) after the onset of trauma: PCL tear and tibial avulsion fracture. The mechanism for the occurrence of these different forms of injury is not known. Herein, we aimed to investigate this mechanism by comparing the intercondylar notch parameters between patients with PCL tears and those with PCL avulsion fractures of the tibial insertion. METHODS Fifty-three patients with PCL tears (37 male, 16 female: median age of 37 years: range 18-54 years) and 46 patients with avulsion fractures of tibial insertion (33 male, 13 female: median age of 33 years: range 18-55 years) were included in this study. Three-dimensional computed tomography (CT) was applied to measure the intercondylar notch width index and intercondylar notch volume. The intercondylar notch volume was simulated as the truncated-pyramid shape. Measurements of the top and bottom areas of this model were conducted on the slice containing the most proximal (S1) and most distal (S2) levels of Blumensaat's line. Femoral condyle height (h) was defined as the vertical distance between two parallel planes, and the volume was calculated as h(S1 + S2 + √(S1S2))/3. The values of S1, S2, h, notch volume, the body mass index (BMI), intercondylar notch width (NW), femoral condylar width (FW) and notch width index (NWI) were compared among the PCL tear and avulsion-fracture groups. RESULTS The results show a significant difference in the S2 and normalized intercondylar notch volumes among patients with PCL tears and tibial avulsion injuries. Patients with PCL tears have smaller S2 and intercondylar notch volumes than those with tibial avulsion. There were no significant differences between the two groups in S1 or the 2D notch measurement parameters, such as the NW, FW and NWI. In addition, logistic regression analysis revealed notch volume and body mass index (BMI) as two significant independent predictors for PCL tears. CONCLUSION Decreased intercondylar notch volume and increased BMI are associated with an increased incidence of PCL tears. The occurrence of PCL tears and tibial avulsion injuries is influenced by the femoral intercondylar notch volume, and the measurement of the notch volume could be useful for identifying patients at risk for PCL tears.
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D'Ambrosi R, Hallé A, Hardy A. Good clinical and radiological results following remnant-preserving posterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 31:2418-2432. [PMID: 36208342 PMCID: PMC10183434 DOI: 10.1007/s00167-022-07192-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The objective of this systematic literature review was to report the results and complications of recent remnant preservation techniques in posterior cruciate ligament (PCL) reconstruction. METHODS A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers searched the PubMed, Scopus, Embase, and Cochrane Library databases using the terms "posterior cruciate ligament" or "PCL" and "remnant preserving." The outcome measures extracted from the studies were the Lysholm score, the International Knee Documentation Committee's (IKDC) subjective and objective scores, Tegner scores, Orthopädische Arbeitsgruppe Knie (OAK) rate of return to sports, and rate of complications. Data were also extracted from studies that used stress radiographs to perform a quantitative assessment of the preoperative and postoperative anteroposterior stability. RESULTS The systematic review included 13 studies. The patient cohort of consisted of 643 participants (544 [84.6%] men and 99 [15.4%] women) with a mean age of 32.9 ± 4.0 years. The mean postoperative follow-up was 34.5 ± 10.9 months (range: 24-96 months), while the mean time from injury to surgery was 14.4 ± 9.9 months (range: 0-240 months). All studies reported clinically significant improvement at final follow-up, as evident from the measured subjective and objective IKDC scores, Lysholm score, Tegner score, and OAK rate. Only three studies reported return to sports activity, with a mean percentage of 90.8% (99/109). All studies showed a significant improvement in posterior translation, from 11.5 ± 1.2 mm to 3.3 ± 1.1 mm, using radiography (side-to-side difference). This systematic review revealed 13 (2.0%) failures and 33 (5.1%) minor complications: 10 (1.6%) cases of stiffness, 21 (4.9%) screws removal, 1 (0.2%) injury of the peroneal nerve, and 1 (0.2%) fibular fracture. CONCLUSIONS With the currently available data, all studies included in the review on posterior cruciate ligament reconstruction with remnant preservation demonstrated satisfactory outcomes at mid-term follow-up (> 24 months), despite varying surgical techniques and graft types, and intervals from injury to surgery. For clinical relevance, standard PCL reconstruction is a highly effective operation in terms of improvement in functional status, knee stability, quality of life, and cost effectiveness. The remnant preservation technique requires more comprehensive diagnostic assessments of the PCL remnant patterns and more complicated surgical procedures. Given the absence so far of high quality studies with long-term follow-up, the remnant-preserving techniques should be recommended only by experienced knee arthroscopic surgeons. LEVEL OF EVIDENCE Level IV. STUDY REGISTRATION reviewregistry1376- www.researchregistry.com .
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
| | - Aurélien Hallé
- Service de Chirurgie Orthopedique et Traumatologique, CHU de Cochin, Paris, France
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Ifarraguerri AM, Quan T, Bernstein SL, Malyavko A, Gioia C, Gu A, Doerre T, Best MJ. The effect of obesity on complications following isolated posterior cruciate ligament reconstruction. Knee 2022; 38:164-169. [PMID: 36058124 DOI: 10.1016/j.knee.2022.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/27/2022] [Accepted: 08/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study assessed the risk of 30-day complications for obese patients compared to non-obese patients undergoing isolated posterior cruciate ligament (PCL) reconstruction. METHODS From 2006 to 2019, the National Surgical Quality Improvement Program database was queried for patients undergoing isolated PCL reconstruction. Two patient cohorts were defined: patients with obesity (BMI ≥ 30.0 kg/m2) and patients without obesity (BMI < 30 kg/m2). Patients' baseline demographics and medical comorbidities were collected and compared between the cohorts. Postoperative outcomes were assessed using bivariate and multivariate analyses. RESULTS 414 patients underwent PCL reconstruction. 258 patients (62.3%) were non-obese and 156 patients (37.7%) were obese. Obese patients were more likely to be older, have a higher American Society of Anesthesiologists classification, and have hypertension compared to non-obese patients (p < 0.05 for all). The rates of superficial surgical site infections, wound dehiscence, transfusion necessity, deep vein thrombosis, and re-operation were not significant between obese and non-obese patients. Following adjustment on multivariate analyses, relative to patients without obesity, those with obesity had an increased risk of admission to the hospital overnight (OR 1.66; p = 0.048). CONCLUSIONS To our knowledge, this is the first study to evaluate obesity on complications in isolated PCL reconstruction. Our results and the heterogeneity in the literature indicate that obesity significantly impacts the rates of hospital readmission for PCL reconstruction. Therefore, surgeons should carefully weigh the risks and benefits of operating on obese patients and plan accordingly as obese patients may require postoperative hospital admission after PCL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anna M Ifarraguerri
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Theodore Quan
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Sophie L Bernstein
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Alisa Malyavko
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Casey Gioia
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Teresa Doerre
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Matthew J Best
- Department of Orthopaedic Surgery, Johns Hopkins, Columbia, MD, United States
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Low posterior tibial slope is associated with increased risk of PCL graft failure. Knee Surg Sports Traumatol Arthrosc 2022; 30:3277-3286. [PMID: 35028674 DOI: 10.1007/s00167-021-06760-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the effect of posterior tibial slope (PTS) on patient-reported outcomes (PROs) and posterior cruciate ligament (PCL) graft failure after PCL reconstruction. METHODS Patients undergoing PCL reconstruction with a minimum 2-year follow-up were included in this retrospective cohort study. A chart review was performed to collect patient-, injury-, and surgery-related data. Medial PTS was measured on preoperative lateral radiographs. Validated PROs, including the International Knee Documentation Committee Subjective Knee Form, Knee injury and Osteoarthritis Outcome Score, Lysholm Score, Tegner Activity Scale, and Visual Analogue Scale for pain, were collected at final follow-up. A correlation analysis was conducted to assess the relationship between PTS and PROs. A logistic regression model was performed to evaluate if PTS could predict PCL graft failure. RESULTS Overall, 79 patients with a mean age of 28.6 ± 11.7 years and a mean follow-up of 5.7 ± 3.3 years were included. After a median time from injury of 4.0 months, isolated and combined PCL reconstruction was performed in 22 (28%) and 57 (72%) patients, respectively. There were no statistically significant differences in PROs and PTS between patients undergoing isolated and combined PCL reconstruction (non-significant [n.s.]). There were no significant correlations between PTS and PROs (n.s.). In total, 14 (18%) patients experienced PCL graft failure after a median time of 17.5 months following PCL reconstruction. Patients with PCL graft failure were found to have statistically significantly lower PTS than patients without graft failure (7.0 ± 2.3° vs. 9.2 ± 3.3°, p < 0.05), while no differences were found in PROs (n.s.). PTS was shown to be a significant predictor of PCL graft failure, with a 1.3-fold increase in the odds of graft failure for each one-degree reduction in PTS (p < 0.05). CONCLUSIONS This study showed that PTS does not affect PROs after PCL reconstruction, but that PTS represents a surgically modifiable predictor of PCL graft failure. LEVEL OF EVIDENCE III.
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Sports activity and quality of life improve after isolated ACL, isolated PCL, and combined ACL/PCL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 31:1781-1789. [PMID: 35809104 PMCID: PMC10090003 DOI: 10.1007/s00167-022-07060-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare patient-reported outcomes following isolated anterior cruciate ligament reconstruction (ACL-R), isolated posterior cruciate ligament reconstruction (PCL-R), and combined ACL-R and PCL-R (ACL/PCL-R), at a minimum follow-up of 2 years. METHODS This was a prospective observational registry cohort study based on the Swedish National Knee Ligament Registry. Patients undergoing isolated ACL-R, isolated PCL-R, and combined ACL/PCL-R between 2005 and 2019 were eligible for inclusion. Demographic characteristics as well as injury- and surgery-related data were queried from the SNKLR. To evaluate functional outcomes, the Knee Injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1- and 2-year follow-ups and compared between the treatment groups. RESULTS In total, 45,169 patients underwent isolated ACL-R, 192 patients isolated PCL-R, and 203 patients combined ACL/PCL-R. Preoperatively, and at the 1- and 2-year follow-ups, KOOS subscales were highest for the isolated ACL-R group, followed by the isolated PCL-R, and lowest for the combined ACL/PCL-R groups. Significant improvements were observed across all treatment groups in the majority of KOOS subscales between the preoperative, and 1- and 2-year follow-ups. All treatment groups showed the greatest improvements between the preoperative and 2-year follow-ups in the knee-related quality of life (mean improvement: isolated ACL-R, + 28 points; isolated PCL-R, + 23 points; combined ACL/PCL-R, + 21 points) and the function in sport and recreation (mean improvement: isolated ACL-R, + 26 points; isolated PCL-R, + 20 points; combined ACL/PCL-R, + 19 points) subscales. CONCLUSION Clinically relevant improvements in knee function can be expected after isolated ACL-R, isolated PCL-R, and combined ACL/PCL-R. Functional improvements were particularly pronounced in the KOOS function in sport and recreation subscale, indicating the importance of knee stability for sports activity. This study facilitates more comprehensive patient education about functional expectations after surgical treatment of isolated and combined ACL and PCL injuries. LEVEL OF EVIDENCE Level 2.
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The treatment of posterolateral knee instability with combined arthroscopic popliteus bypass and PCL reconstruction provides good-to-excellent clinical results in the mid-term follow-up. Knee Surg Sports Traumatol Arthrosc 2022; 30:1414-1422. [PMID: 34059968 DOI: 10.1007/s00167-021-06590-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/21/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes of patients who were treated with an arthroscopic popliteus bypass (PB) technique, in cases of a posterolateral rotational instability (PLRI) and a concomitant posterior cruciate ligament (PCL) injury of the knee. METHODS This was a retrospective case series in which 23 patients were clinically evaluated after a minimum of 2 years following arthroscopic PB and combined PCL reconstruction. Lysholm, Tegner and Knee Injury and Osteoarthritis Outcome scores as well as visual analog scales (VAS) for joint function and pain were evaluated. Posterior laxity was objectified with stress radiography and a Rolimeter examination. Rotational instability was graded with the dial test. RESULTS 23 patients were available for follow-up, 46.0 ± 13.6 months after surgery. The median time interval from the initial injury to the surgery was 6.0 (3.5;10.5) months. The postoperative Lysholm Score was 95.0 (49-100); the Tegner Score changed from 6.0 (3-10) before the injury to 5.0 (0-10) at the follow-up examination (p = 0.013). The side-to-side difference on stress radiography (SSD) of posterior translation changed from 10.4 (6.6-14.8) mm before the injury to 4.0 (0.2-5.7) mm postoperatively (p < 0.01). Rotational instability was reduced to grade A (82.6%) or B (17.4%) (IKDC). The Rolimeter SSD was 2.0 (0-3) mm at the follow-up examination. VAS Function 0 (0-5), VAS pain 0 (0-6). CONCLUSIONS The arthroscopic PB graft technique provided good-to-excellent clinical results in the mid-term follow-up in patients with type A PLRI and concomitant PCL injury. However, an exact differentiation of lateral, rotational and dorsal instabilities of posterolateral corner (PLC) injuries is crucial, for the correct choice of therapy, as cases with lateral instabilities require more complex reconstruction techniques. Arthroscopic posterolateral corner reconstruction is a safe procedure with a high success rate in the mid-term follow-up. LEVEL OF EVIDENCE IV.
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Zsidai B, Horvath A, Winkler PW, Narup E, Kaarre J, Svantesson E, Musahl V, Hamrin Senorski E, Samuelsson K. Different injury patterns exist among patients undergoing operative treatment of isolated PCL, combined PCL/ACL, and isolated ACL injuries: a study from the Swedish National Knee Ligament Registry. Knee Surg Sports Traumatol Arthrosc 2022; 30:3451-3460. [PMID: 35357530 PMCID: PMC9464165 DOI: 10.1007/s00167-022-06948-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare demographic characteristics and concomitant injury patterns in patients undergoing primary isolated posterior cruciate ligament reconstruction (PCL-R) and combined posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) reconstruction (PCL-R/ACL-R) with isolated ACL reconstruction (ACL-R) as a reference using data from the Swedish National Knee Ligament Registry (SNKLR). METHODS This cohort study based on the SNKLR comprised patients undergoing either PCL-R, ACL-R, or combined PCL-R/ACL-R between January 1, 2005 and December 31, 2019 in Sweden. Demographic and surgery-related data with regards to injury mechanism, concomitant intraarticular lesions and their treatment, neurovascular damage, and concomitant ligamentous injuries were extracted. Exclusion criteria included concomitant fractures of the femur, fibula, patella or tibia, and quadriceps or patellar tendon injury. RESULTS A total of 45,564 patients were included in this study. Isolated PCL-R, combined PCL-R/ACL-R, and isolated ACL-R were performed in 192 (0.4%), 203 (0.5%) and 45,169 (99.1%) patients, respectively. Sports were identified as the cause of 64% of PCL-Rs, 54% of PCL-R/ACL-Rs, and 89% of ACL-Rs, while a traffic-related mechanism was identified in 20% of PCL-Rs, 27% of PCL-R/ACL-Rs and 2% of ACL-Rs. Meniscus injury prevalence was 45% in ACL-Rs, 31% in PCL-R/ACL-Rs and 16% in isolated PCL-Rs (p < 0.001). Cartilage injuries were more common in PCL-R (37%) and PCL-R/ACL-R patients (40%) compared to ACL-R patients (26%, p < 0.001). Concomitant knee ligament injury was identified in 28-44% of PCL-R/ACL-R patients. Neurovascular injuries were present in 9% of PCL-R/ACL-Rs, 1% of PCL-Rs, and 0.3% of ACL-Rs (p < 0.001). CONCLUSION Differences in injury mechanisms among patient groups confirm that operatively treated PCL tears are frequently caused by both traffic and sports. Cartilage and ligament injuries were more frequent in patients with PCL-R compared to ACL-R. Consequently, combined PCL and ACL tears should raise suspicion for concomitant knee lesions with clinical relevance during the operative treatment of these complex injuries. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Bálint Zsidai
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Alexandra Horvath
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Philipp W Winkler
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Eric Narup
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Janina Kaarre
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
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Frings J, Weiß S, Kolb J, Behrendt P, Frosch KH, Krause M. Arthroscopic anatomy of the posterolateral corner of the knee: anatomic relations and arthroscopic approaches. Arch Orthop Trauma Surg 2022; 142:443-453. [PMID: 33751186 PMCID: PMC8843911 DOI: 10.1007/s00402-021-03864-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/08/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although open-surgical techniques for the reconstruction of the posterolateral corner (PLC) are well established, the use of arthroscopic procedures has recently increased. When compared with open surgical preparation, arthroscopic orientation in the PLC is challenging and anatomic relations may not be familiar. Nevertheless, a profound knowledge of anatomic key structures and possible structures at risk as well as technical variations of arthroscopic approaches are mandatory to allow a precise and safe surgical intervention. MATERIALS AND METHODS In a cadaveric video demonstration, an anterolateral (AL), anteromedial (AM), posteromedial (PM) and posterolateral (PL) portal, as well as a transseptal approach (TSA) were developed. Key structures of the PLC were defined and sequentially exposed during posterolateral arthroscopy. Finally, anatomic relations of all key structures were demonstrated. RESULTS All key structures of the PLC can be visualized during arthroscopy. Thereby, careful portal placement is crucial in order to allow an effective exposure. Two alternatives of the TSA were described, depending on the region of interest. The peroneal nerve can be visualized dorsal to the biceps femoris tendon (BT), lateral to the soleus muscle (SM) and about 3 cm distal to the fibular styloid (FS). The distal attachment of the fibular collateral ligament (FCL) can be exposed on the lateral side of the fibular head (FH). The fibular attachment of the popliteofibular ligament (PFL) is exposed at the tip of the FS. CONCLUSION Arthroscopy of the posterolateral recessus allows full visualization of all key structures of the posterolateral corner, which provides the basis for anatomic and safe drill channel placement in PLC reconstruction. A sufficient exposure of relevant anatomic landmarks and precise portal preparation reduce the risk of iatrogenic vascular and peroneal nerve injury.
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Affiliation(s)
- Jannik Frings
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Sebastian Weiß
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jan Kolb
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Peter Behrendt
- Department of Orthopaedic and Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany ,Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Monson J, Schoenecker J, Schwery N, Palmer J, Rodriguez A, LaPrade RF. Postoperative Rehabilitation and Return to Sport Following Multiligament Knee Reconstruction. Arthrosc Sports Med Rehabil 2022; 4:e29-e40. [PMID: 35141534 PMCID: PMC8811527 DOI: 10.1016/j.asmr.2021.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/30/2021] [Indexed: 12/18/2022] Open
Abstract
Multiligament knee injuries (MLKIs) are debilitating injuries that increasingly occur in young athletes. Return to sport (RTS) has historically been considered unlikely due to the severity of these injuries. Reporting in the literature regarding objective outcomes following MLKI, including RTS, is lacking, as are clear protocols for both rehabilitation progressions and RTS testing. RTS following MLKI is a complex process that requires an extended recovery duration compared to other surgery types. Progressions through postoperative rehabilitation and RTS should be thoughtful, gradual, and criterion based. After effective anatomic reconstruction to restore joint stability, objective measures of recovery including range of motion, strength, movement quality, power, and overall conditioning guide decision-making throughout the recovery process. It is important to frame the recovery process of the athlete in the context of the severity of their injury, as it is typically slower and less linear. Improved reporting on objective outcomes will enhance our understanding of recovery expectations within this population by highlighting persistent deficits that may interfere with a full recovery, including RTS.
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Affiliation(s)
- Jill Monson
- Twin Cities Orthopedics, Eagan, Minnesota, U.S.A
- Training HAUS, Eagan, Minnesota, U.S.A
| | - Jon Schoenecker
- Twin Cities Orthopedics, Eagan, Minnesota, U.S.A
- Training HAUS, Eagan, Minnesota, U.S.A
| | | | - Jamie Palmer
- Twin Cities Orthopedics, Edina, Minnesota, U.S.A
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Clinical outcomes of rectangular tunnel technique in posterior cruciate ligament reconstruction were comparable to the results of conventional round tunnel technique. Knee Surg Sports Traumatol Arthrosc 2021; 29:3724-3734. [PMID: 33392699 DOI: 10.1007/s00167-020-06381-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/17/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE To compare clinical outcomes between the conventional round and rectangular tunnel techniques in single-bundle posterior cruciate ligament (PCL) reconstruction. METHODS Twenty-seven and 108 patients who underwent PCL reconstructions using a rectangular dilator (Group 1) and rounded tunnel reamer (Group 2), respectively, were included. The exclusion criteria were having a concomitant fracture, osteotomy, subtotal or total meniscectomy, and no remnant PCL tissue. A 4:1 propensity score matching was performed. The knee laxity on stress radiography, International Knee Documentation Committee Subjective Knee Evaluation score, Tegner activity score and Orthopädische Arbeitsgruppe Knie score were evaluated. RESULTS No significant differences were found between the groups in terms of clinical scores. (n.s.) The mean posterior translations were also not significantly different between the Group 1 and 2 (3.6 ± 2.8 and 3.8. ± 3.1 mm, respectively; n.s.). However, 3 patients (11.1%) in Group 1 and 15 patients (13.8%) in Group 2 showed posterior translation of > 5 mm. The combined posterolateral corner sling technique was performed for 27 patients (100%) in Group 1 and for 96 patients (88.9%) in Group 2. We found no significant difference in rotational stability at the final follow-up. One patient was found to have a femoral condyle fracture during rectangular femoral tunnel establishment, which was healed after screw fixation, without laxity, during follow-up. The intra- and inter-observer reliabilities of the radiological measurements ranged from 0.81 to 0.89. CONCLUSION Arthroscopic anatomical remnant-preserving PCL reconstruction using a rectangular dilator showed satisfactory clinical results and stability as compared with PCL reconstruction using a conventional rounded reamer. Rectangular tunnel technique in PCL reconstruction could be a good treatment option with theoretical advantage to be anatomic. LEVEL OF EVIDENCE Level IV.
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21
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Xie WQ, He M, He YQ, Yu DJ, Jin HF, Yu F, Li YS. The effects of posterior cruciate ligament rupture on the biomechanical and histological characteristics of the medial collateral ligament: an animal study. J Orthop Surg Res 2021; 16:330. [PMID: 34020667 PMCID: PMC8139104 DOI: 10.1186/s13018-021-02443-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/22/2021] [Indexed: 12/23/2022] Open
Abstract
Background To investigate the effect of complete rupture of the posterior cruciate ligament (PCL) on the biomechanics and histology of the medial collateral ligament (MCL). Materials and methods Seventy-two male rabbits were randomly divided into two groups: the ruptured group was treated with complete PCL amputation, while the intact group was only subjected to PCL exposure without amputation. Eighteen rabbits were randomly sacrificed at 8, 16, 24, and 40 weeks after the operation, and their specimens were processed for mechanical tensile testing, nano-indentation experiments, hematoxylin-eosin (HE) staining, and picrosirius-polarization staining. Results There was no significant difference in the length and maximum displacement of the MCL between the ruptured group and the intact group at each time point. The maximum load of the ruptured group was significantly smaller than that of the intact group at 40 W. The elastic modulus and micro-hardness of the ruptured group increased significantly at 24 W and decreased significantly at 40 W. At 16 W and 24 W after PCL rupture, the number of type I collagen fibers and type III collagen fibers in the MCL of the ruptured group was significantly increased compared with that of the intact group. While the type I collagen fibers of the ruptured group were significantly decreased compared with the intact group at 40 W, there was no significant difference in type III collagen fibers between the ruptured group and the intact group. Conclusion PCL rupture has no significant effect on the mechanical and histological properties of MCL in a short period of time under physiological loading, but the histological and mechanical properties of MCL decrease with time.
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Affiliation(s)
- Wen-Qing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Miao He
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Yu-Qiong He
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Deng-Jie Yu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hong-Fu Jin
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Fang Yu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
| | - Yu-Sheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
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22
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Liu L, Gui Q, Zhao F, Shen XZ, Pei YL. Isolated Partial Femoral Avulsion Fracture of the Posterior Cruciate Ligament in Adults. Orthop Surg 2021; 13:1290-1298. [PMID: 33960134 PMCID: PMC8274204 DOI: 10.1111/os.12951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/06/2021] [Accepted: 01/20/2021] [Indexed: 12/11/2022] Open
Abstract
Objective To investigate the manifestation, mechanisms, and treatment of isolated partial femoral avulsion fractures of the posterior cruciate ligament (PCL) in adults. Methods From January 2011 to December 2018, we retrospectively reviewed the clinical data of three patients with isolated partial femoral avulsion fractures of the PCL who were admitted to our institution. All of these patients were admitted to our emergency department within 24 h after injury. After physical examination and radiographs were taken and reviewed, all patients were admitted and underwent surgical treatment. In a 26‐year‐old man who underwent arthroscopic surgery through the traditional medial and lateral approach before finally converting to open surgery with the posterior approach, the fragment that was finally removed was partially attached to the PCL. In the other two patients, women aged 63 and 68 years, who underwent arthroscopic surgery via the traditional medial and lateral approach, the fragments were large and attached to most fibers of the PCL. We fixed the fragments using hollow screws in arthroscopic view. In addition, in the 63‐year‐old patient, an anchor was embedded to restore the tension of the PCL. Four weeks after surgery, the patients started to wear long leg braces in full extension with the tibia blocked up by cushion. Physical examinations were conducted and radiographs were taken preoperatively and at 4 weeks and 3 months after surgery to evaluate the condition of the injury. The range of motion and the Lysholm knee scoring scale for the knee joint were compared before and after the surgery. Results For the three patients, the radiographs taken at 3 months postoperatively showed that the fixation of the screws did not fail, and the subchondral bone was generally normal compared to the preoperative radiographs. CT scanning at 3 months after surgery showed that the fracture healed in the original position of the avulsion site. For all patients, the affected knees presented as stable at physical examination 3 months after surgery; the Lachmann test and the anterior drawer test results were negative. In addition, the flexion–extension, internal rotation, and external rotation were approximately 0°–130°, 0°–30°, and 0°–40° in the 26‐year‐old patient, respectively. The flexion–extension, internal rotation, and external rotation were approximately 0°–100°, 0°–20°, and 0°–35° for the 63‐year‐old patient, respectively. The flexion–extension, internal rotation, and external rotation were approximately 0°–100°, 0°–15°, and 0°–20° for the 68‐year‐old patient, respectively. There was no pain or only little pain 3 months after surgery. There was no swelling or discomfort at the 3‐month follow up. The Lysholm knee scores of the 68‐year‐old, 63‐year‐old, and 26‐year‐old patient were 80, 87, and 95 at 3 months after surgery, respectively, which were obviously improved postoperatively. Conclusion The manifestation of isolated partial femoral avulsion fractures of the PCL in adults is often related to the injury mechanism, and surgery is essential for the treatment of these patients. Most of these fractures can be repaired by arthroscopic surgery, but some have to be treated by open surgery.
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Affiliation(s)
- Liang Liu
- Department of Sports Medicine, Beijing LUHE Hospital Capital Medical University, Beijing, China
| | - Qi Gui
- Department of Sports Medicine, Beijing LUHE Hospital Capital Medical University, Beijing, China
| | - Feng Zhao
- Department of Sports Medicine, Beijing LUHE Hospital Capital Medical University, Beijing, China
| | - Xue-Zhen Shen
- Department of Sports Medicine, Beijing LUHE Hospital Capital Medical University, Beijing, China
| | - Yi-Lun Pei
- Department of Sports Medicine, Beijing LUHE Hospital Capital Medical University, Beijing, China
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23
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Ewing MA, Stannard JP, Cook JL. Diagnosis and Management of Articular Cartilage and Meniscus Pathology in the Posterior Cruciate Ligament-Injured Knee. J Knee Surg 2021; 34:599-604. [PMID: 33648008 DOI: 10.1055/s-0041-1725176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Posterior cruciate ligament (PCL) injuries commonly occur in association with participation in sporting or recreational activities or due to a direct trauma. Cartilage and meniscal lesions are prevalent in PCL-injured knees with increasing likelihood and severity based on extent and duration of trauma to the knee. As such, comprehensive diagnostics should be performed to ascertain all related pathology, and patients should be thoroughly educated regarding treatment options, likely sequelae including posttraumatic osteoarthritis, and associated outcomes. Treatments should address the joint as an organ, ensuring stability, alignment, and functional tissue restoration are optimized by the most efficient and effective means possible. Compliance with patient- and procedure-specific postoperative management protocols is critical for optimizing successful outcomes for these complex cases. The objectives of this review article are to highlight the likelihood and importance of osteochondral and meniscal pathology in the PCL-injured knee, and to provide the best current evidence regarding comprehensive evaluation and management for PCL-injured knees with cartilage and/or meniscal comorbidities.
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Affiliation(s)
- Michael A Ewing
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, Mizzou BioJoint Center, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, Mizzou BioJoint Center, University of Missouri, Columbia, Missouri
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Drenck TC, Preiss A, Domnick C, Herbort M, Frings J, Akoto R, Krause M, Frosch KH. The Popliteus Bypass provides superior biomechanical properties compared to the Larson technique in the reconstruction of combined posterolateral corner and posterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2021; 29:732-741. [PMID: 32372281 DOI: 10.1007/s00167-020-05987-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/07/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to compare the biomechanical properties of the popliteus bypass against the Larson technique for the reconstruction of a combined posterolateral corner and posterior cruciate ligament injury. METHODS In 18 human cadaver knees, the kinematics for 134 N posterior loads, 10 Nm varus loads, and 5 Nm external rotational loads in 0°, 20°, 30°, 60,° and 90° of knee flexion were measured using a robotic and optical tracking system. The (1) posterior cruciate ligament, (2) meniscofibular/-tibial fibers, (3) popliteofibular ligament (PFL), (4) popliteotibial fascicle, (5) popliteus tendon, and (6) lateral collateral ligament were cut, and the measurements were repeated. The knees underwent posterior cruciate ligament reconstruction, and were randomized into two groups. Group PB (Popliteus Bypass; n = 9) underwent a lateral collateral ligament and popliteus bypass reconstruction and was compared to Group FS (Fibular Sling; n = 9) which underwent the Larson technique. RESULTS Varus angulation, posterior translation, and external rotation increased after dissection (p < 0.01). The varus angulation was effectively reduced in both groups and did not significantly differ from the intact knee. No significant differences were found between the groups. Posterior translation was reduced by both techniques (p < 0.01), but none of the groups had restored stability to the intact state (p < 0.02), with the exception of group PB at 0°. No significant differences were found between the two groups. The two techniques revealed major differences in their abilities to reduce external rotational instability. Group PB had less external rotational instability compared to Group FS (p < 0.03). Only Group PB had restored rotational instability compared to the state of the intact knee (p < 0.04) at all degrees of flexion. CONCLUSION The popliteus bypass for posterolateral reconstruction has superior biomechanical properties related to external rotational stability compared to the Larson technique. Therefore, the popliteus bypass may have a positive influence on the clinical outcome. This needs to be proven through clinical trials.
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Affiliation(s)
- Tobias C Drenck
- Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Achim Preiss
- Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Christoph Domnick
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Mirco Herbort
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Jannik Frings
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ralph Akoto
- Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Matthias Krause
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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McCadden A, Akelman M, Traven SA, Woolf SK, Xerogeanes JW, Slone HS. Quadriceps tendon autograft is an effective alternative graft for posterior cruciate ligament reconstruction in isolated or multiligament injuries: a systematic review. J ISAKOS 2021; 6:220-225. [PMID: 34272298 DOI: 10.1136/jisakos-2020-000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 01/12/2023]
Abstract
IMPORTANCE High-grade posterior cruciate ligament (PCL) tears can be a significant cause of patient morbidity and knee instability. The graft of choice for operative repair remains controversial, although recently there has been increased interest in quadriceps tendon (QT) as an autologous graft option. OBJECTIVE The purpose of this study was to perform a systematic review to assess reported clinical outcomes of PCL reconstructions using QT autografts. EVIDENCE REVIEW A comprehensive review of clinical studies was performed evaluating PCL reconstruction with QT autograft including a systematic search of PubMed, Scopus, Cochrane and Google Scholar databases, and reference lists of relevant papers. Clinical results, stability results, functional outcomes, range-of-motion outcomes, complications and morbidity, and the conclusions of each study were evaluated. FINDINGS Seven studies were included in the review of clinical results, including 145 subjects undergoing PCL reconstructions with QT autograft. All studies evaluated quadriceps tendon bone (QT-B) grafts. Among these seven studies, two included isolated PCL reconstruction while five included multiligamentous knee injury reconstruction. These studies suggest that QT-B autograft offers a viable graft option for primary PCL reconstruction with generally favourable patient-reported outcomes, knee stability and range of motion reported along with relatively low complication rates. CONCLUSIONS AND RELEVANCE Use of the QT-B autograft may be a reasonable graft option for PCL reconstruction. However, high-quality prospective studies are required to evaluate the long-term safety, efficacy and functional outcomes. LEVEL OF EVIDENCE Level IV (Systematic review of Level IV studies).
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Affiliation(s)
- Austin McCadden
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Matthew Akelman
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sophia A Traven
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shane K Woolf
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John W Xerogeanes
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, USA
| | - Harris S Slone
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Longo UG, Viganò M, Candela V, de Girolamo L, Cella E, Thiebat G, Salvatore G, Ciccozzi M, Denaro V. Epidemiology of Posterior Cruciate Ligament Reconstructions in Italy: A 15-Year Study. J Clin Med 2021; 10:jcm10030499. [PMID: 33535403 PMCID: PMC7867089 DOI: 10.3390/jcm10030499] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 01/02/2023] Open
Abstract
Background: The posterior cruciate ligament (PCL) is an essential element in knee stability. PCL reconstructions represent an under-investigated topic in the literature due to the rarity of this type of knee injury. This study aims to investigate the incidence of PCL reconstructive surgeries in Italy, following their trend during a 15-year period. Methods: The National Hospital Discharge records (SDO) collected by the Italian Ministry of Health between January 2001 and October 2015 were analyzed. The database reports anonymous data comprising patients’ ages, genders, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for diagnosis and intervention, census regions, regions of hospitalization, lengths of hospitalization and types of reimbursement. Results: The overall incidence of PCL reconstructions in the Italian population during the study period was 0.46 surgeries per 100,000 inhabitants/year, ranging from 0.32 to 0.54. The median patient’s age was 30 years old, and the male:female ratio was 5.3. PCL lesions were isolated in 39.7% of patients, while anterior cruciate ligament injuries were the most frequently associated lesions (31.1%). Conclusions: The incidence of PCL reconstruction in Italy was low and stable during the study period. Young men are the category at the highest risk for these procedures. Given the paucity of epidemiological data on PCL reconstructions, this data may represent a reference for the current and foreseeable needs in PCL surgeries for countries sharing similar cultural context.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (U.G.L.); (G.S.); (V.D.)
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.V.); (G.T.)
| | - Vincenzo Candela
- Medical Statistics and Molecular Epidemiology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (V.C.); (E.C.); (M.C.)
| | - Laura de Girolamo
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.V.); (G.T.)
- Correspondence: ; Tel.: +39-02-6621-4059
| | - Eleonora Cella
- Medical Statistics and Molecular Epidemiology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (V.C.); (E.C.); (M.C.)
| | - Gabriele Thiebat
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.V.); (G.T.)
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (U.G.L.); (G.S.); (V.D.)
| | - Massimo Ciccozzi
- Medical Statistics and Molecular Epidemiology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (V.C.); (E.C.); (M.C.)
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (U.G.L.); (G.S.); (V.D.)
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Treatment of medial-sided injuries in patients with early bicruciate ligament reconstruction for knee dislocation. Knee Surg Sports Traumatol Arthrosc 2021; 29:1872-1879. [PMID: 32862240 PMCID: PMC8126547 DOI: 10.1007/s00167-020-06207-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/03/2020] [Indexed: 11/14/2022]
Abstract
PURPOSE In knee dislocation with bicruciate ligament and medial side injury (KDIIIM), treatment method of medial side injuries is controversial. The purpose of this study was to evaluate the outcomes of non-operative treatment of proximal and midsubstance and operative treatment of distal avulsion medial collateral ligament (MCL) ruptures in patients with early bicruciate reconstruction. METHODS One-hundred and forty-seven patients with a knee dislocation and bicruciate ligament injury (KDII-KDV) were identified. Sixty-two patients had KDIIIM injury. Of these, 24 patients were excluded and 13 were lost to follow-up. With a minimum of 2 years of follow-up, IKDC2000 (subjective and objective), Lysholm and Tegner scores and stress radiographs were recorded. RESULTS Twenty-five patients were available for follow-up: 18 had a proximal or midsubstance grade-III MCL rupture (proximal MCL group) and 7 had a distal MCL avulsion (distal MCL group). In the proximal MCL and distal MCL groups, respectively, median IKDC2000 subjective scores were 80 (range 57-99) and 62 (range 39-87), and median Lysholm scores were 88 (range 57-99) and 75 (range 40-100). The median medial opening (side-to-side difference) was 2.4 mm (range 0.1-9.2) in the proximal MCL group and 2.5 mm (range 0.2-4.8) in the distal MCL group. CONCLUSION We found acceptable recorded outcomes in patients who underwent non-operative treatment of proximal and midsubstance grade-III MCL rupture and operative treatment of distal MCL avulsion with early bicruciate ligament reconstruction. LEVEL OF EVIDENCE Level IV.
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Winkler PW, Zsidai B, Wagala NN, Hughes JD, Horvath A, Senorski EH, Samuelsson K, Musahl V. Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 1: anatomy, biomechanics and diagnostics. Knee Surg Sports Traumatol Arthrosc 2021; 29:672-681. [PMID: 33201271 PMCID: PMC7917041 DOI: 10.1007/s00167-020-06357-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/26/2020] [Indexed: 01/10/2023]
Abstract
The posterior cruciate ligament (PCL) represents an intra-articular structure composed of two distinct bundles. Considering the anterior and posterior meniscofemoral ligaments, a total of four ligamentous fibre bundles of the posterior knee complex act synergistically to restrain posterior and rotatory tibial loads. Injury mechanisms associated with high-energy trauma and accompanying injury patterns may complicate the diagnostic evaluation and accuracy. Therefore, a thorough and systematic diagnostic workup is necessary to assess the severity of the PCL injury and to initiate an appropriate treatment approach. Since structural damage to the PCL occurs in more than one third of trauma patients experiencing acute knee injury with hemarthrosis, background knowledge for management of PCL injuries is important. In Part 1 of the evidence-based update on management of primary and recurrent PCL injuries, the anatomical, biomechanical, and diagnostic principles are presented. This paper aims to convey the anatomical and biomechanical knowledge needed for accurate diagnosis to facilitate subsequent decision-making in the treatment of PCL injuries.Level of evidence V.
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Affiliation(s)
- Philipp W. Winkler
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA 15203 USA
| | - Bálint Zsidai
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Nyaluma N. Wagala
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA 15203 USA
| | - Jonathan D. Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA 15203 USA
| | - Alexandra Horvath
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA 15203 USA
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