1
|
Influence of the Tibial Tunnel Angle and Posterior Tibial Slope on "Killer Turn" during Posterior Cruciate Ligament Reconstruction: A Three-Dimensional Finite Element Analysis. J Clin Med 2023; 12:jcm12030805. [PMID: 36769453 PMCID: PMC9917875 DOI: 10.3390/jcm12030805] [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: 12/08/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
This study aimed to evaluate the influence of various posterior tibial slopes (PTSs) and tibial tunnel angles (TTAs) on "killer turn" in posterior cruciate ligament (PCL) reconstruction by using three-dimensional finite element analysis (FEA). The study models were created using computed tomography images of a healthy young Asian male. Using SolidWorks, PCL grafts and tibial bone tunnels at different tibial drilling angles (30°, 45°, 60°) were developed. Anterior opening wedge high tibial osteotomy (aOW-HTO) was performed to evaluate the influence of the PTS (+8°, +4°, native, -4°, -8°). An FEA was performed utilizing the ANSYS software program. In the same PTS model, the peak of the equivalent Von Mises stress in PCL grafts decreased as the angle of the TTA increased. In the same TTA model, the peak of the Von Mises in PCL grafts decreased as the PTS angle increased. The "high-contact stress area" (contact stress greater than 10 MPa) was diminished when the TTA and PTS were increased. aOW-HTO was used to steepen the PTS, and a larger TTA may reduce the stress at the "killer turn" during PCL reconstruction. In conclusion, the study findings suggest that using aOW-HTO to steepen the PTS and a larger TTA may reduce the stress at the "killer turn" during PCL reconstruction. The usefulness and safety of this surgical procedure need to be evaluated in future clinical studies.
Collapse
|
2
|
The promotive effect of grafts with the double-stranded peroneus longus tendon and with the four-stranded hamstring tendon on reconstruction of the posterior cruciate ligament injury. Orthop Traumatol Surg Res 2022; 108:103336. [PMID: 35643366 DOI: 10.1016/j.otsr.2022.103336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 02/07/2022] [Accepted: 03/16/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Posterior cruciate ligament (PCL) injury hampers the rotational stability and stability front to back of the knee joint, seriously affecting the quality of life of patients. Some studies have reported that the peroneus longus tendon (PLT) has sufficient length and strength. HYPOTHESIS We hypothesized that the PLT can be used as a novel appropriate material for PCL reconstruction therapy. MATERIALS AND METHODS Herein, we systematically analysed the clinical effect of the double-stranded PLT and the four-stranded hamstring tendon in the reconstruction of the PCL and compared the effectiveness and safety of these two surgical approaches in the reconstruction of PCL injury. A total of 48 patients with complete rupture of the PCL were divided into Group A (reconstructed with the double-stranded PLT, 25 cases) and Group B (reconstructed with the four-stranded hamstring tendon, 23 cases). RESULTS The patients were followed up for more than 1 year. The intraoperative time for tendon extraction was significantly shorter in Group A than Group B. Twenty-four months after operation, patients in the two groups showed the alleviated tibial posterior displacement and the increased IKDC score, Lysholm score and Tegner score. Nevertheless, these scores showed no significant differences between the two groups. Additionally, compared with the therapy using the four-stranded hamstring tendon, therapy using the double-stranded PLT is simpler and safer. DISCUSSION Both surgical methods are effective in the treatment of PCL injury. The PLT could be a good choice for PCL injury reconstruction material, especially when the four-stranded hamstring tendon is accidentally damaged or ineffective. Our study may provide guidance for the clinical treatment of PCL injury. LEVEL OF EVIDENCE III, retrospective study.
Collapse
|
3
|
Allografts as alternative to autografts in primary posterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07258-y. [PMID: 36449047 DOI: 10.1007/s00167-022-07258-y] [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: 08/31/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Following posterior cruciate ligament (PCL) rupture, autografts and allografts are routinely used for its reconstruction. This study investigated the efficacy and safety of allografts for primary PCL reconstruction, comparing them to autografts in terms of patient-reported outcome measures (PROMs), functional tests, and complications. METHODS This study followed the PRISMA guidelines. PubMed, Web of Science, Google Scholar, Embase, and Scopus were accessed in October 2022. All the clinical studies investigating the outcomes of primary PCL reconstruction using allografts, or comparing the outcomes of allografts versus autografts, were accessed. The outcomes of interests were: instrumental laxity, range of motion (ROM), Telos stress radiography, drawer test, International Knee Documentation Committee (IKDC), Tegner Activity Scale, and the Lysholm Knee Scoring Scale. Data on complications were also recorded. RESULTS A total of 445 patients were included. The mean follow-up was 45.2 ± 23.8 months. The mean age of the patients was 30.6 ± 2.2 years. The time span between the injury and surgical intervention was 12.9 ± 10 months. Overall, 28% (125 of 445 patients) were women. Good baseline comparability was found between the two cohorts. No difference was found in terms of Lysholm Score, ROM, Tegner Scale, IKDC, arthrometer laxity, drawer test, and Telos stress radiography. No difference was found in the rates of anterior knee pain and revision. CONCLUSION Allografts can be considered a suitable alternative to autografts for PCL reconstruction. LEVEL OF EVIDENCE III.
Collapse
|
4
|
Knapik DM, Gopinatth V, Jackson GR, Chahla J, Smith MV, Matava MJ, Brophy RH. Global variation in isolated posterior cruciate ligament reconstruction. J Exp Orthop 2022; 9:104. [PMID: 36209443 PMCID: PMC9548455 DOI: 10.1186/s40634-022-00541-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/29/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose In the setting of persistent instability or failed non-operative management, surgical reconstruction is commonly recommended for isolated posterior cruciate ligament (PCL) tears. The purpose of this study was to systematically review published studies to evaluate regional variation in the epidemiology of and surgical approaches to primary, isolated PCL reconstruction. Methods A systematic review was performed in June 2022 to identify studies examining operative techniques during primary, isolated PCL reconstruction. Collected variables consisted of reconstruction technique, graft type, graft source, tibial reconstruction technique, femoral and tibial drilling and fixation methods, and whether the remnant PCL was preserved or debrided. Studies were classified into four global regions: Asia, Europe, North America, and South America. Results Forty-five studies, consisting of 1461 total patients, were identified. Most of the included studies were from Asia (69%, n = 31/45). Single bundle reconstruction was more commonly reported in studies out of Asia, Europe, and North America. Hamstring autografts were utilized in 51.7% (n = 611/1181) of patients from Asia and 60.8% (n = 124/204) of patients from Europe. Trans-tibial drilling and outside-in femoral drilling were commonly reported in all global regions. The PCL remnant was generally debrided, while remnant preservation was commonly reported in studies from Asia. Conclusion Surgical treatment of isolated PCL injuries varies by region, with the majority of published studies coming from Asia. Single-bundle reconstruction with hamstring autograft through a trans-tibial approach is the most commonly reported technique in the literature, with males reported to undergo isolated reconstruction more often than females. Level of Evidence Systematic review, Level IV. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00541-4.
Collapse
|
5
|
Migliorini F, Pintore A, Vecchio G, Oliva F, Hildebrand F, Maffulli N. Hamstring, bone-patellar tendon-bone, quadriceps and peroneus longus tendon autografts for primary isolated posterior cruciate ligament reconstruction: a systematic review. Br Med Bull 2022; 142:23-33. [PMID: 35460407 PMCID: PMC9351477 DOI: 10.1093/bmb/ldac010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Several autografts are available to reconstruct the posterior cruciate ligament (PCL). SOURCE OF DATA Current scientific literature published in PubMed, Google scholar, Embase and Scopus. AREAS OF AGREEMENT Hamstring, bone-patellar tendon-bone (BPTB), quadriceps and peroneus longus (PLT) are the most common tendon autografts used for primary isolated PCL reconstruction. AREAS OF CONTROVERSY The optimal tendon source for PCL reconstruction remains nevertheless debated. Identifying the most suitable tendon autograft could assist the surgeon during primary PCL reconstruction. GROWING POINTS The present study compared the outcome of PCL reconstruction using hamstring, BPTB, quadriceps and PLT autografts. The focus was on patient-reported outcome measures (PROMs), joint laxity, range of motion and complications. AREAS TIMELY FOR DEVELOPING RESEARCH All autografts are viable options for PCL reconstruction, with BTB and hamstring autografts demonstrating superior PROMs. However, further clinical investigations are required to determine the ideal autograft construct.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen 52064, Germany
| | - Andrea Pintore
- Department of Orthopaedics, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi, Salerno (SA) 84081, Italy
| | - Gianluca Vecchio
- Department of Orthopaedics, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi, Salerno (SA) 84081, Italy
| | - Francesco Oliva
- Department of Orthopaedics, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi, Salerno (SA) 84081, Italy
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen 52064, Germany
| | - Nicola Maffulli
- Correspondence address. Queen Mary University of London, , Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK. E-mail:
| |
Collapse
|
6
|
Operative management of isolated posterior cruciate ligament injuries improves stability and reduces the incidence of secondary osteoarthritis: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:1733-1743. [PMID: 34505176 DOI: 10.1007/s00167-021-06723-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the evidence for operative and non-operative management of isolated posterior cruciate ligament (PCL) injuries. METHODS Using Pubmed, EMBASE and Cochrane databases, a systematic review was conducted of studies investigating the treatment of isolated PCL injuries published until July 2020. Quality assessment was performed with the Cochrane risk of bias tool (level I), the Newcastle-Ottowa Scale (level II-III) and the National Institute of Health quality assessment tool (level IV). Clinical outcome measures included residual laxity, return to sports, patient-reported outcome measures, subsequent articular degeneration and complications. RESULTS Twenty-seven studies [23 case series, 2 case-control, 1 cohort study and 1 randomized controlled trial (RCT)] including 5197 patients (5199 knees) with a mean age of 29.5 ± 3.6 years (range 15-68) fulfilled the study requirements. Significantly less residual laxity was found after posterior cruciate ligament reconstruction (PCLR) compared to non-operative management (3.43 vs. 5.47 mm, CI: 1.84-2.23, p < 0.001). Both treatment modalities yielded satisfying functional outcomes and a high return to sports (64-77%, mean: 70.3, CI: 67.8-72.2). Osteoarthritis (OA) occurred less frequently following PCLR (21.5 vs. 44.1%, p < 0.001). CONCLUSION In the absence of level I RCTs, this systematic review suggests that surgical management for selected isolated PCL injuries is a reasonable option to consider, especially when the surgeon aims at minimizing residual laxity and presumably secondary osteoarthritis. LEVEL OF EVIDENCE IV.
Collapse
|
7
|
Migliorini F, Pintore A, Spiezia F, Oliva F, Hildebrand F, Maffulli N. Single versus double bundle in posterior cruciate ligament (PCL) reconstruction: a meta-analysis. Sci Rep 2022; 12:4160. [PMID: 35264676 PMCID: PMC8907238 DOI: 10.1038/s41598-022-07976-w] [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: 07/04/2021] [Accepted: 02/01/2022] [Indexed: 11/17/2022] Open
Abstract
Posterior cruciate ligament (PCL) reconstruction can be performed using single bundle (SB) and double bundle (DB) techniques. The present study investigated whether DB PCL reconstruction is superior to SB reconstruction in terms of patient reported outcome measures (PROMs) and joint stability. In December 2021 Embase, Google Scholar, Pubmed, Scopus databases were accessed. All clinical trials comparing SB versus DB reconstruction to address PCL insufficiency in skeletally mature patients were considered. Data from 483 procedures were retrieved. The mean follow-up was 31.0 (28.0 to 107.6) months, and the mean timespan between injury and surgery was 11.3 (6 to 37) months. The mean age of the patients was 29.3 ± 3.8 years. 85 of 483 patients (18%) were women. At a mean of 31.0 months post reconstruction, ROM (P = 0.03) was slightly greater in the SB group, while the Tegner score (P = 0.03) and the Telos stress (P = 0.04) were more favorable in the DB cohort. Similarity was found in instrumental laxity (P = 0.4) and Lysholm score (P = 0.3). The current evidence does not support the use of DB techniques for PCL reconstruction. Both methods could restore knee stability and motion with satisfactory short term patient reported outcome measures. Further high quality clinical trials are required to validate these results on a larger scale.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074, Aachen, Germany.
| | - Andrea Pintore
- Department of Orthopaedics, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
| | - Filippo Spiezia
- Department of Orthopedic and Trauma Surgery, Ospedale San Carlo, Potenza, Italy
| | - Francesco Oliva
- Department of Orthopaedics, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Orthopaedics, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, E1 4DG, England.,Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Thornburrow Drive, Stoke on Trent, England
| |
Collapse
|
8
|
Posterior cruciate ligament reconstruction with peroneus longus tendon versus hamstring tendon: a comparison of functional outcome and donor site morbidity. Knee Surg Sports Traumatol Arthrosc 2021; 29:1045-1051. [PMID: 32476036 DOI: 10.1007/s00167-020-06077-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/20/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE This study aimed to evaluate the differences in clinical outcome and donor site morbidity between the Peroneus Longus Tendon (PLT) and Hamstring Tendon (HT) in single-bundle Posterior Cruciate Ligament (PCL) reconstruction. METHODS Patients with an isolated PCL injury underwent single-bundle PCL reconstruction using consecutive sampling. Patients were allocated into two groups (PLT and HT) and prospectively observed. The tendon graft diameter was measured intraoperatively. Functional scores (IKDC, Lysholm, and modified Cincinnati scores) were recorded preoperatively and 2 years postoperatively. The thigh circumference and functional score according to the Foot and Ankle Disability Index (FADI) and American Orthopedic Foot and Ankle Society (AOFAS) were recorded to evaluate the morbidities in the ankle. RESULTS Fifty-five patients (hamstring n = 27, peroneus n = 28) met the inclusion criteria. The diameter of the PLT graft (8.2 ± 0.6 mm) was comparable to that of the HT graft (8.3 ± 0.5 mm). Both groups had excellent postoperative knee functional outcome scores. The mean AOFAS and FADI scores were excellent, with no difference in thigh circumference between the groups. CONCLUSION PLT is a good choice as a graft in PCL reconstruction at the 2-year follow-up, with minimal donor site morbidity. LEVEL OF EVIDENCE II.
Collapse
|
9
|
Rhatomy S, Utomo DN, Suroto H, Mahyudin F. Posterior cruciate ligament research output in asian countries from 2009 - 2019: A systematic review. Ann Med Surg (Lond) 2020; 59:76-80. [PMID: 32994987 PMCID: PMC7501478 DOI: 10.1016/j.amsu.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose This study aimed to determine the number of posterior cruciate ligament (PCL) publications performed in Asian countries and to identify factors associated with research output in this region. Materials and methods Searches of existing academic journal articles were performed using PubMed, Google Scholar, and the Cochrane Library from January 1, 2009 until December 31, 2019. Results A total of 265 articles were published in the last 10 years in Asian countries, with an increase in publications after 2010 and an average of 26 articles every year. More than half (70%) of the articles were published in journals with an impact factor (IF) ≥1. The majority of the publications were cohort studies (27%), followed by case reports (16%), systematic reviews/meta-analyses (2.6%), laboratory studies (1.8%), and case-control studies (1.5%). South Korea and China had the most PCL publications, and most authors were from South Korea. Conclusion The PCL research output in Asia is low in quantity but high in quality publications, and the majority of publications come from South Korea, China and Japan, with most being cohort studies and case reports.
Collapse
Affiliation(s)
| | - Dwikora Novembri Utomo
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Heri Suroto
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Ferdiansyah Mahyudin
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Indonesia
| |
Collapse
|
10
|
Abstract
Several techniques for posterior cruciate ligament (PCL) reconstruction have been described. Reported clinical outcomes for the various techniques are often affected by concomitant injuries. Therefore, the optimal surgical technique choice remains controversial. Variations include transtibial versus tibial inlay, single-bundle versus double-bundle, and autograft versus allograft. The all-inside technique has recently been described as a transtibial method that uses adjustable loop suspensory fixation through sockets rather than tunnels on both the femur and tibia. This technique preserves more bone and may decrease the risk of tunnel convergence during multiligament reconstruction or concomitant meniscus procedures. This paper outlines the options available to surgeons performing PCL reconstruction and describes the authors' preferred technique for all-inside PCL reconstruction.
Collapse
|
11
|
Kernkamp WA, Jens AJT, Varady NH, van Arkel ERA, Nelissen RGHH, Asnis PD, LaPrade RF, Van de Velde SK, Li G. Anatomic is better than isometric posterior cruciate ligament tunnel placement based upon in vivo simulation. Knee Surg Sports Traumatol Arthrosc 2019; 27:2440-2449. [PMID: 30367194 DOI: 10.1007/s00167-018-5233-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 10/17/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To elucidate the effects of various tibial and femoral attachment locations on the theoretical length changes and isometry of PCL grafts in healthy knees during in vivo weightbearing motion. METHODS The intact knees of 14 patients were imaged using a combined magnetic resonance and dual fluoroscopic imaging technique while the patient performed a quasi-static lunge (0°-120° of flexion). The theoretical end-to-end distances of the 3-dimensional wrapping paths between 165 femoral attachments, including the anatomic anterolateral bundle (ALB), central attachment and posteromedial bundle (PMB) of the PCL, connected to an anterolateral, central, and posteromedial tibial attachment were simulated and measured. A descriptive heatmap was created to demonstrate the length changes on the medial condyle and formal comparisons were made between the length changes of the anatomic PCL and most isometric grafts. RESULTS The most isometric graft, with approximately 3% length change between 0° and 120° of flexion, was located proximal to the anatomic femoral PCL attachments. Grafts with femoral attachments proximal to the isometric zone decreased in length with increasing flexion angles, whereas grafts with more distal attachments increased in length with increasing flexion angles. The ALB and central single-bundle graft demonstrated a significant elongation from 0° to 120° of flexion (p < 0.001). The PMB decreased in length between 0° and 60° of flexion after which the bundle increased in length to its maximum length at 120° (p < 0.001). No significant differences in length changes were found between either the ALB or PMB and the central graft, and between the ALB and PMB at flexion angles ≥ 60° (n.s.). CONCLUSIONS The most isometric attachment was proximal to the anatomic PCL footprint and resulted in non-physiological length changes. Moving the femoral attachment locations of the PCL significantly affected length change patterns, whereas moving the tibia locations did not. The importance of anatomically positioned (i.e., distal to the isometric area) femoral PCL reconstruction locations to replicate physiological length changes is highlighted. These data can be used to optimize tunnel positioning in either single- or double-bundle and primary or revision PCL reconstruction cases. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Willem A Kernkamp
- Bioengineering Laboratory, Newton-Wellesley Hospital, Newton, MA, 02462, USA.,Sports Medicine Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Axel J T Jens
- Bioengineering Laboratory, Newton-Wellesley Hospital, Newton, MA, 02462, USA.,Focus Clinic Orthopedic Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Nathan H Varady
- Bioengineering Laboratory, Newton-Wellesley Hospital, Newton, MA, 02462, USA.,Sports Medicine Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Ewoud R A van Arkel
- Focus Clinic Orthopedic Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Rob G H H Nelissen
- Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter D Asnis
- Sports Medicine Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | | | - Samuel K Van de Velde
- Division of Pediatric Orthopaedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Guoan Li
- Bioengineering Laboratory, Newton-Wellesley Hospital, Newton, MA, 02462, USA.
| |
Collapse
|
12
|
Noh JH, Yoon KH, Kyung HS, Roh YH, Kang TS. Multiple looping technique for tibial fixation in posterior cruciate ligament reconstruction using free tendon Achilles allograft. Knee Surg Sports Traumatol Arthrosc 2017; 25:2640-2645. [PMID: 26085189 DOI: 10.1007/s00167-015-3674-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 06/08/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE This study was conducted to evaluate case series outcomes of a new tibial fixation technique using a free tendon graft during posterior cruciate ligament (PCL) reconstruction which is less affected by tibial metaphysis bone density. METHODS Thirty-two subjects underwent single-bundle PCL reconstruction using a free tendon Achilles allograft. The graft was looped to be double stranded. The free ends of the graft were fixed to the femoral side using suture washer, and the looped end was fixed to the tibial side using the multiple looping technique. Range of motion of the knee and side-to-side difference were assessed at the last follow-up. The Lysholm Knee score was evaluated preoperatively and at the last follow-up. The Tegner Activity Scale score was evaluated before injury and at the last follow-up. RESULTS Twenty-eight subjects were followed up for at least 18 months. Mean follow-up was 27.7 ± 4.8 months. All subjects showed normal range of motion at the last follow-up. The mean side-to-side difference was 10.4 ± 2.8 mm preoperatively and 2.3 ± 1.8 mm at the last follow-up (p < 0.001). The mean Lysholm Knee score was 58 ± 9 preoperatively and 91 ± 5 at the last follow-up (p < 0.001). The median Tegner Activity Scale score was 7 (range 5-9) before injury and 6 (range 4-8) at the last follow-up (p = 0.001). CONCLUSIONS The multiple looping technique for tibial fixation resulted in satisfactory outcomes from single-bundle PCL reconstruction without any significant complications. LEVEL OF EVIDENCE Therapeutic case series, Level IV.
Collapse
Affiliation(s)
- Jung Ho Noh
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon-si, Gangwon-do, 200-701, South Korea
| | - Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyunghee University School of Medicine, Seoul, South Korea
| | - Hee Soo Kyung
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Young Hak Roh
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, 1198, Kuwol-dong, Namdong-gu, Inchon, 405-760, Korea.
| | - Tae Seok Kang
- Department of Family Medicine, Daerim St. Mary's Hospital, Seoul, South Korea
| |
Collapse
|
13
|
Li Y, Zhang J, Song G, Li X, Feng H. The mechanism of "killer turn" causing residual laxity after transtibial posterior cruciate ligament reconstruction. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2016; 3:13-18. [PMID: 29264255 PMCID: PMC5730655 DOI: 10.1016/j.asmart.2015.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 12/06/2015] [Accepted: 12/09/2015] [Indexed: 11/02/2022]
Abstract
Background The residual laxity after transtibial posterior cruciate ligament (PCL) reconstruction has been reported by several authors. The sharp angle where the graft exits the tibial tunnel, which is known as "killer turn", is believed to be the main reason. The purpose of this study was to reveal the mechanism of "killer turn" and its effect on both graft and tunnel inlet. Methods A total of 60 New Zealand white rabbits were included. All transtibial PCL reconstructions were performed in vitro using Achilles tendon autograft. The cyclic loading tests were conducted when reconstructed knees were subjected to 1500 cycles of tensile force of 50 N with the angle of pull at 45° to the tibial plateau. The tunnel inlet enlargement, graft elongation, stiffness, graft displacement, load to failure, and failure site were all recorded and analysed. Results Fifty-eight New Zealand white rabbits were available for biomechanical evaluation. The subjects had significant graft elongation and tunnel enlargement. The graft displacement increased by a mean of 0.92 ± 0.36 mm (16.70%). At the 1500th cycle, the grafts were significantly elongated by 5.59 ± 4.98%, and the tunnel inlet diameter was also significantly enlarged by 12.08 ± 4.31%. There was a linear correlation between total graft displacement and the two variables (R2 = 0.402, F = 18.515, p < 0.001). The coefficient for tunnel inlet enlargement was 0.419 (p = 0.006), and for graft elongation was 0.583 (p = 0.002). At the load-to-failure test, the failure load was 81.19 ± 20.13 N. Of the 58 grafts, 31 (53.45%) failed at the "killer turn", 13 (22.41%) for the para-tunnel fracture, seven (12.07%) for the graft pull-out, and the remaining seven (12.07%) for the rupture at the mounting site. Conclusion The mechanism of "killer turn" compromising posterior stability was that the repetitive friction between graft and tunnel inlet not only attenuated the graft, but also enlarged the tunnel inlet, leading to the displacement of the graft.
Collapse
Affiliation(s)
- Yue Li
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Jin Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Guanyang Song
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Xu Li
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Hua Feng
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| |
Collapse
|
14
|
King AH, Prince MR, Reardon PJ, Levy BA, Stuart MJ. All-Inside Posterior Cruciate Ligament Reconstruction. OPER TECHN SPORT MED 2015. [DOI: 10.1053/j.otsm.2015.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
15
|
All-Inside Posterior Cruciate Ligament Reconstruction: GraftLink Technique. Arthrosc Tech 2015; 4:e619-24. [PMID: 26900564 PMCID: PMC4722703 DOI: 10.1016/j.eats.2015.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/17/2015] [Indexed: 02/03/2023] Open
Abstract
Posterior cruciate ligament (PCL) injuries account for nearly 20% of knee ligament injuries. PCL injuries can occur in isolation or, more commonly, in the setting of multiligamentous knee injuries. Isolated PCL disruptions are commonly treated nonoperatively; however, symptomatic grade III injuries, as well as PCL injuries found in multiligamentous injuries, are frequently treated surgically. Several reconstructive techniques exist for the treatment of PCL deficiency without a clear optimal approach. We describe our preferred operative technique to reconstruct the PCL using an all-inside arthroscopic approach with a quadrupled tibialis anterior or peroneus longus allograft with both tibial and femoral suspensory fixation.
Collapse
|