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Agres AN, Brisson NM, Duda GN, Jung TM. Activity-Dependent Compensation at the Hip and Ankle at 8 Years After the Reconstruction of Isolated and Combined Posterior Cruciate Ligament Injuries. Am J Sports Med 2024:3635465241248819. [PMID: 38761007 DOI: 10.1177/03635465241248819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
BACKGROUND After posterior cruciate ligament reconstruction (PCLR), functional deficits at the knee can persist. It remains unclear if neighboring joints compensate for the knee during demanding activities of daily living. PURPOSE To assess long-term alterations in lower limb mechanics in patients after PCLR. STUDY DESIGN Descriptive laboratory study. METHODS A total of 28 patients who had undergone single-bundle unilateral isolated or combined PCLR performed stair navigation, squat, sit-to-stand, and stand-to-sit tasks at 8.2 ± 2.2 years after surgery. Motion capture and force plates were used to collect kinematic and kinetic data. Then, 3-dimensional hip, knee, and ankle kinematic data of the reconstructed limb were compared with those of the contralateral limb using statistical parametric mapping. RESULTS Side-to-side differences at the knee were primarily found during upward-driven movements at 8 years after surgery. The reconstructed knee exhibited lower internal rotation during the initial loading phase of stair ascent versus the contralateral knee (P = .005). During the sit-to-stand task, higher flexion angles during the midcycle (P = .017) and lower external rotation angles (P = .049) were found in the reconstructed knee; sagittal knee (P = .001) and hip (P = .016) moments were lower in the reconstructed limb than the contralateral limb. In downward-driven movements, side-to-side differences were minimal at the knee but prominent at the ankle and hip: during stair descent, the reconstructed ankle exhibited lower dorsiflexion and lower external rotation during the midcycle versus the contralateral ankle (P = .006 and P = .040, respectively). Frontal hip moments in the reconstructed limb were higher than those in the contralateral limb during the stand-to-sit task (P = .010); during squats, sagittal hip angles in the reconstructed limb were higher than those in the contralateral limb (P < .001). CONCLUSION Patients after PCLR exhibited compensations at the hip and ankle during downward-driven movements, such as stair descent, squats, and stand-to-sit. Conversely, residual long-term side-to-side differences at the knee were detected during upward-driven movements such as stair ascent and sit-to-stand. CLINICAL RELEVANCE After PCLR, side-to-side differences in biomechanical function were activity-dependent and occurred either at the knee or neighboring joints. When referring to the contralateral limb to assess knee function in the reconstructed limb, concentric, upward-driven movements should be prioritized. Compensations at the hip and ankle during downward-driven movements lead to biases in long-term functional assessments.
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Affiliation(s)
- Alison N Agres
- Julius Wolff Institute, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nicholas M Brisson
- Julius Wolff Institute, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias M Jung
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Moatshe G, LaPrade CM, Fenstad AM, Persson A, LaPrade M, Martin RK, Engebretsen L, LaPrade RF. Rates of Subjective Failure After Both Isolated and Combined Posterior Cruciate Ligament Reconstruction: A Study From the Norwegian Knee Ligament Registry 2004-2021. Am J Sports Med 2024; 52:1491-1497. [PMID: 38551134 PMCID: PMC11064468 DOI: 10.1177/03635465241238461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/10/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Outcomes after posterior cruciate ligament (PCL) reconstruction (PCLR) have been reported to be inferior to those of anterior cruciate ligament reconstruction. Furthermore, combined ligament injuries have been reported to have inferior outcomes compared with isolated PCLR. PURPOSE/HYPOTHESIS The purpose of this study was to report on PCLR outcomes and failure rates and compare these outcomes between isolated PCLR and multiligament knee surgery involving the PCL. The hypothesis was that combined PCL injury reconstruction would have higher rates of subjective failure and revision relative to isolated PCLR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients with primary PCLR with or without concomitant ligament injuries registered in the Norwegian Knee Ligament Registry between 2004 and 2021 were included. Knee injury and Osteoarthritis Outcome Score (KOOS) totals were collected preoperatively and at 2 years and 5 years postoperatively. The primary outcome measure was failure, defined as either a revision surgery or a KOOS Quality of Life (QoL) subscale score <44. RESULTS The sample included 631 primary PCLR procedures, with 185 (29%) isolated PCLR procedures and 446 (71%) combined reconstructions, with a median follow-up time of 7.3 and 7.9 years, respectively. The majority of patients had poor preoperative knee function as defined by a KOOS QoL score <44 (90.1% isolated PCLR, 85.7% combined PCL injuries; P = .24). Subjective outcomes improved significantly at 2- and 5-year follow-up compared with preoperative assessments in both groups (P < .001); however, at 2 years, 49.5% and 46.5% had subjective failure (KOOS QoL <44) for isolated PCLR and combined PCLR, respectively (P = .61). At 5 years, the subjective failure rates of isolated and combined PCLR were 46.7% and 34.2%, respectively (P = .04). No significant difference was found in revision rates between the groups at 5 years (1.9% and 4.6%, respectively; P = .07). CONCLUSION Patients who underwent PCLR had improved KOOS QoL scores relative to their preoperative state. However, the subjective failure rate was high for both isolated and multiligament PCLR. Within the first 2 years after surgery, patients who undergo isolated PCLR can be expected to have similar failure rates to patients who undergo combined ligament reconstructions.
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Affiliation(s)
- Gilbert Moatshe
- Oslo University Hospital and University of Oslo, Oslo, Norway
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
| | | | - Anne Marie Fenstad
- Norwegian Knee Ligament Registry, Haukeland University Hospital, Bergen, Norway
| | - Andreas Persson
- Oslo University Hospital and University of Oslo, Oslo, Norway
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
- Norwegian Knee Ligament Registry, Haukeland University Hospital, Bergen, Norway
| | - Matthew LaPrade
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - R. Kyle Martin
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Orthopedics, CentraCare, St Cloud, Minnesota, USA
| | - Lars Engebretsen
- Oslo University Hospital and University of Oslo, Oslo, Norway
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
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Pourmodheji R, Chalmers BP, Debbi EM, Long WJ, Wright TM, Westrich GH, Mayman DJ, Imhauser CW, Sculco PK, Kahlenberg CA. Impact of Selective Posterior Cruciate Ligament Fiber Release on Femoral Rollback in Cruciate-Retaining Total Knee Arthroplasty: A Computational Study. J Arthroplasty 2024:S0883-5403(24)00302-4. [PMID: 38599529 DOI: 10.1016/j.arth.2024.03.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Partial or total release of the posterior cruciate ligament (PCL) is often performed intraoperatively in cruciate-retaining total knee arthroplasty (CR-TKA) to alleviate excessive femoral rollback. However, the effect of the release of selected fibers of the PCL on femoral rollback in CR-TKA is not well understood. Therefore, we used a computational model to quantify the effect of selective PCL fiber releases on femoral rollback in CR-TKA. METHODS Computational models of 9 cadaveric knees (age: 63 years, range 47 to 79) were virtually implanted with a CR-TKA. Passive flexion was simulated with the PCL retained and after serially releasing each individual fiber of the PCL, starting with the one located most anteriorly and laterally on the femoral notch and finishing with the one located most posteriorly on the medial femoral condyle. The experiment was repeated after releasing only the central PCL fiber. The femoral rollback of each condyle was defined as the anterior-posterior distance between tibiofemoral contact points at 0° and 90° of flexion. RESULTS Release of the central PCL fiber in combination with the anterolateral (AL) fibers, reduced femoral rollback a median of 1.5 [0.8, 2.1] mm (P = .01) medially and by 2.0 [1.2, 2.5] mm (P = .04) laterally. Releasing the central fiber alone reduced the rollback by 0.7 [0.4, 1.1] mm (P < .01) medially and by 1.0 [0.5, 1.1] mm (P < .01) laterally, accounting for 47 and 50% of the reduction when released in combination with the AL fibers. CONCLUSIONS Releasing the central fibers of the PCL had the largest impact on reducing femoral rollback, either alone or in combination with the release of the entire AL bundle. Thus, our findings provide clinical guidance regarding the regions of the PCL that surgeons should target to reduce femoral rollback in CR-TKA.
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Affiliation(s)
- Reza Pourmodheji
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Brian P Chalmers
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Eytan M Debbi
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - William J Long
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - David J Mayman
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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Chen CY, Hsu CH, Chen P, Hsu KY, Yang CP, Sheu H, Chang SS, Chiu CH. Anatomic versus Low Tibial Tunnel in Double-Bundle Posterior Cruciate Ligament Reconstruction: Clinical and Radiologic Outcomes with a Minimum 2-Year Follow-Up. Medicina (Kaunas) 2024; 60:545. [PMID: 38674191 PMCID: PMC11051884 DOI: 10.3390/medicina60040545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
There is currently no consensus on the optimal placement of the tibial tunnel for double-bundle posterior cruciate ligament (PCL) reconstruction. The purpose of this study was to compare the clinical and radiologic outcomes of double-bundle PCL reconstruction utilizing anatomic versus low tibial tunnels. We conducted a retrospective cohort study involving patients who underwent double-bundle PCL reconstruction between Jan 2019 and Jan 2022, with a minimum follow-up of 2 years (n = 36). Based on the tibial tunnel position on postoperative computed tomography, patients were categorized into two groups: anatomic placement (group A; n = 18) and low tunnel placement (group L; n = 18). We compared the range of motion, stability test, complications, and side-to-side differences in tibial posterior translation using kneeling stress radiography between the two groups. There were no significant differences between the groups regarding clinical outcomes or complication rates. No significant differences in the posterior drawer test and side-to-side difference on kneeling stress radiography (2.5 ± 1.2 mm in group A vs. 3.7 ± 2.0 mm in group L; p = 0.346). In conclusion, the main findings of this study indicate that both anatomic tunnel and low tibial tunnel placements in double-bundle PCL reconstruction demonstrated comparable and satisfactory clinical and radiologic outcomes, with similar overall complication rates at the 2-year follow-up.
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Affiliation(s)
- Chung-Yu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-Y.C.); (C.-H.H.); (C.-P.Y.)
| | - Chen-Heng Hsu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-Y.C.); (C.-H.H.); (C.-P.Y.)
| | - Poyu Chen
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan;
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-Y.C.); (C.-H.H.); (C.-P.Y.)
| | - Huan Sheu
- Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (H.S.); (S.-S.C.)
| | - Shih-Sheng Chang
- Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (H.S.); (S.-S.C.)
| | - Chih-Hao Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-Y.C.); (C.-H.H.); (C.-P.Y.)
- Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Comprehensive Sports Medicine Center (CSMC), Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Sass JO, Johnson K, Darques JB, Buerstenbinder L, Soodmand I, Bader R, Kebbach M. Influence of posterior cruciate ligament tension on tibiofemoral and patellofemoral joint contact mechanics in cruciate-retaining total knee replacement: a combined musculoskeletal multibody and finite-element simulation. Comput Methods Biomech Biomed Engin 2024:1-13. [PMID: 38511844 DOI: 10.1080/10255842.2024.2329946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Abstract
The influence of posterior cruciate ligament (PCL) tension on the clinical outcome of cruciate-retaining total knee replacement (CR-TKR) remains controversial. Various numerical approaches have been used to study this influence systematically, but the models used are limited by certain assumptions and simplifications. Therefore, the objective of this computational study was to develop a combined musculoskeletal multibody and finite-element simulation during a squat motion to 90° knee flexion with a CR-TKR design to overcome previous limitations regarding model inputs. In addition, different PCL tensions (tight, lax, resected) were modeled and the influence on tibiofemoral and resurfaced patellofemoral joint dynamics and contact stresses was evaluated. The effect of the PCL on knee joint dynamics and contact stresses was more pronounced at higher flexion angles. Tibiofemoral joint dynamics were influenced and a tight PCL induced increased posterior femoral translation during flexion. The maximum contact stress in the tibial insert increased from 20.6 MPa to 22.5 MPa for the resected and tightest PCL at 90° knee flexion. Patellofemoral joint dynamics were only slightly affected by PCL tension. However, the maximum contact stress in the patellar component decreased from 58.0 MPa to 53.7 MPa for the resected and tightest PCL at 90° knee flexion. The combination of musculoskeletal multibody and finite-element simulation is a sufficient method to comprehensively investigate knee joint dynamics and contact stresses in CR-TKR. The PCL tension after CR-TKR affects joint dynamics and contact stresses at the articulating implant surfaces.
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Affiliation(s)
- Jan-Oliver Sass
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Kurt Johnson
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Jean-Baptiste Darques
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
- Polytech Marseille, école d'ingénieurs d'Aix Marseille Université, Marseille, France
| | - Lucas Buerstenbinder
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Iman Soodmand
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Rainer Bader
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Maeruan Kebbach
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
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Fathi A, Thompson AA, Bolia IK, Mayfield CK, Korber SS, Iyer A, Hatch III GF. Patient Reported Clinical Outcomes Following PCL Suture Augmentation in Patients with Multiligamentous Knee Injury: A Retrospective Observational Study. Orthop Res Rev 2024; 16:67-74. [PMID: 38380086 PMCID: PMC10878190 DOI: 10.2147/orr.s425781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
Purpose To compare the patient-reported outcomes between patients with posterior cruciate ligament (PCL) reconstruction or repair alone versus PCL reconstruction or repair with internal bracing (IB) in the context of multi-ligament knee injuries (MLKI). Methods All patients who underwent surgical management of MLKI at two institutions between 2006 and 2020 were retrospectively identified and offered participation in the study. Patient reported outcomes were measured via three instruments: Lysholm Knee score, Multiligament Quality of Life (ML-QOL), and the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT). The postoperative outcomes and reoperation rates were compared between the internal bracing and non-internal bracing groups. Results Fifty-two patients were analyzed; 34 were included in the IB group (17.6% female; age 33.1 ±1.60 years), and 18 were included in the non-IB group (11.1% female; age 34.1 ±3.72 years). Mean follow-up time of the entire cohort was 1.44 ± 0.22 years (IB: 1.21 ± 0.18; non-IB: 2.1 ±0.65). There were no significant differences between PROMIS CAT [PROMIS Pain (54.4 ±1.78 vs 51.7 ±1.70, p=0.319), Physical Function (44.3 ±2.27 vs 47.9 ±1.52, p=0.294), Mobility (44.0 ±1.71 vs 46.1 ±2.10, p=0.463)], ML-QOL [ML-QOL Physical Impairment (40.7 ±4.21 vs 41.7±5.10, p=0.884), Emotional Impairment (49.2 ±4.88 vs 44.7±5.87, p=0.579), Activity Limitation (43.5 ±4.56 vs 31.5±3.62, p=0.087), Societal Involvement (44.9 ±4.96 vs 37.5 ±5.30, p=0.345)] and Lysholm knee score (61.8 ±4.55 vs 61.0 ±4.95, p=0.916) postoperatively compared to the non-IB group. Conclusion In this group of patients, function and patient-reported outcomes between patients treated with PCL reconstruction and repair without internal brace versus those with additional internal brace augmentation were not significantly different. Further research encompassing a larger patient sample is necessary to investigate the efficacy of the internal brace for PCL injury in the context of MLKI injuries.
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Affiliation(s)
- Amir Fathi
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ashley A Thompson
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Cory K Mayfield
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Shane S Korber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Avinash Iyer
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - George F Hatch III
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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Oehme S, Moewis P, Boeth H, Bartek B, von Tycowicz C, Ehrig R, Duda GN, Jung T. Altered knee kinematics after posterior cruciate ligament single-bundle reconstruction-a comprehensive prospective biomechanical in vivo analysis. Front Bioeng Biotechnol 2024; 12:1322136. [PMID: 38352697 PMCID: PMC10863728 DOI: 10.3389/fbioe.2024.1322136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Purpose: Passive tibiofemoral anterior-posterior (AP) laxity has been extensively investigated after posterior cruciate ligament (PCL) single-bundle reconstruction. However, the PCL also plays an important role in providing rotational stability in the knee. Little is known in relation to the effects of PCL single-bundle reconstruction on passive tibiofemoral rotational laxity. Gait biomechanics after PCL reconstruction are even less understood. The aim of this study was a comprehensive prospective biomechanical in vivo analysis of the effect of PCL single-bundle reconstruction on passive tibiofemoral rotational laxity, passive anterior-posterior laxity, and gait pattern. Methods: Eight patients undergoing PCL single-bundle reconstruction (seven male, one female, mean age 35.6 ± 6.6 years, BMI 28.0 ± 3.6 kg/m2) were analyzed preoperatively and 6 months postoperatively. Three of the eight patients received additional posterolateral corner (PLC) reconstruction. Conventional stress radiography was used to evaluate passive translational tibiofemoral laxity. A previously established rotometer device with a C-arm fluoroscope was used to assess passive tibiofemoral rotational laxity. Functional gait analysis was used to examine knee kinematics during level walking. Results: The mean side-to-side difference (SSD) in passive posterior translation was significantly reduced postoperatively (12.1 ± 4.4 mm vs. 4.3 ± 1.8 mm; p < 0.01). A significant reduction in passive tibiofemoral rotational laxity at 90° knee flexion was observed postoperatively (27.8° ± 7.0° vs. 19.9° ± 7.5°; p = 0.02). The range of AP tibiofemoral motion during level walking was significantly reduced in the reconstructed knees when compared to the contralateral knees at 6-month follow-up (16.6 ± 2.4 mm vs. 13.5 ± 1.6 mm; p < 0.01). Conclusion: PCL single-bundle reconstruction with optional PLC reconstruction reduces increased passive tibiofemoral translational and rotational laxity in PCL insufficient knees. However, increased passive tibiofemoral translational laxity could not be fully restored and patients showed altered knee kinematics with a significantly reduced range of tibiofemoral AP translation during level walking at 6-month follow-up. The findings of this study indicate a remaining lack of restoration of biomechanics after PCL single-bundle reconstruction in the active and passive state, which could be a possible cause for joint degeneration after PCL single-bundle reconstruction.
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Affiliation(s)
- Stephan Oehme
- Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Philippe Moewis
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute Berlin, Berlin, Germany
| | - Heide Boeth
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute Berlin, Berlin, Germany
| | - Benjamin Bartek
- Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | | | - Rainald Ehrig
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute Berlin, Berlin, Germany
- Zuse Institute Berlin, Berlin, Germany
| | - Georg N. Duda
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute Berlin, Berlin, Germany
| | - Tobias Jung
- Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Loeb AE, Ithurburn MP, Kidwell-Chandler A, Atkinson A, Cain EL. Technique and Outcomes of Posterior Cruciate Ligament Repair With Augmentation. Orthop J Sports Med 2024; 12:23259671231213988. [PMID: 38264412 PMCID: PMC10804929 DOI: 10.1177/23259671231213988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/19/2023] [Indexed: 01/25/2024] Open
Abstract
Background Posterior cruciate ligament (PCL) injuries to the knee are uncommon, and ideal surgical management of these injuries is unclear. Current surgical techniques include PCL reconstruction with remnant debridement, remnant-preserving techniques, and primary PCL repair. Augmentation of PCL repairs and reconstructions has been proposed to protect repairs or grafts in the postoperative period. Purpose To describe PCL repair with the hamstring autograft augmentation technique and examine our preliminary midterm outcomes from a sequential cohort of patients. Study Design Case series; Level of evidence, 4. Methods The authors identified patients at their institution who underwent remnant-preserving primary PCL repair with hamstring autograft augmentation for both isolated tears and tears associated with multiligament knee injury (MLKI). Patient-reported outcomes were evaluated at a minimum 2-year follow-up using the International Knee Documentation Committee (IKDC) subjective knee form, the 12-item Short Form Survey, and a custom return-to-play questionnaire. Patient-reported outcomes data were summarized, and the predictors of outcomes from the descriptive data and clinical measures were further examined. Results A total of 23 patients with a mean follow-up of 5.3 years met the inclusion criteria. Of these patients, 87% were associated with MLKI. The mean IKDC score was 87.7. Approximately 83% of patients were able to successfully return to their sport or occupation. Among 19 athletes, only 2 reported being unable to return to their preinjury level of sport because of limitations from their PCL surgery. Patient-reported outcome scores and return to sport or occupation did not have a statistically significant association with age, sex, body mass index, time from injury to surgery, or follow-up time. Conclusion Outcomes of our cohort with remnant-preserving primary PCL repairs with hamstring autograft augmentation demonstrated comparable clinical outcomes to previously published PCL data. The advantages of remnant preservation, primary repair, and augmentation with an independent hamstring autograft reconstruction are combined within this technique.
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Affiliation(s)
- Alexander E. Loeb
- The American Sports Medicine Institute, Birmingham, Alabama, USA
- North Florida Orthopaedics, Tallahassee, Florida, USA
| | - Matthew P. Ithurburn
- The American Sports Medicine Institute, Birmingham, Alabama, USA
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Andrew Atkinson
- The American Sports Medicine Institute, Birmingham, Alabama, USA
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | - E. Lyle Cain
- The American Sports Medicine Institute, Birmingham, Alabama, USA
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
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Rupp GE, Adrian KM, Bomar JD, Chau J, Pennock AT, Edmonds EW. Comparison of Outcomes in Pediatric and Adolescent Posterior Cruciate Ligament Injuries With and Without Meniscal Tears: Operative Versus Nonoperative Management. Orthop J Sports Med 2024; 12:23259671231222281. [PMID: 38264411 PMCID: PMC10804905 DOI: 10.1177/23259671231222281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 01/25/2024] Open
Abstract
Background Despite the posterior cruciate ligament (PCL) being an essential stabilizer of the knee, there is a paucity of data regarding injury management in pediatric patients. Purpose/Hypothesis The purpose of this study was to evaluate differences in outcomes after operative (OP) versus nonoperative (NOP) management of pediatric isolated (single-ligament) PCL tears. It was hypothesized that managing PCL tears operatively would lead to improved functional outcomes compared with NOP management, especially in the setting of an associated meniscal tear. Study Design Cohort study; Level of evidence, 3. Methods Pediatric patients with an isolated PCL injury between 2006 and 2020 were identified and grouped according to whether they had a concomitant meniscal tear (PCL+M) or no meniscal tear (PCL-M). These cohorts were further sorted into OP, NOP, and nonoperative converted to operative (NOP2OP) treatment cohorts. Outcome data collected included Lysholm score, current activity level, and whether the patient returned to sports after treatment. Results A total of 48 patients (49 knees) met study inclusion criteria (31 male, 18 female; mean age at injury, 15.6 years; age range, 8.3-18.9 years). There were 37 knees in the PCL-M cohort (30 NOP, 2 NOP2OP, and 5 OP) and 12 knees in the PCL+M cohort (4 NOP, 4 NOP2OP, and 4 OP). The mean duration of follow-up was 6.2 years (range, 2.4-15.7 years). The mean Lysholm scores were not significantly different between the OP and NOP knees in either the PCL-M cohort (P = .582) or the PCL+M cohort (P = .570); however, the PCL-M cohort overall had significantly higher scores compared with the PCL+M cohort (92.7 ± 13.0 vs 82.8 ± 18.8, respectively; P = .019). Conclusion The pediatric patients in this series had similar functional outcomes when managed operatively or nonoperatively for their single-ligament PCL tear. When considering concomitant meniscal injury, the results indicated that children with meniscal injury had a worse outcome than those without a meniscal injury. Shared decision-making with patients and their family should take these results into consideration.
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Affiliation(s)
- Garrett E. Rupp
- University of California–San Diego, San Diego, California, USA
| | | | | | - Justin Chau
- Rady Children's Hospital, San Diego, California, USA
| | - Andrew T. Pennock
- University of California–San Diego, San Diego, California, USA
- Rady Children's Hospital, San Diego, California, USA
| | - Eric W. Edmonds
- University of California–San Diego, San Diego, California, USA
- Rady Children's Hospital, San Diego, California, USA
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10
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Pruneski JA, Heyworth BE, Kocher MS, Tavabi N, Milewski MD, Kramer DE, Christino MA, Yen YM, Micheli LJ, Murray MM, Gilreath L, Kim A, Murray J, Kiapour AM. Prevalence and Predictors of Concomitant Meniscal and Ligamentous Injuries Associated With ACL Surgery: An Analysis of 20 Years of ACL Reconstruction at a Tertiary Care Children's Hospital. Am J Sports Med 2024; 52:77-86. [PMID: 38164668 DOI: 10.1177/03635465231205556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND There is an increasing rate of procedures being performed for concomitant injuries during anterior cruciate ligament (ACL) surgery. Few studies have examined risk factors for these associated injuries in young patients. HYPOTHESIS There are patient-related factors predictive of concomitant knee pathology that differ between age-based cohorts. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Natural language processing was used to extract clinical variables from available notes of patients undergoing ACL surgery between 2000 and 2020 at a single institution (5174 ACL surgeries; mean age, 17 ± 4 years; 53.1% female; accuracy, >98%). Patients were stratified to pediatric (5-13 years), adolescent (14-19 years), and young adult (20-35 years) cohorts. Logistic regression was used to determine predictors of concomitant injury to the menisci, medial collateral ligament (MCL), posterolateral corner (PLC), and posterior cruciate ligament (PCL). RESULTS Between 2000 and 2020, 54% of pediatric, 71% of adolescent, and 70% of adult patients had ≥1 concomitant soft tissue injury. In children and adolescents, increased age was consistently predictive of sustaining a concomitant injury (P < .02). Female children had increased odds of concomitant medial meniscal injury, while female adults had decreased odds (P≤ .046). Adolescent and adult female patients had decreased odds of concomitant lateral meniscal injury (P≤ .027). Female children had increased odds of injury to the MCL (P = .015), whereas female children and adolescents had decreased odds of PCL injury (P≤ .044). Adolescents undergoing revision ACL surgery had increased odds of meniscal injury (P≤ .001) and decreased odds of concomitant MCL injury (P = .028). Increased body mass index (BMI) was associated with increased odds of concomitant medial meniscal injury in all cohorts (P≤ .041), lateral meniscal injury in adults (P = .045), and PLC injury in children (P = .016). Contact injuries were associated with increased odds of MCL injury in adolescents (P = .017) and PLC injury in adolescents and adults (P < .014). CONCLUSION These findings support the hypothesis, as there were multiple factors that significantly affected the risk of concomitant injuries that differed between cohorts. Increased age, BMI, and contact injury history were generally associated with increased odds of sustaining a concomitant injury, whereas female sex and revision ACL surgery had mixed effects. Further studies are essential to investigate the sex-based differences in risk for concomitant injuries and to develop tailored treatment plans that minimize the risk of secondary ACL injury.
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Affiliation(s)
- James A Pruneski
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton E Heyworth
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mininder S Kocher
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nazgol Tavabi
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew D Milewski
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis E Kramer
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa A Christino
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yi-Meng Yen
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lyle J Micheli
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Martha M Murray
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leah Gilreath
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Kim
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph Murray
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ata M Kiapour
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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11
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Dasari SP, Warrier AA, Condon JJ, Mameri ES, Khan ZA, Kerzner B, Gursoy S, Swindell HW, Hevesi M, Chahla J. A Comprehensive Meta-analysis of Clinical and Biomechanical Outcomes Comparing Double-Bundle and Single-Bundle Posterior Cruciate Ligament Reconstruction Techniques. Am J Sports Med 2023; 51:3567-3582. [PMID: 36533945 DOI: 10.1177/03635465221137059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Posterior cruciate ligament (PCL) reconstruction techniques have historically focused on single-bundle (SB) reconstruction of the larger anterolateral bundle without addressing the codominant posteromedial bundle. The SB technique has been associated with residual laxity and instability, leading to the development of double-bundle (DB) reconstruction techniques. PURPOSE To perform a meta-analysis of comparative clinical and biomechanical studies to differentiate the pooled outcomes of SB and DB PCL reconstruction cohorts. STUDY DESIGN Meta-analysis and systematic review: Level of evidence, 3. METHODS Six databases were queried in February 2022 for literature directly comparing clinical and biomechanical outcomes for patients or cadaveric specimens undergoing DB PCL reconstruction against SB PCL reconstruction. Biomechanical outcomes included posterior tibial translational laxity, external rotational laxity, and varus laxity at 30° and 90° of knee flexion. Clinical outcomes included the side-to-side difference in posterior tibial translation during postoperative stress radiographs, risk of a major complication, and the following postoperative patient-reported outcome measures: Lysholm, Tegner, and International Knee Documentation Committee (IKDC) subjective and objective scores. A random-effects model was used to compare pooled clinical and biomechanical outcomes between the cohorts. RESULTS Fifteen biomechanical studies and 13 clinical studies were included in this meta-analysis. The DB group demonstrated significantly less posterior tibial translation at 30° and 90° of knee flexion (P < .00001). Additionally, the DB group demonstrated significantly less external rotation laxity at 90° of knee flexion (P = .0002) but not at 30° of knee flexion (P = .33). There was no difference in varus laxity between the groups at 30° (P = .56) or 90° (P = .24) of knee flexion. There was significantly less translation on stress radiographs in the DB group (P = .02). Clinically, there was no significant difference between the groups for the Lysholm score (P = .95), Tegner score (P = .14), or risk of a major complication (P = .93). DB PCL reconstruction led to significantly higher odds of achieving "normal" or "near normal" objective IKDC outcomes for the included prospective studies (P = .04) and higher subjective IKDC scores (P = .01). CONCLUSION DB PCL reconstruction leads to superior biomechanical outcomes and clinical outcomes relative to SB PCL reconstruction. Re-creating native anatomy during PCL reconstruction maximizes biomechanical stability and clinical outcomes.
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Affiliation(s)
- Suhas P Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alec A Warrier
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua J Condon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Zeeshan A Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Benjamin Kerzner
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Safa Gursoy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hasani W Swindell
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Mario Hevesi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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12
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Nayyar AK, R Gupta RG. Morphometry of Posterior Cruciate Ligament in Knee joint - A Cadaveric Study. Clin Ter 2023; 174:525-530. [PMID: 38048116 DOI: 10.7417/ct.2023.5020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Objectives Surgical repair of severely injured posterior cruciate ligament is mandatory. Therefore, the anatomical features of the PCL and its two bundles description help to define the appropriate size of the allograft for excellent results in reconstruction surgeries. Material and methods Fifty knees were dissected from twenty-five fresh human cadavers (15 male and 10 female) of donors used for teaching purpose. The length and footprint area of PCL and patellar tendon length were measured, and determined the range of normality according to sex and height. Results The average lengths of the PCL's Antero-medial (AM) and posterolateral (PL) bundle were 35. 52 ± 0.66 mm and 32.76 ± 0.64mm, respectively in male and 35.37 ± 0.07 & 32.58 ± 0.61mm in female. The femoral footprint of PCL was 133.10 ± 0.7 mm2 in male and 133.05 ± 0.7 mm2 in female observed, while the tibial footprint 132.21± 1.02 mm2 in male and 132.42 ± 0.8 mm2 in female was observed. Conclusion The AM and PL bundle lengths were higher in males than females. There was a strong correlation between height and length of ligaments but no correlation with age.
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Affiliation(s)
- A K Nayyar
- Department of Anatomy, All India Institute of Medical Sciences AIIMS Jodhpur
| | - R Gupta R Gupta
- Department of Anatomy, All India Institute of Medical Sciences AIIMS Jodhpur
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13
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Suneja A, Deshpande SV, Wamborikar H, Date SV, Goel S, Sekhon G. Outcome Analysis of Posterior Cruciate Ligament Injuries: A Narrative Review. Cureus 2023; 15:e47410. [PMID: 38022148 PMCID: PMC10658065 DOI: 10.7759/cureus.47410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
The primary posterior stabilizer of the knee is the posterior cruciate ligament (PCL), the largest intra-articular ligament in the human knee. One of the four primary ligaments of the knee joint, the PCL, serves to support the tibia on the femur. An extreme force applied anteriorly to the proximal tibia of the flexed knee results in trauma to the PCL. Dashboard injuries, which occur when the knee is driven into the dashboard after a collision with a motor vehicle, are frequent causes. Grade 1 and 2 acute injuries are often addressed conservatively due to the PCL's natural capacity for mending. If a grade 3 injury occurs, a cautious trial can be conducted on elderly or low-demand patients. When standard treatment for isolated grade 3 injuries has failed, surgery is advised. Single-bundle or double-bundle techniques using either transtibial tunnel or tibial inlay techniques are among the reconstruction approaches. Restoring the natural kinematics of the knee and forestalling persistent posterior and mixed rotatory knee laxity are the ultimate goals of treating PCL injuries through a personalized strategy. These injuries may become more common in the future as more people participate in sports. As a result of ongoing instability, discomfort, diminished function, and the emergence of inflammatory and degenerative disorders of joints, PCL rips are becoming more well-acknowledged as a cause of morbidity and decreased function.
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Affiliation(s)
- Anmol Suneja
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sanjay V Deshpande
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Hitendra Wamborikar
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapnil V Date
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Goel
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gursimran Sekhon
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Gopinatth V, Mameri ES, Casanova FJ, Khan ZA, Jackson GR, McCormick JR, Brophy RH, Knapik DM, LaPrade RF, Chahla J. Systematic Review and Meta-analysis of Clinical Outcomes After Management of Posterior Cruciate Ligament Tibial Avulsion Fractures. Orthop J Sports Med 2023; 11:23259671231188383. [PMID: 37724253 PMCID: PMC10505349 DOI: 10.1177/23259671231188383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/19/2023] [Indexed: 09/20/2023] Open
Abstract
Background There is no consensus regarding the management of posterior cruciate ligament (PCL) avulsion fractures and the expected outcomes after treatment. Purpose To systematically review clinical outcomes and complications after management of tibial-sided avulsion fractures of the PCL. Study Design Systematic review; Level of evidence, 4. Methods A literature search of Scopus, PubMed, Medline, and the Cochrane Central Register for Controlled Trials was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included were studies with evidence levels 1 to 4 that reported clinical outcomes after treatment of PCL tibial-sided avulsion fractures in humans. The quality of the included studies was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. A meta-analysis was performed for patient-reported outcome measures using random-effects modeling with 95% CIs. Results A total of 58 studies published between 1999 and 2022 were identified. The mean MINORS score was 9.90 ± 4.12, indicating overall low-quality evidence with high risk of bias. The studies comprised 1440 patients (mean age, 32.59 ± 5.69 years; 75.2% males) with a mean follow-up of 26.9 ± 19.6 months (range, 5.3-126 months). Most patients were treated with open surgery (63.6%), followed by arthroscopic surgery (29.7%) and nonoperative treatment (6.7%). All patients reported significant posttreatment improvement in both subjective and objective outcomes (P < .05 for all). Arthroscopic surgery was associated with lower postoperative posterior tibial translation compared with open surgery (range, 0.6-3.2 vs 1.7-3.1 mm), greater preoperative to postoperative improvement in Lysholm score (54.6 vs 48.8; P < .0001), higher postoperative Tegner score (6.64 ± 1.03 vs 6.14 ± 2.29; P = .0448), and a higher rate of return to sport (100% vs 89.5%; P = .009). Nonoperative management was associated with a significantly lower fracture union rate (87% vs 99.1%; P < .0001) and greater postoperative side-to-side posterior translation (4.9 ± 4.3 mm) when compared with operative management. Conclusion Although nonoperative and surgical management of PCL tibial avulsion fractures resulted in high rates of fracture union and improvement in functional outcome scores and a low incidence of complications, nonoperative treatment yielded a high side-to-side posterior displacement (>4 mm) with a lower rate of fracture union compared to surgical treatment.
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Affiliation(s)
- Varun Gopinatth
- Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Enzo S. Mameri
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Felipe J. Casanova
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Zeeshan A. Khan
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Garrett R. Jackson
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | | | - Robert H. Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Derrick M. Knapik
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | | | - Jorge Chahla
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
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15
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Jin X, Xu Y. Differences in postoperative knee joint function and prognostic quality of life in patients undergoing posterior cruciate ligament reconstruction at different surgical timing under enhanced recovery after surgery. Medicine (Baltimore) 2023; 102:e34345. [PMID: 37505147 PMCID: PMC10378877 DOI: 10.1097/md.0000000000034345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023] Open
Abstract
To explore the differences in postoperative knee joint function and prognostic quality of life in patients undergoing posterior cruciate ligament (PCL) reconstruction at different timing of surgery under the enhanced recovery after surgery (ERAS) protocol. A total of 266 cases of PCL injury admitted to our hospital between March 2019 and October 2022 were included in this retrospective study and divided them into a short-term group (147 cases with PCL reconstruction completed within 3 weeks after injury) and a long-term group (119 cases with PCL reconstruction performed 3 weeks after injury) according to the timing of surgery after injury. All patients received ERAS care during treatment. The operation time, intraoperative blood loss, and incision length of both cohorts were counted to evaluate the clinical efficacy. Perioperative patients were assessed by the Visual Analogue Scale for pain severity. The pre- and post-operative knee function and knee joint range of motion were assessed by the International Knee Documentation Committee and Lysholm Knee Scoring Scale. Furthermore, the complication rate was counted and the quality of life was evaluated by the Short-Form 36 Item Health Survey. Patients were also assessed for their psychological states using the Self-rating Anxiety/Depression Scale and their satisfaction with care. The 2 groups showed similar operation time, intraoperative blood loss, incision length, overall response rate, and Visual Analogue Scale (P > .05), but the short-term group had higher knee range of motion and scores of International Knee Documentation Committee and Lysholm Scale than the long-term group (P < .05). A similar complication rate was also determined in the 2 groups (P > .05), but the Short-Form 36 Item Health Survey scores were significantly higher in the short-term group (P < .05). Self-rating Anxiety Scale and Self-rating Depression Scale in both groups decreased after treatment (P < .05), and no statistical difference was determined in nursing satisfaction (P = 198). PCL reconstruction within 3 weeks after PCL injury is more conducive to the recovery of patients' knee joint function, and the ERAS protocol can more effectively improve the therapeutic effect of patients.
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Affiliation(s)
- Xiaoyun Jin
- Department of Anesthesiology, Fuyang TCM Hospital of Orthopedics Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuping Xu
- Department of Equipment, Fuyang TCM Hospital of Orthopedics Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
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Stoianov AG, Patrascu JM, Hogea BG, Andor B, Florescu S, Misca LC, Laza R, Fericean RM, Mavrea A, Terzi A, Patrascu JM. Point-of-Care Ultrasound for the Evaluation and Management of Posterior Cruciate Ligament Injuries: A Systematic Review. Diagnostics (Basel) 2023; 13:2352. [PMID: 37510096 PMCID: PMC10378212 DOI: 10.3390/diagnostics13142352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Posterior cruciate ligament (PCL) injuries, though less common than other knee ligament injuries, pose significant management challenges. This study aimed to systematically review and analyze the current evidence on the use of point-of-care ultrasound (POCUS) for the evaluation and management of PCL injuries. It was hypothesized that POCUS has comparable diagnostic accuracy to magnetic resonance imaging (MRI) and that the use of POCUS improves patient outcomes and reduces healthcare costs. A comprehensive systematic review of articles published up to April 2023 was conducted using PubMed, Web of Science, Cochrane, and Scopus databases and adhered to the PRISMA guidelines. Studies were selected based on relevance to the research question, with a focus on diagnostic accuracy, reliability, clinical utility, and cost-effectiveness of POCUS in PCL injuries. Seven studies, analyzing a total of 242 patients with PCL injuries, were included. The reported sensitivity and specificity of POCUS for diagnosing PCL injuries ranged from 83.3% to 100% and 86.7% to 100%, respectively, across the studies. In one study, POCUS demonstrated a positive predictive value (PPV) of 87.9% and a negative predictive value (NPV) of 82.4%. Additionally, three studies reported 100% accuracy in PCL injury detection using POCUS, suggesting a substantial potential for cost savings by eliminating the need for MRI. This systematic review supports the use of POCUS in the evaluation and management of PCL injuries, suggesting that POCUS is a reliable, cost-effective tool with high diagnostic accuracy comparable to that of MRI, offering the potential to improve patient outcomes and reduce healthcare costs. The data collated in this review can inform clinical practice and guide future research in the field.
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Affiliation(s)
- Anca Gabriela Stoianov
- Department of Orthopedics and Traumatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Jenel Marian Patrascu
- Department of Orthopedics and Traumatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Bogdan Gheorghe Hogea
- Department of Orthopedics and Traumatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Bogdan Andor
- Department of Orthopedics and Traumatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Sorin Florescu
- Department of Orthopedics and Traumatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Liviu Coriolan Misca
- Department of Orthopedics and Traumatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Ruxandra Laza
- Department of Infectious Diseases, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Roxana Manuela Fericean
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Adelina Mavrea
- Department of Internal Medicine I, Cardiology Clinic, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Artiom Terzi
- Department of General Medicine, "Nicolae Testemitanu" State University of Medicine and Pharmacy, Stefan cel Mare si Sfant Boulevard 165, 2004 Chisinau, Moldova
| | - Jenel Marian Patrascu
- Department of Orthopedics and Traumatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
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Park SY, Nam HS, Ho JPY, Tu NT, Lee YS. Association Between Tunnel Position, Tunnel Angle, Graft Signal Intensity, and Graft Thickness in the Reconstructed Posterior Cruciate Ligament. Orthop J Sports Med 2023; 11:23259671231168893. [PMID: 37435427 PMCID: PMC10331204 DOI: 10.1177/23259671231168893] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 07/13/2023] Open
Abstract
Background An appropriate tunnel position, tunnel angle, and tunnel-graft angle are important factors for maintaining the stability and mechanical properties of a posterior cruciate ligament (PCL) graft. Purpose To evaluate the association between tunnel position, tunnel angle, graft signal intensity ratio (SIR), and graft thickness after remnant-preserving PCL reconstruction. Study Design Cross-sectional study; Level of evidence, 3. Methods Included were patients who had undergone remnant-preserving single-bundle PCL reconstruction using a tibialis anterior allograft between March 2014 and September 2020 and who had minimum 12-month postoperative magnetic resonance imaging scans. Tunnel position and angle were evaluated via 3-dimensional computed tomography, and their association with graft SIR on both the femoral and the tibial sides was determined. Graft thickness and SIR at 3 areas of the graft were evaluated and compared, and their association with tunnel-graft angle was also determined. Results Overall, 50 knees (50 patients; 43 male, 7 female) were included. The mean time to postoperative magnetic resonance imaging was 25.8 ± 15.8 months. The mean SIR of the graft's midportion was higher compared with that of the proximal and distal portions (P = .028 and P < .001, respectively), and the SIR of the proximal portion was higher compared with that of the distal portion (P = .002). The femoral tunnel-graft angle was more acute than the tibial tunnel-graft angle (P = .004). A more anteriorly and distally located femoral tunnel led to a less acute femoral tunnel-graft angle (P = .005) and a decreased SIR of the proximal portion (P = .040), and a more laterally located tibial tunnel was associated with a less acute tibial tunnel-graft angle (P = .024) and a reduced SIR of the distal portion (P = .044). The mean thicknesses of the graft's midportion and distal portion were larger than that of the proximal portion (P < .001). The SIR of the graft's midportion was positively correlated with its thickness (r = 0.321; P = .023). Conclusion The SIR of the proximal portion of the graft around the femoral tunnel was higher than that of the distal portion around the tibial tunnel. An anteriorly and distally positioned femoral tunnel and a laterally positioned tibial tunnel resulted in less acute tunnel-graft angles that were associated with decreased signal intensity.
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Affiliation(s)
- Seong Yun Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hee Seung Nam
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jade Pei Yuik Ho
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Nguyen Thanh Tu
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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朱 波, 董 佩, 唐 晓, 李 志, 王 友. [Effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament tibial insertion fracture in adults]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:658-662. [PMID: 37331939 PMCID: PMC10277245 DOI: 10.7507/1002-1892.202303026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/20/2023]
Abstract
Objective To explore the effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament (PCL) tibial insertion fractures in adults. Methods Between October 2019 and October 2021, 16 patients with PCL tibial insertion fractures were treated with arthroscopic binding fixation using suture through single bone tunnel. There were 11 males and 5 females with an average age of 41.1 years (range, 26-58 years). The fractures were caused by traffic accident in 12 cases and sports in 4 cases. The time from injury to operation ranged from 2 to 10 days with an average of 6.0 days. The fractures were classified as Meyers-McKeever type Ⅱ in 4 cases and type Ⅲ in 9 cases, and Zaricznyi type Ⅳ in 3 cases. There were 2 cases of grade Ⅰ, 7 cases of grade Ⅱ, and 7 cases of grade Ⅲ in the posterior drawer test. There were 3 cases combined with lateral collateral ligament injury and 2 cases with meniscus injury. The visual analogue scale (VAS) score, Lysholm score, International Knee Documentation Committee (IKDC) score, and knee range of motion were used to evaluate knee joint function. The posterior drawer test and knee stability tester (Kneelax 3) were used to evaluate knee joint stability. The X-ray films were used to evaluate fracture reduction and healing. Results All incisions healed by first intention after operation. There was no incision infection, popliteal neurovascular injury, or deep venous thrombosis of lower limbs. All patients were followed up 6-12 months, with an average of 10 months. X-ray films at 6 months after operation showed the fractures obtained bone union. There were 11 cases of grade 0, 4 cases of gradeⅠ, and 1 case of grade Ⅱin posterior drawer test, showing significant difference when compared with preoperative results ( Z=23.167, P<0.001). The VAS score, Lysholm score, IKDC score, knee range of motion, and the results of Kneelax3 examination all significantly improved when compared with preoperative results ( P<0.05). Conclusion For adult patients with PCL tibial insertion fractures, the arthroscopic binding fixation using suture through single bone tunnel has the advantages of minimal trauma, good fracture reduction, reliable fixation, and fewer complications. The patient's knee joint function recovers well.
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Affiliation(s)
- 波涛 朱
- 南通大学附属医院骨科(江苏南通 226001)Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong Jiangsu, 226001, P. R. China
- 扬州大学建湖临床医学院骨科(江苏盐城 224700)Department of Orthopedics, Jianhu Clinical Medical College of Yangzhou University, Yancheng Jiangsu, 224700, P. R. China
| | - 佩龙 董
- 南通大学附属医院骨科(江苏南通 226001)Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong Jiangsu, 226001, P. R. China
| | - 晓波 唐
- 南通大学附属医院骨科(江苏南通 226001)Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong Jiangsu, 226001, P. R. China
| | - 志云 李
- 南通大学附属医院骨科(江苏南通 226001)Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong Jiangsu, 226001, P. R. China
| | - 友华 王
- 南通大学附属医院骨科(江苏南通 226001)Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong Jiangsu, 226001, P. R. China
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Chen J, Chen S. Relationship Between Mechanoreceptors in the Posterior Cruciate Ligament and Patient Age or Osteoarthritis Severity. Orthop J Sports Med 2023; 11:23259671231168894. [PMID: 37332534 PMCID: PMC10273789 DOI: 10.1177/23259671231168894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/24/2023] [Indexed: 06/20/2023] Open
Abstract
Background Mechanoreceptors in the posterior cruciate ligament (PCL) can produce proprioception, which is an important reason why patients choose cruciate-retaining total knee arthroplasty (TKA). The number of mechanoreceptors in the PCL of patients with knee osteoarthritis (OA) is unknown. Purpose To provide a theoretical basis for estimating the number of mechanoreceptors in the PCL by evaluating the relationship between this number and patient age or OA severity. Study Design Cross-sectional study; Level of evidence, 3. Methods An overall 28 PCLs from patients with knee OA were collected at the time of TKA and grouped according to patient age (group A, 60-69 years [n = 8]; group B, 70-79 years [n = 12]; group C, ≥80 years [n = 8]) and OA based on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (group I, ≤80 [n = 8]; group II, 81-120 [n = 10]; group III, >120 [n = 10]). Hematoxylin and eosin and S-100 immunohistochemical staining were performed on the slices near the tibial attachment of the PCL, and the number of mechanoreceptors in each slice was counted. Multifactor analysis of variance was used to evaluate the relationship between the number of mechanoreceptors and patient age or WOMAC score. Results The number of mechanoreceptors (mean ± SD) in groups A, B, and C was 24.00 ± 15.19, 30.92 ± 11.41, and 23.38 ± 11.39, respectively, with no significant between-group differences. The number of mechanoreceptors in groups I, II, and III was 43.50 ± 4.99, 25.00 ± 5.27, and 15.20 ± 5.61, with significant differences between groups I and II, groups I and III, and groups II and III (P < .001 for all). Conclusion In patients with knee OA, age had no significant effect on mechanoreceptor count, but the number of mechanoreceptors in the PCL decreased significantly with higher (worse) WOMAC score. These findings suggest that in patients of any age with high WOMAC scores, there may be little value as it relates to knee proprioception in performing a PCL-retaining TKA.
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Affiliation(s)
- Jinlong Chen
- Orthopedic and Joint Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shirong Chen
- Orthopedic and Joint Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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20
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Guo H, Yao Z, Gao L, Wang C, Shang X, Fan H, Cheng W, Liu C. Corrigendum: Treatment of avulsion fracture of posterior cruciate ligament tibial insertion by a minimally invasive approach in the posterior medial knee. Front Surg 2023; 10:1170095. [PMID: 37215347 PMCID: PMC10198769 DOI: 10.3389/fsurg.2023.1170095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/14/2023] [Indexed: 05/24/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fsurg.2022.885669.].
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Affiliation(s)
- Huihui Guo
- Fuyang People’s Hospital, Fuyang, China
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhao Yao
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liang Gao
- Center for Clinical Medicine, Huatuo Institute of Medical Innovation (HTIMI), Berlin, Germany
| | - Chen Wang
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xianbo Shang
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Haitao Fan
- Fuyang Hospital of Anhui Medical University, Anhui, China
| | - Wendan Cheng
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chang Liu
- Anhui Provincial Armed Police General Hospital, Hefei City, China
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Yoon HK, Park SH, Oh HC, Ha JW, Choi H. Combined PCL and PLC Reconstruction Improves Residual Laxity in PCL Injury Patients with Posterolateral Knee Laxity Less Than Grade III. Yonsei Med J 2023; 64:313-319. [PMID: 37114634 PMCID: PMC10151226 DOI: 10.3349/ymj.2022.0487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE To compare the short-term clinical and radiologic outcomes of combined posterior cruciate ligament (PCL) and posterolateral complex (PLC) reconstruction to those of isolated PCL reconstruction (PCLR) for patients with posterolateral knee laxity less than grade III. MATERIALS AND METHODS We retrospectively reviewed 49 patients (51 knees) who underwent PCLR between January 2008 and December 2015. Patients with a minimum follow-up of 24 months were included and divided into two groups (group A, isolated PCLR; group B, combined PCL and PLC reconstruction). Clinical outcomes were evaluated as the International Knee Documentation Committee (IKDC) subjective, Lysholm, and Tegner activity scale scores. Radiologic outcomes were also assessed using the side-to-side differences in posterior tibial translation via stress radiographs. RESULTS A total of 30 cases were analyzed. There were no significant differences in the Lysholm and Tegner activity scale scores between the two groups preoperatively and at the final follow-up. However, group B showed a higher IKDC subjective score compared to group A at the final follow-up (group A, 72.8±8.9; group B, 77.7±10.1; p<0.05). Regarding the radiologic outcomes, group B also showed a significantly less side-to-side difference in posterior tibial translation compared to group A at the final follow-up (group A, 4.8±2.3 mm; group B, 3.8±2.1 mm; p<0.05). CONCLUSION Combined PCL and PLC reconstruction resulted in improved clinical and radiologic outcomes than isolated PCLR in patients who have less than grade III posterolateral laxity of the knee. In cases of PCL rupture with ambiguous PLC injury, combined PCL and PLC reconstruction may help to improve posterior residual laxity of the knee.
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Affiliation(s)
- Han-Kook Yoon
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang-Hoon Park
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
| | - Hyun-Cheol Oh
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Joong-Won Ha
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Heemin Choi
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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22
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Hayashi S, Miyazaki S. Gross Appearances of the Posterior Cruciate Ligament Correlate With Its Histological Features but not With In Vivo Function in Cruciate-Retaining Total Knee Arthroplasty. Cureus 2023; 15:e38128. [PMID: 37252485 PMCID: PMC10212607 DOI: 10.7759/cureus.38128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Background No study has evaluated whether the macroscopic appearance or histological features of the posterior cruciate ligament (PCL) affect the in vivo PCL function in cruciate-retaining (CR) total knee arthroplasty (TKA). The aim of this study is to elucidate the correlation between intraoperative gross appearances of the PCL and clinical parameters, their corresponding histological features, and the in vivo function. Methods The intraoperative gross appearances of the PCLs were evaluated; we also examined their correlations with clinical parameters, corresponding histological features, and the in vivo function in CR-TKA. Results There were significant correlations between intraoperative gross appearances of the PCL and that of the anterior cruciate ligament, the preoperative knee flexion angle, and the intercondylar notch stenosis. There was a significant correlation between the intraoperative gross appearance in the middle part and the corresponding histological features. However, there was no significant correlation between the intraoperative gross appearance or histological features and the PCL tension, amount of rollback, and maximum knee flexion angle. Conclusions The intraoperative gross appearance of the PCL correlated with clinical parameters. Also, there was a significant correlation between the intraoperative gross appearance in the middle part and the corresponding histological features; however, there was no correlation between the intraoperative gross appearance or histological features and the in vivo function.
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Affiliation(s)
- Seiju Hayashi
- Orthopedic Surgery, Yawatahama City General Hospital, Ehime, JPN
| | - Satoshi Miyazaki
- Orthopedic Surgery, Yawatahama City General Hospital, Ehime, JPN
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23
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Corbi-Aguirre F, Forriol F. Relationship of the Cruciate and Meniscofemoral Ligaments with the Knee Osteology. An Anatomical Study
*. Rev Bras Ortop 2023; 58:85-91. [PMID: 36969781 PMCID: PMC10038723 DOI: 10.1055/s-0042-1750073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/28/2022] [Indexed: 03/26/2023] Open
Abstract
Objective
To analyze the dimensions of the posterior cruciate ligament (PCL), anterior cruciate ligament (ACL), the presence of meniscus-femoral ligaments MFLs in human knees, and the correlation with the dimensions of the knee skeleton.
Methods
Anatomical study on 29 specimens of human knees in which we measured the length and width of the cruciate and meniscus-femoral ligaments and the dimensions of femoral and tibia condyles and the femoral notch. The ACL length was calculated with different degrees of knee flexion. The relationship between the ligaments and bone dimensions were analyzed.
Results
The length of the ACL and the PCL were similar. Posterior MFL was more frequent and longer than the anterior MFL. We found the posterior MFL in the 72.41% of the knees and anterior MFL in 20.69%. The ACL presented 30% of its maximum length up to 60°, approximately half of its length between 90° and 120°, reaching its maximum length at 170°. We found a strong correlation between the length of the ACL and that of the PCL (
p
= 0.001). However, the lengths of the ACL and PCL were not related with the bone dimensions.
Conclusion
We have found no correlations between the cruciate and MFLs and the anatomical dimensions of the intercondylar notch and the proximal tibia and distal femur. The presence of the posterior MFL was more frequent and longer than that of the anterior ligament.
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Affiliation(s)
- Fernando Corbi-Aguirre
- Cirurgia Ortopédica e Traumatologia, Faculdade de Medicina, Universidade CEU-San Pablo, Madrid, Espanha
| | - Francisco Forriol
- Cirurgia Ortopédica e Traumatologia, Faculdade de Medicina, Universidade CEU-San Pablo, Madrid, Espanha
- Endereço para correspondência Prof. Francisco Forriol, MD, PhD School of Medicine, University CEU-San Pablo Campus de MontepríncipeAv. de Monteprincipe, 5 - 28925 Alcorcón, MadridSpain
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Talebian P, Aref Daneshi S, Soleimani M. Direct posterior approach to posterior cruciate ligament bony avulsion fractures: a case series introducing a new surgical technique. Ann Med Surg (Lond) 2023; 85:545-549. [PMID: 36923773 PMCID: PMC10010804 DOI: 10.1097/ms9.0000000000000265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/26/2023] [Indexed: 03/18/2023] Open
Abstract
Posterior cruciate ligament bony avulsion is one of the well-known knee injuries, which includes about 3-20% of knee ligament injuries. Failure to properly treat this injury causes instability in the knee. Although various surgical approaches have been introduced for this injury, there is controversy regarding selecting the suitable method under certain conditions. Method In this study, as well as introducing our new surgical technique, we reported the treatment results of our patients who underwent surgery between April 2021 and June 2022. In this approach, in a short time with about 5 cm incisions, we can directly access the fracture site and directly fix the fracture with minimal tissue damage. Result Results of this study showed that the operating time was about 24.2 min on average. And in the 6-month follow-up results of our patients, no complications were reported, while the results stipulate a complete recovery of knee pain, range of motion, and stability in examinations. Conclusion Apparently, the direct posterior approach to posterior cruciate ligament bony avulsion fractures is a safe method with minimal complications and suitable treatment results for patients.
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Affiliation(s)
- Parham Talebian
- Orthopedic Surgery Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - S Aref Daneshi
- Orthopedic Surgery Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Orthopedic Surgery Research Centre, Tehran University of Medical Sciences, Tehran, Iran
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Sun K, Fan M. Study of double button plate and cannulated screw fixation for posterior cruciate ligament avulsion fracture. Front Surg 2023; 9:887010. [PMID: 36713664 PMCID: PMC9880984 DOI: 10.3389/fsurg.2022.887010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 10/20/2022] [Indexed: 01/15/2023] Open
Abstract
Background The posterior cruciate ligament (PCL) plays an important role in maintaining the stability of the knee joint. To date, researchers have not reached agreement on which type of fixation material should be used to treat PCL tibial avulsion fractures. The aim of this study was to investigate the effects of double button plate and cannulated screw fixation in the treatment of PCL avulsion fractures. Methods We retrospectively reviewed our database, which was collected prospectively. From January 2019 to January 2020, 46 patients with posterior cruciate ligament avulsion fractures who were treated with double button plate and cannulated screw fixation. The primary outcomes of this study were surgical complications (fixation failure/displacement, implant breakage, nonunion, infection), radiological parameters, and knee function and secondary outcomes included reoperation rates for the fixation methods and the prevalence of symptomatic hardware causing soft tissue irritation outcomes were included. Values were analysed using multiple comparisons, where P-values of 0.05 or less were considered significant. Results Double button plate fixation had significantly higher values than cannulated screw fixation. The results showed that double button plate fixation was related to greater decreases in the length of surgery, intraoperative blood loss, hospital days, full weight bearing time, and incidence of complications, as well as greater increases in postoperative range of motion and Knee Society Score function and Lysholm scores. Conclusion Compared with cannulated screw fixation, the use of double button plate fixation technology has the following advantages: less trauma, shorter operation time, convenient use of instruments and fixtures, and it does not need to be removed, thus avoiding secondary trauma. Moreover, double button plate fixation under direct vision is safe and reliable without the need for additional equipment.
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Guo H, Zhao Y, Gao L, Wang C, Shang X, Fan H, Cheng W, Liu C. Treatment of avulsion fracture of posterior cruciate ligament tibial insertion by minimally invasive approach in posterior medial knee. Front Surg 2023; 9:885669. [PMID: 36684149 PMCID: PMC9852621 DOI: 10.3389/fsurg.2022.885669] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 11/02/2022] [Indexed: 01/07/2023] Open
Abstract
Objective The study aims to explore the feasibility and clinical effect of posterior minimally invasive treatment of cruciate ligament tibial avulsion fracture. Methods Posterior knee minimally invasive approach was used to treat avulsion fracture of posterior cruciate ligament (PCL) tibia in 15 males and 11 females. The length of the incision, intraoperative blood loss, operation time, postoperative hospital stay, residual relaxation, and fracture healing time were analyzed to evaluate the curative effect, learning curve, and advantages of the new technology. Neurovascular complications were recorded. During the postoperative follow-up, the International Knee Joint Documentation Committee (IKDC), Lysholm knee joint score, and knee joint range of motion were recorded to evaluate the function. Results All 26 patients were followed up for 18-24 months, with an average of 24.42 ± 5.00 months. The incision length was 3-6 cm, with an average of 4.04 ± 0.82 cm. The intraoperative blood loss was about 45-60 ml, with an average of 48.85 ± 5.88 ml. The operation time was 39-64 min, with an average of 52.46 ± 7.64 min. The postoperative hospital stay was 2-5 days, with an average of 2.73 ± 0.87 days. All incisions healed grade I without neurovascular injury. All fractures healed well with an average healing time of 9.46 ± 1.33 weeks (range, 8-12 weeks). The Lysholm score of the affected knee was 89-98 (mean, 94.12 ± 2.49) at 12-month follow-up. The IKDC score was 87-95 with an average of 91.85 ± 2.19, and the knee range of motion was 129-148° with an average of 137.08 ± 5.59°. The residual relaxation was 1-3 mm, with an average of 1.46 ± 0.65 mm. Conclusion This minimally invasive method provides sufficient exposure for internal fixation of PCL tibial avulsion fractures without the surgical complications associated with traditional open surgical methods. The process is safe, less invasive, and does not require a long learning curve.
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Affiliation(s)
- Huihui Guo
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China,Fuyang People's Hospital, Fuyang, China
| | - Yao Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liang Gao
- Center for Clinical Medicine, Hua Tuo Institute of Medical Innovation (HTIMI), Berlin, Germany
| | - Chen Wang
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xianbo Shang
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | | | - Wendan Cheng
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China,Correspondence: Wendan Cheng Chang Liu
| | - Chang Liu
- Anhui Armed Police General Hospital, Hefei, China,Correspondence: Wendan Cheng Chang Liu
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Teng Y, Jia G, Lu F, Da L, Teng F, Zhao L, Geng B, Yun X, Han H, Xia Y. Biomechanical comparison of proximal, distal, and anatomic tibial tunnel for transtibial posterior cruciate ligament reconstruction. Proc Inst Mech Eng H 2023; 237:104-112. [PMID: 36426874 DOI: 10.1177/09544119221135935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
No consensus has been reached on the optimal position of PCL tibial tunnel. The purpose of this study was to compare the biomechanical properties of proximal, distal and anatomic tibial tunnel in transtibial posterior cruciate ligament reconstruction. An in-vitro model of transtibial posterior cruciate ligament reconstruction was simulated using porcine tibias and bovine extensor tendons. Two models of biomechanical testing, load-to-failure loading, and cyclic loading, were performed in this study. The load-to-failure loading found that distal tibial tunnel resulted in greater ultimate load and yield load than the anatomic and proximal tunnel group (p < 0.05), whereas there were no significant differences in mean tensile stiffness among three groups (p > 0.05). The cyclic loading found no differences in the graft displacement at 250, 500, and 1000 cycles among three groups (p > 0.05). It was found that distal tibial tunnel showed superior ultimate load and yield load in load-to-failure loading testing compared with proximal and anatomic tibial tunnels, whereas no significant difference was found in terms of the mean displacement of the survived grafts in cyclic loading testing among three groups.
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Affiliation(s)
- Yuanjun Teng
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Gengxin Jia
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Fan Lu
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Lijun Da
- Department of Oncology, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Fei Teng
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Lianggong Zhao
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Bin Geng
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Xiangdong Yun
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Hua Han
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Yayi Xia
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
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White CC, Powell CW, Langley C, Bruce JR. A Sleepwalking Patient Presenting with Concomitant ACL, PCL, and Meniscal Root Avulsion Fractures: A Case Report. J Orthop Case Rep 2023; 13:54-58. [PMID: 37143565 PMCID: PMC10152954 DOI: 10.13107/jocr.2023.v13.i01.3514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/14/2022] [Indexed: 05/06/2023] Open
Abstract
Introduction Tibial-sided anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) avulsion fractures compose a rare subset of cruciate ligament injuries. Fixation strategies are mixed in the literature, particularly regarding the PCL, which has traditionally been addressed using an open approach. Case Report A 41-year-old male sustained avulsion fractures of the tibial eminence involving the ACL, PCL, and posterior medial meniscal root through an unknown mechanism while sleepwalking. Surgical treatment comprised of entirely arthroscopic reduction and transtibial suture fixation. Only seven cases of combined ACL/PCL avulsion fracture have been reported and all but one utilized open fixation for at least the PCL and restricted weight-bearing postoperatively. Conclusion This previously unreported triad of injury was successfully managed arthroscopically, negating a posterior approach to the knee. Early post-operative weight-bearing and aggressive range of motion aided in swift recovery and a favorable outcome.
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Affiliation(s)
- Charles Cody White
- Department of Orthopaedic Surgery, University of Tennessee, College of Medicine, Chattanooga, Tennessee
| | - Charles W Powell
- Department of Orthopaedic Surgery, University of Tennessee, College of Medicine, Chattanooga, Tennessee
| | - Collins Langley
- University of Tennessee, College of Medicine-Memphis, Memphis, Tennessee
| | - Jeremy R Bruce
- Department of Orthopaedic Surgery, University of Tennessee, College of Medicine, Chattanooga, Tennessee
- Address of Correspondence: Dr. Jeremy R. Bruce, Department of Orthopaedic Surgery, University of Tennessee, College of Medicine, Chattanooga, Tennessee. E-mail:
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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30
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Therrien E, Pareek A, Song BM, Wilbur RR, Till SE, Krych AJ, Stuart MJ, Levy BA. Comparison of Posterior Cruciate Ligament Reconstruction Using an All-Inside Technique With and Without Independent Suture Tape Reinforcement. Orthop J Sports Med 2022; 10:23259671221137357. [PMID: 36479468 PMCID: PMC9720802 DOI: 10.1177/23259671221137357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background Biomechanical studies support the use of suture tape reinforcement for limiting graft elongation and increasing strength in knee ligament reconstructions. Purpose To compare posterior cruciate ligament (PCL) laxity, complication and reoperation rates, and patient-reported outcomes (PROs) after all-inside single-bundle PCL reconstruction (PCLR) with versus without independent suture tape reinforcement. Study Design Cohort study; Level of evidence, 3. Methods A retrospective cohort study of consecutive patients who underwent primary, all-inside allograft single-bundle PCLR with and without independent suture tape reinforcement at a single academic institution from 2012 to 2019. Medical records were reviewed for patient characteristics, additional injuries, and concomitant procedures. PRO scores (including the International Knee Documentation Committee [IKDC], Tegner activity scale, and Lysholm scores), bilateral comparison kneeling radiographs, and physical examination findings were collected at a minimum of 2 years postoperatively. Results Included were 50 patients: 19 with suture tape reinforcement (mean age 30.6 ± 2.9 years) and 31 without suture tape reinforcement (control group; mean age 26.2 ± 1.6 years). One PCLR graft in the suture tape group failed. Posterior drawer examination revealed grade 1+ laxity in 4 of 19 (21%) of the suture tape cohort versus 6 of 31 (19%) of the control cohort (P > .999). Bilateral kneeling radiographs showed similar side-to-side differences in laxity between the groups (suture tape vs control: mean, 1.9 ± 0.4 vs 2.6 ± 0.6 mm; P = .361). There were no statistically significant differences between the groups in postoperative IKDC (suture tape vs control: 79.3 vs 79.6; P = .779), Lysholm (87.5 vs 84.3; P = .828), or Tegner activity (5.6 vs 5.7; P = .562) scores. Conclusion All-inside single-bundle PCLR with and without independent suture tape reinforcement demonstrated low rates of graft failure, complications, and reoperations, with satisfactory PROs at a minimum 2-year follow-up. Radiographic posterior tibial translation was comparable between the 2 groups.
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Affiliation(s)
- Erik Therrien
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayoosh Pareek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryant M. Song
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan R. Wilbur
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara E. Till
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J. Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A. Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA. ,Bruce A. Levy, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA ()
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31
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Feng K, Wang T, Tang J, Hao X, Ma X, Qu Z, Wang W. Application of CT-MRI Fusion-Based Three-Dimensional Reconstruction Technique in the Anatomic Study of Posterior Cruciate Ligament. Orthop Surg 2022; 14:2845-2853. [PMID: 36120826 PMCID: PMC9627086 DOI: 10.1111/os.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/28/2022] Open
Abstract
Objective During PCL reconstruction surgery, precise and personalized positioning of the graft tunnel is very important. In order to obtain patient‐specific anatomical data, we established a three‐dimensional knee joint fusion model to provide a unified imaging strategy, as well as anatomical information, for individualized and accurate posterior cruciate ligament (PCL) reconstruction. Methods This is an exploration study. From January 2019 to January 2020, 20 healthy adults randomly were enrolled and assessed via CT and MRI imaging. A three‐dimensional fusion model of the knee joint was generated using the modified MIMIMICS and image fusion software. On the fused image, the areas of the femoral and tibial PCL footprint of both knees were measured. The anatomical center of the PCL footprint was measured at the femoral and tibial ends. The relevant bony landmarks surrounding the PCL femoral and tibial attachment were also measured. Paired t‐tests were employed for all statistical analyzes, and p < 0.05 was considered as statistically significant. Results All 20 subjects achieved successful image fusion modeling and measurement, with an average duration of 12 h. The lengths of the LF1‐LF3 were 32.1 ± 1.8, 6.8 ± 2.5, and 23.3 ± 2.1 mm, respectively. The lengths of the LT1‐LT3 were 37.3 ± 3.3, 45.6 ± 5.3, and 6.0 ± 1.2 mm, respectively. The distances between the tibial PCL center of the left knee to the medial groove, champagne‐glass drop‐off, and the apex of the medial intercondylar were 8.4 ± 2.4, 9.2 ± 1.8, and 15.3 ± 1.4 mm, respectively, and the corresponding distances from the right knee were 8.0 ± 2.0, 9.4 ± 2.2, and 16.1 ± 1.8 mm, respectively. We observed no difference between the bilateral sides, in terms of the distance from the PCL center to the PCL attachment‐related landmark, under arthroscopic guidance. The area of the femoral and tibial PCL footprints on the left knee were 115.3 ± 33.5 and 146.6 ± 24.4 mm2, respectively, and the corresponding areas on the right knee were 121.8 ± 35.6 and 142.8 ± 19.5 mm2, respectively. There was no difference between the bilateral sides in terms of the PCL footprint areas. Conclusion In the fusion image, the PCL attachment center and relevant bony landmarks which can be easily identified under arthroscopy can be accurately measured. The model can also obtain personalized anatomical data of the PCL on the unaffected side of the patient, which can guide clinical PCL reconstruction.
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Affiliation(s)
- Keyi Feng
- Department of Bone and Joint Surgery, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Tianyue Wang
- Department of Maxillofacial Surgery, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Jin Tang
- Department of Bone and Joint Surgery, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Xiaorui Hao
- Department of Orthopaedics, Nanping First Hospital affiliated to Fujian Medical University, Nanping, China
| | - Xiaojun Ma
- Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Zhenan Qu
- Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Weiming Wang
- Deportment of Sports Medicine, Affiliated Xinhua Hospital of Dalian University, Dalian, China
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Clinger BN, Plaster S, Passarelli T, Marshall J, Wascher DC. Differentiation in Posterior Tibial Slope by Sex, Age, and Race: A Cadaveric Study Utilizing 3-Dimensional Computerized Tomography. Am J Sports Med 2022; 50:2698-2704. [PMID: 35853159 DOI: 10.1177/03635465221108187] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posterior tibial slope (PTS) has recently gained increased attention for its possible role in anterior cruciate ligament and posterior cruciate ligament injury. The possible differences among age, sex, and ethnicity in PTS have not yet been reported. PURPOSE To describe demographic variances of proximal tibial anatomy and to detect differences in regard to ethnicity, sex, and age. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS In total, 250 cadaveric specimens with full-body computerized tomography scans from the New Mexico Descendant Imaging Database were randomly selected (inclusion/exclusion criteria: older than 18 years, complete imaging of the knee without previous surgery or arthroplasty) and reviewed by 3 independent observers measuring medial posterior tibial slope (MPTS), lateral posterior tibial slope (LPTS), and global posterior tibial slope (PTS), which was calculated as the mean of the MPTS and LPTS. Individuals were evenly divided among male and female and ethnicities/races: African American/Black, Asian American, Hispanic, Native American, and White. Intraclass correlation coefficient was calculated for interobserver reliability and analysis of variance statistical testing to determine statistical significance between groups. Fisher exact test was also used to understand PTS differences among ethnicities when looking at clinically significant values for potential ligamentous injury. RESULTS Measurements were obtained from 250 specimens with a mean age of 49.4 years (range, 19 to 103 years). The mean PTS was 8.92° (range, -9.4° to 14.95°). Asian Americans had a 1.7° greater mean MPTS than Whites (P = .016), and African Americans/Blacks had a 1.6° greater mean PTS than Whites (P = .022). No difference in mean PTS was seen between age and sex. When looking at clinically significant PTS, 61 (24.4%) individuals had tibial slopes <6° or >12°, 32 (12.8%) and 29 (11.6%), respectively. Statistically significant differences were seen among ethnicities with PTS <6° (P = .017) but not with PTS >12° (P = .106). No sex-based differences were seen in the percentage of specimens with a PTS of >12° or <6°. CONCLUSION Among ethnicities, African Americans/Blacks and Asian Americans have increased PTS in comparison with Whites. Nearly 25% of individuals have clinically significant slopes of <6° or >12°, with no difference in tibial slope among sex or age groups.
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Affiliation(s)
- Bryce N Clinger
- Department of Orthopaedics and Rehabilitation, University of New Mexico Hospitals, Albuquerque, New Mexico, USA
| | - Scott Plaster
- Department of Orthopaedics and Rehabilitation, University of New Mexico Hospitals, Albuquerque, New Mexico, USA
| | - Talia Passarelli
- Univeristy of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Justin Marshall
- Department of Radiology, University of New Mexico Hospitals, Albuquerque, New Mexico, USA
| | - Daniel C Wascher
- Department of Orthopaedics and Rehabilitation, University of New Mexico Hospitals, Albuquerque, New Mexico, USA
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Chen YJ, Yang CP, Ho CS, Weng CJ, Chen ACY, Hsu WH, Hsu KY, Chan YS. Midterm Outcomes After Revision Posterior Cruciate Ligament Reconstruction With a Single-Bundle Transtibial Autograft. Orthop J Sports Med 2022; 10:23259671221115423. [PMID: 35990875 PMCID: PMC9382067 DOI: 10.1177/23259671221115423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background: There is a lack of consensus regarding the optimal technique for revision
posterior cruciate ligament (PCL) reconstruction. Purpose: To evaluate midterm outcomes after revision PCL reconstruction using a
single-bundle transtibial autograft. Study Design: Case series; Level of evidence, 4. Methods: We reviewed 17 patients who underwent revision PCL reconstruction performed
in our medical center by a single surgeon from 2003 to 2016. The cohort
included 12 male and 5 female patients with a mean age of 31.3 years (range,
17-48 years). All of the patients underwent single-bundle transtibial
reconstruction using the same surgical technique and were reviewed at a
minimum of 4 years postoperatively. Preoperative and postoperative posterior
stress radiography was performed. The preoperative tibial slope and
tibiofemoral angle were also measured. Preoperative and postoperative
functional outcomes were evaluated using the International Knee
Documentation Committee (IKDC) subjective and objective scores as well as
the Lysholm score. Results: The most common factor that contributed to the failure of primary surgery was
misplaced tunnels, especially on the femoral side. There were 2 patients who
had grade 2 laxity preoperatively, and 15 patients had grade 3 laxity
preoperatively. At the latest follow-up, all 17 patients had grade 1 laxity.
On posterior stress radiography, posterior displacement improved from 10.8 ±
2.1 mm preoperatively to 2.9 ± 1.1 mm at the latest follow-up
(P < .001). The IKDC subjective score improved from
34.9 ± 6.8 preoperatively to 75.3 ± 15.7 postoperatively (P
< .001), and the Lysholm score improved from 38.1 ± 10.0 preoperatively
to 88.5 ± 7.6 postoperatively (P < .001). All patients
reached the minimal clinically important difference (MCID) for the Lysholm
score, and 94% reached the MCID for the IKDC subjective score, with 65%
reaching the Patient Acceptable Symptom State. Conclusion: According to the findings of this study, arthroscopic revision PCL
reconstruction with a single-bundle transtibial autograft offered
satisfactory outcomes at midterm follow-up.
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Affiliation(s)
- Yi-Jou Chen
- Department of Orthopedic Surgery, Division of Sports Medicine, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Division of Sports Medicine, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan.,Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan
| | - Chin-Shan Ho
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan
| | - Chun-Jui Weng
- Department of Orthopedic Surgery, Division of Sports Medicine, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan.,Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan
| | - Alvin Chao-Yu Chen
- Department of Orthopedic Surgery, Division of Sports Medicine, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan.,Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan
| | - Wei-Hsiu Hsu
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery, Division of Sports Medicine, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan.,Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan
| | - Yi-Sheng Chan
- Department of Orthopedic Surgery, Division of Sports Medicine, Chang Gung Memorial Hospital, Taoyuan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan.,Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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:
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35
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Fontanella CG, Belluzzi E, Pozzuoli A, Scioni M, Olivotto E, Reale D, Ruggieri P, De Caro R, Ramonda R, Carniel EL, Favero M, Macchi V. Exploring Anatomo-Morphometric Characteristics of Infrapatellar, Suprapatellar Fat Pad, and Knee Ligaments in Osteoarthritis Compared to Post-Traumatic Lesions. Biomedicines 2022; 10. [PMID: 35740391 DOI: 10.3390/biomedicines10061369] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Several studies have investigated cartilage degeneration and inflammatory subchondral bone and synovial membrane changes using magnetic resonance (MR) in osteoarthritis (OA) patients. Conversely, there is a paucity of data exploring the role of knee ligaments, infrapatellar fat pad (IFP), and suprapatellar fat pad (SFP) in knee OA compared to post-traumatic cohorts of patients. Therefore, the aim of this study was to analyze the volumetric and morphometric characteristics of the following joint tissues: IFP (volume, surface, depth, femoral and tibial arch lengths), SFP (volume, surface, oblique, antero−posterior, and cranio−caudal lengths), anterior (ACL) and posterior cruciate ligament (PCL) (volume, surface, and length), and patellar ligament (PL) (volume, surface, arc, depth, and length). Eighty-nine MR images were collected in the following three groups: (a) 32 patients with meniscal tears, (b) 29 patients with ACL rupture (ACLR), and (c) 28 patients affected by end-stage OA. Volume, surface, and length of both ACL and PCL were determined in groups a and c. A statistical decrease of IFP volume, surface, depth, femoral and tibial arch lengths was found in end-stage OA compared to patients with meniscal tear (p = 0.002, p = 0.008, p < 0.0001, p = 0.028 and p < 0.001, respectively) and patients with ACLR (p < 0.0001, p < 0.0001, p = 0.008 and p = 0.011, respectively). An increment of volume and surface SFP was observed in group b compared to both groups a and c, while no differences were found in oblique, antero−posterior, and cranio−caudal lengths of SFP among the groups. No statistical differences were highlighted comparing volume, surface, arc, and length of PL between the groups, while PL depth was observed to be decreased in end-OA patients compared with meniscal tear patients (p = 0.023). No statistical differences were observed comparing ACL and PCL lengths between patients undergoing meniscectomy and TKR. Our study confirms that IFP MR morphometric characteristics are different between controls and OA, supporting an important role of IFP in OA pathology and progression in accordance with previously published studies. In addition, PL depth changes seem to be associated with OA pathology. Multivariate analysis confirmed that OA patients had a smaller IFP compared to patients with meniscal tears, confirming its involvement in OA.
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Meneghini RM, Deckard ER, Banks SA. The Effect of Posterior Cruciate Ligament Release on Kinematics and Outcomes in Primary Total Knee Arthroplasty With a Dual-Pivot Conforming Polyethylene. J Arthroplasty 2022; 37:S231-S237. [PMID: 35217184 DOI: 10.1016/j.arth.2022.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ultracongruent bearings are increasingly utilized in total knee arthroplasty (TKA); however, implications of surgical technique on knee kinematics and outcomes with these bearings are not well understood. This study's purpose was to evaluate the relationship of 3-dimensional knee kinematics and patient-reported outcome measures (PROMs) in a dual-pivot congruent bearing TKA with and without posterior cruciate ligament (PCL) release. METHODS Forty patients undergoing TKA with an asymmetric ultracongruent bearing were prospectively enrolled for gait analysis preoperatively and 4 months postoperatively. Three-dimensional gait analysis was performed utilizing infrared motion capture. Knee kinematic data and PCL disposition were analyzed for correlations with PROMs. RESULTS The PCL was fully released in 52.5% (21/40) of cases. Greater maximum anteroposterior femoral translation correlated with lower Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (rho = -0.596, P = .012), greater Knee Society Score pain with level walking (rho = 0.411, P = .101), and greater Knee Society Score pain while climbing stairs (rho = 0.469, P = .058) at 4-month follow-up. The PCL-release group was associated with greater maximum femoral anteroposterior translation (9.8 vs 5.5 mm, P = .053) and greater maximum internal tibial rotation (-6.2° vs -3.0°, P = .040), supporting a more anterior-based position of the medial condyle. The PCL released group had lower median Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores (70.7 vs 76.3, P = .031) and reported that their knees "sometimes or always" feel normal less frequently (81.8% vs 92.3%, P = .576). CONCLUSION With this asymmetric ultracongruent bearing TKA, preservation or partial titration release of the PCL, as opposed to full PCL release, appears to minimize deleterious anterior femoral translation and internal tibial rotation, which is correlated with optimized patient-reported outcomes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- R Michael Meneghini
- Department of Orthopaedic Surgery; Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, Indiana
| | - Evan R Deckard
- Department of Orthopaedic Surgery; Indiana University School of Medicine, Indianapolis, Indiana
| | - Scott A Banks
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, Florida
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Kinsey TL, Mont MA, Mahoney OM. Increased Prevalence of Posterior Cruciate Ligament Dysfunction Noted With 3-Dimensional Intraoperative Kinematic Evaluation in Total Knee Arthroplasty. J Arthroplasty 2022; 37:S182-S186. [PMID: 35331612 DOI: 10.1016/j.arth.2022.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Poor restoration of cruciate-driven kinematics after total knee arthroplasty may result from technical difficulties, but the ligament may also be functionally compromised by the presence of arthritis. We asked whether the function of the posterior cruciate ligament (PCL) could be assessed intraoperatively to predict the quality of the resulting posterior cruciate kinematics. METHODS PCL integrity was assessed using intraoperative infrared trackers to monitor knee kinematics in 73 patients. Three-dimensional images of the femur and tibia were projected onto a screen, allowing the surgeon to visualize kinematic relationships in real time. We measured femoral rollback (distance of femoral contact as a percentage of antero-posterior tray width) from images captured by the robotic system during initial kinematic assessment, gap balancing, and assessment of the final construct and from lateral flexion radiographs obtained 2 years after surgery. Associations were characterized using Pearson's correlation and graphical methods. RESULTS Thirty-six knees (49%) showed rollback <60% during gap balancing, indicative of PCL insufficiency. The rollback during gap balancing was positively correlated with that seen in the final cruciate retaining constructs (r = 0.60, P < .001), which in turn predicted rollback 2 years after surgery on lateral flexion X-rays (r = 0.50, P = .006). CONCLUSION Intraoperative functional evaluations can allow the surgeon to identify cases where rollback is not consistent with desirable knee kinematics, and posterior stabilization may lead to a better outcome for those patients.
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Sasaki R, Nagashima M, Takeshima K, Otani T, Okada Y, Aida S, Ishii K. Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration. J Int Med Res 2022; 50:3000605221084865. [PMID: 35272510 PMCID: PMC8921757 DOI: 10.1177/03000605221084865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Magnetic resonance imaging (MRI) findings of a tram-track appearance and celery stalk appearance in mucoid degeneration of the cruciate ligament are valuable; however, their pathological basis is unclear. Because these appearances are generally seen throughout the entire ligament, the association between MRI findings and pathological findings must be verified in specimens of the whole degenerated ligament, including the ligamentous attachments to bone. We herein report two cases of mucoid degeneration of the posterior cruciate ligament with osteoarthritis of the knee requiring total knee arthroplasty. The entire degenerated ligament, including the ligamentous attachments to bone, was removed and pathologically evaluated. On pathological examination, the central portion of the lesion showed typical mucoid degeneration, whereas the marginal and adherent portions showed normal ligament tissue, consistent with a tram-track appearance on T2-weighted MRI. The fibrous normal ligament tissues in the longitudinal direction in regions of mucoid degeneration were consistent with a celery stalk appearance on T2-weighted MRI. No mucoid degeneration was found in the attachment area. The tram-track appearance and celery stalk appearance of mucoid degeneration on MRI can be explained by the pathological findings.
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Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita city, Chiba 286-8686, Japan.,Department of Orthopaedic Surgery, 36767International University of Health and Welfare Mita Hospital, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita city, Chiba 286-8520, Japan
| | - Masaki Nagashima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita city, Chiba 286-8686, Japan.,Department of Orthopaedic Surgery, 36767International University of Health and Welfare Mita Hospital, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita city, Chiba 286-8520, Japan
| | - Kenichiro Takeshima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita city, Chiba 286-8686, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita city, Chiba 286-8520, Japan
| | - Toshiro Otani
- Department of Orthopaedic Surgery, 38259International University of Health and Welfare Ichikawa Hospital, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kōnodai, Ichikawa city, Chiba 272-0827, Japan
| | - Yoshifumi Okada
- Department of Orthopaedic Surgery, 36767International University of Health and Welfare Mita Hospital, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Shinsuke Aida
- Department of Pathology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita city, Chiba 286-8686, Japan.,Department of Orthopaedic Surgery, 36767International University of Health and Welfare Mita Hospital, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita city, Chiba 286-8520, Japan
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Moser LB, Koch M, Hess S, Prabhakar P, Rasch H, Amsler F, Hirschmann MT. Stress Radiographs in the Posterior Drawer Position at 90° Flexion Should Be Used for the Evaluation of the PCL in CR TKA with Flexion Instability. J Clin Med 2022; 11:jcm11041013. [PMID: 35207284 PMCID: PMC8880224 DOI: 10.3390/jcm11041013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 01/27/2023] Open
Abstract
The purpose of this study was to define a cut-off value for the posterior drawer position in stress radiography that confirms an insufficiency of the posterior cruciate ligament (PCL) in cruciate-retaining (CR) total knee arthroplasty (TKA). In this retrospective study, 20 symptomatic patients with flexion instability and suspected PCL insufficiency in CR TKA were included. Asymptomatic patients served as an age- and sex-matched control group. All of the patients had undergone stress radiography, and the posterior translation was measured in a posterior drawer position at 30° and 90° flexion. The two groups were compared using t-tests and chi-square tests. The stress radiographs showed significantly more posterior translation in the symptomatic group (p < 0.01). Stress radiographs at 90° flexion more effectively discriminated between the patients with and without PCL insufficiency compared with those carried out at 30° flexion. Sensitivity and specificity testing revealed the best sensitivity (90.5%) and the best specificity (94.7%) at 90° posterior drawer radiographs at a cut-off value of 10 mm. Stress radiographs including the posterior drawer position at 90° flexion should be part of the diagnostic algorithm in patients with suspected flexion instability. A posterior translation of more than 10 mm in CR TKA strongly indicates an insufficiency of the PCL.
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Affiliation(s)
- Lukas B. Moser
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, CH-4101 Basel, Switzerland; (M.K.); (M.T.H.)
- Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, Department of Clinical Research, University of Basel, CH-4001 Basel, Switzerland;
- Correspondence:
| | - Matthias Koch
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, CH-4101 Basel, Switzerland; (M.K.); (M.T.H.)
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany
| | - Silvan Hess
- Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, Department of Clinical Research, University of Basel, CH-4001 Basel, Switzerland;
| | - Ponnaian Prabhakar
- Department of Orthopaedics, Trauma and Arthroplasty, Care Superspeciality Hospitals, Nampally, Hyderabad 500 001, India;
| | - Helmut Rasch
- Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, CH-4101 Liestal, Switzerland;
| | | | - Michael T. Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, CH-4101 Basel, Switzerland; (M.K.); (M.T.H.)
- Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, Department of Clinical Research, University of Basel, CH-4001 Basel, Switzerland;
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Abstract
OBJECTIVE To investigate the short-term effectiveness of one-stage anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and posterolateral complex (PLC) reconstruction combined with medial collateral ligament repair for KD-Ⅳ knee dislocation. METHODS Between January 2018 and June 2020, 9 patients with KD-Ⅳ knee dislocation were treated. Of 9 cases, 7 were male and 2 were female with an average age of 32.3 years (range, 23-43 years). The knee dislocation was caused by falling from height in 6 cases and traffic accident in 3 cases. The injury located at left knee in 2 cases and right knee in 7 cases. The time from injury to operation was 14-24 days, with an average of 19 days. The preoperative International Knee Joint Documentation Committee (IKDC) score was 45.6±4.2, Lysholm score was 42.4±7.0, and the knee joint active flexion range of motion was (75.2±12.3)°. The posterior drawer test, pivot-shift test, Dial test, and 0° valgus stress test were all positive. Under arthroscopy, PCL was reconstructed with the autologous tendons, ACL with allogeneic Achilles tendon, PLC with the allogeneic anterior tibial tendon by Larson enhanced reconstruction method, and MCL was repaired with anchor or simple suture. RESULTS The operation time was 2-3 hours (mean, 2.5 hours). All incisions healed by first intention after operation. All patients were followed up12-25 months (mean, 16.1 months). After operation, 2 cases developed knee flexion disorder and pain, and 1 case had knee joint stiffness. At last follow-up, the IKDC score was 76.9±7.4, the Lysholm score was 81.6±6.4, and the knee active flexion range of motion was (122.9±7.2)°, all of which significantly improved when compared with preoperative ones ( P<0.05). During follow-up, there was no failure of the grafts. At last follow-up, there were significant differences in the posterior drawer test, pivot-shift test, Dial test, and 0° valgus stress test between pre- and post-operation ( P<0.05). The imaging review showed that the positions of the bone tunnels were satisfactory, the reconstructed ACL, PCL, and PLC structures were continuous, and MCL insertions were restored. CONCLUSION One-stage ACL, PCL, and PLC reconstruction combined with MCL repair to treat KD-Ⅳ knee dislocation can effectively restore knee joint stability, improve joint laxity, and improve joint movement.
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膝关节KD-ⅢM型脱位的诊疗经验. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022; 36. [PMID: 35038797 DOI: 10.7507/1002-1892.202105117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To explore the effectiveness of one-stage posterior medial corner (PMC) repair or reconstruction combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction in treating KD-ⅢM dislocation. METHODS The clinical data of 15 patients with knee KD-ⅢM dislocation who met the selection criteria between January 2016 and July 2019 were retrospectively analyzed. There were 9 males and 6 females, aged 22-61 years (mean, 40.3 years). Injuries were caused by violence of flexion, valgus, and external rotation, including 10 cases of traffic accident injuries, 3 cases of crush injuries, 1 case of winch injury, and 1 case of explosion injury. The time from injury to operation ranged from 3 days to 6 months, with an average of 18.5 days. PMC repair combined with PCL+ACL reconstruction was performed in 10 cases in acute stage (within 3 weeks after injury), including 3 cases of irreducible dislocation. PMC+PCL+ACL reconstruction was performed in 5 cases with chronic dislocation. Before operation and at last follow-up, the knee joint function was evaluated by Lysholm score and International Knee Documentation Committee (IKDC) 2000 score. KT-3000 was used to evaluate the forward stability of the knee (calculated the difference of tibial anterior displacement of both knees), the X-ray films of the stress position of the knee joint was used to evaluate the valgus of the knee (calculated the difference of medial joint space width of both knees) and the backward stability (calculated the difference of tibial posterior displacement of both knees), and the internal and external rotation stability was evaluated by knee flexion 30° tibial external rotation and knee flexion 90° tibial internal rotation tests (calculated the difference of tibial internal rotation and the difference of tibial external rotation of both knees). RESULTS The operation time was 120-240 minutes, with an average of 186.5 minutes. Patients were followed up 24-48 months, with an average of 27.4 months. There was no complication such as infection, deep vein thrombosis, vascular injury, or heterotopic ossification. At last follow-up, the Lysholm score, IKDC2000 score, the difference of tibial anterior displacement of both knees, the difference of medial joint space width of both knees, the difference of tibial posterior displacement of both knees, the difference of tibial internal rotation and the difference of tibial external rotation of both knees significantly improved when compared with preoperative ones ( P<0.05). According to the IKDC2000 valgus stability grading standard, there were 3 cases of grade C and 12 cases of grade D before operation, and 10 cases of grade A and 5 cases of grade B at last follow-up, which was significantly improved when compared with that before operation ( Z=-4.930, P=0.000). At last follow-up, the pivot shift tests of 15 patients were negative. The anterior and posterior drawer tests of 10 patients were negative, 5 patients had mild instability, both the anterior and posterior drawer tests were positive. CONCLUSION KD-ⅢM dislocation of the knee joint can lead to the posterior medial and anterior instability. Acute dislocation combined with "dimple sign" requires surgical reduction as soon as possible to repair PMC and reconstruct PCL and ACL. In chronic patients, PMC is difficult to repair, it is recommended to reconstruct PMC, PCL, and ACL at one stage to improve knee joint stability. The early and middle effectiveness are satisfactory.
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Peters AE, Geraghty B, Bates KT, Akhtar R, Readioff R, Comerford E. Ligament mechanics of ageing and osteoarthritic human knees. Front Bioeng Biotechnol 2022; 10:954837. [PMID: 36082159 PMCID: PMC9446756 DOI: 10.3389/fbioe.2022.954837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
Abstract
Knee joint ligaments provide stability to the joint by preventing excessive movement. There has been no systematic effort to study the effect of OA and ageing on the mechanical properties of the four major human knee ligaments. This study aims to collate data on the material properties of the anterior (ACL) and posterior (PCL) cruciate ligaments, medial (MCL) and lateral (LCL) collateral ligaments. Bone-ligament-bone specimens from twelve cadaveric human knee joints were extracted for this study. The cadaveric knee joints were previously collected to study ageing and OA on bone and cartilage material properties; therefore, combining our previous bone and cartilage data with the new ligament data from this study will facilitate subject-specific whole-joint modelling studies. The bone-ligament-bone specimens were tested under tensile loading to failure, determining material parameters including yield and ultimate (failure) stress and strain, secant modulus, tangent modulus, and stiffness. There were significant negative correlations between age and ACL yield stress (p = 0.03), ACL failure stress (p = 0.02), PCL secant (p = 0.02) and tangent (p = 0.02) modulus, and LCL stiffness (p = 0.046). Significant negative correlations were also found between OA grades and ACL yield stress (p = 0.02) and strain (p = 0.03), and LCL failure stress (p = 0.048). However, changes in age or OA grade did not show a statistically significant correlation with the MCL tensile parameters. Due to the small sample size, the combined effect of age and the presence of OA could not be statistically derived. This research is the first to report tensile properties of the four major human knee ligaments from a diverse demographic. When combined with our previous findings on bone and cartilage for the same twelve knee cadavers, the current ligament study supports the conceptualisation of OA as a whole-joint disease that impairs the integrity of many peri-articular tissues within the knee. The subject-specific data pool consisting of the material properties of the four major knee ligaments, subchondral and trabecular bones and articular cartilage will advance knee joint finite element models.
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Affiliation(s)
- Abby E Peters
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool, Liverpool, United Kingdom.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Brendan Geraghty
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Karl T Bates
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.,Medical Research Council Versus Arthritis Centre for Integrated Research Into Musculoskeletal Ageing (CIMA), University of Liverpool, Liverpool, United Kingdom
| | - Riaz Akhtar
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool, Liverpool, United Kingdom
| | - Rosti Readioff
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool, Liverpool, United Kingdom.,Institute of Medical and Biological Engineering, School of Mechanical Engineering, Faculty of Engineering, University of Leeds, Leeds, United Kingdom.,School of Dentistry, University of Liverpool, Liverpool, United Kingdom
| | - Eithne Comerford
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.,Medical Research Council Versus Arthritis Centre for Integrated Research Into Musculoskeletal Ageing (CIMA), University of Liverpool, Liverpool, United Kingdom.,School of Veterinary Science, University of Liverpool, Liverpool, United Kingdom
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Kumar A, Sinha S, Arora R, Gaba S, Khan R, Kumar M. The 50 Top-Cited Articles on the Posterior Cruciate Ligament: A Bibliometric Analysis and Review. Orthop J Sports Med 2021; 9:23259671211057851. [PMID: 34881343 PMCID: PMC8647263 DOI: 10.1177/23259671211057851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/24/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Limited attention has been paid to the natural history, management, and treatment outcomes related to the posterior cruciate ligament (PCL)–deficient knee joint. Purpose: To perform a comprehensive bibliometric analysis to evaluate the 50 top-cited articles in PCL research. Study Design: Cross-sectional study. Methods: We performed a keyword-based search in the Thomson Reuters Web of Science to generate a list of the 50 most cited articles relevant to the PCL. The included articles were analyzed according to journal, country of origin, publication year, total number of citations, citations per year, citation trends, and type of study (clinical vs basic science). Results: The 50 top-cited articles were published between 1975 and 2012, and the number of individual article citations ranged between 98 and 410. The listed articles were published in 7 journals, with the American Journal of Sports Medicine contributing to more than half of the articles and citations. The United States contributed the most articles (84%) and citations (n = 4873). There were 32 clinical studies and 18 basic science studies. All clinical studies had level 4 clinical evidence, and topics included the natural history of PCL tears, factors predicting the need for surgical intervention, and long-term outcomes of isolated PCL injuries and combined capsuloligamentous injuries. Most (77.8%) of the top-cited basic science articles consisted of experimental or biomechanical studies on human cadaveric knees. Conclusion: The current analysis suggests that PCL research is still evolving and needs high-quality prospective evidence to establish sound recommendations.
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Affiliation(s)
- Arvind Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Siddhartha Sinha
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Rajesh Arora
- Department of Orthopaedics, University College of Medical Sciences, New Delhi, India
| | - Sahil Gaba
- Department of Orthopaedics, Woodend Hospital, Aberdeen, UK
| | - Rizwan Khan
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Mukesh Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
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Lu CC, Yao HI, Fan TY, Lin YC, Lin HT, Chou PPH. Twelve Weeks of a Staged Balance and Strength Training Program Improves Muscle Strength, Proprioception, and Clinical Function in Patients with Isolated Posterior Cruciate Ligament Injuries. Int J Environ Res Public Health 2021; 18:ijerph182312849. [PMID: 34886588 PMCID: PMC8657930 DOI: 10.3390/ijerph182312849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022]
Abstract
Ligament reconstruction is indicated in patients with an isolated posterior cruciate ligament (PCL) injury who fail conservative treatment. To eliminate the need for PCL reconstruction, an ideal rehabilitation program is important for patients with an isolated PCL injury. The purpose of this study was to investigate the improvement in functional outcome, proprioception, and muscle strength after a Both Sides Up (BOSU) ball was used in a balance combined with strength training program in patients with an isolated PCL injury. Ten patients with isolated PCL injuries were recruited to receive a 12 week training program as a study group. In the control group (post-PCL reconstruction group), ten subjects who had undergone isolated PCL reconstruction for more than 2 years were enrolled without current rehabilitation. The Lysholm score, IKDC score, proprioception (active and passive), and isokinetic muscle strength tests at 60°/s, 120°/s, and 240°/s, were used before and after training on the injured and normal knees in the study group, and in the post-PCL reconstruction group. The results were analyzed with a paired t-test to compare the change between pre-training, post-training, and the normal leg in the study group, and with an independent t-test for comparisons between the study and post-PCL reconstruction groups. Both the Lysholm and IKDC scores were significantly improved (p < 0.01) after training, and no difference was observed compared to the post-PCL reconstruction group. The active and passive proprioception was improved post-training compared to pre-training, with no difference to that in the post-PCL reconstruction group. Isokinetic knee quadriceps muscle strength was significantly greater post-training than pre-training in PCL injured knees at 60°/s, 120°/s, and 240°/s, and in hamstring muscle strength at 60°/s and 120°/s. Muscle strength in the post-training injured knee group showed no significant difference compared to that in the post-training normal leg and the post-PCL reconstruction group. The post-training improvement of muscle strength was higher in the PCL injured leg compared to the normal leg and there was no difference between the dominant and non-dominant injured leg in the study group. After 12 weeks of BOSU balance with strength training in patients with an isolated PCL injury, the functional outcome, proprioception, and isokinetic muscle strength were significantly improved, and comparable to the contralateral normal leg and the post-PCL reconstruction group. We suggest that programs combining BOSU balance and strength training should be introduced in patients with a PCL injury to promote positive clinical results.
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Affiliation(s)
- Cheng-Chang Lu
- Department of Orthopaedic Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan;
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hsin-I Yao
- Kaohsiung Municipal Kaohsiung Commercial High School, Kaohsiung 800, Taiwan;
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-Y.F.); (H.-T.L.)
| | - Tsang-Yu Fan
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-Y.F.); (H.-T.L.)
- Doctoral Degree Program in Biomedical Engineering, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yu-Chuan Lin
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
| | - Hwai-Ting Lin
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-Y.F.); (H.-T.L.)
| | - Paul Pei-Hsi Chou
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-Y.F.); (H.-T.L.)
- Correspondence: ; Tel.: +886-7312-1101 (ext. 5751)
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Luo Y, Wang ZG, Li ZJ, Wei M. Arthroscopic Reconstruction of the Posterior Cruciate Ligament with a Ligament-advanced Reinforcement System and Hamstring Tendon Autograft: A Retrospective Study. Curr Med Sci 2021; 41:930-935. [PMID: 34669116 DOI: 10.1007/s11596-021-2446-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 12/29/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Both ligament-advanced reinforcement system (LARS) and hamstring tendon autograft can serve as grafts for posterior cruciate ligament (PCL) reconstruction. However, few studies have compared the effectiveness of these two approaches. This study therefore aimed to compare the clinical efficacy of arthroscopic reconstruction of the PCL using either the LARS or hamstring tendon autograft. METHODS A total of 36 patients who underwent PCL reconstruction were retrospectively analyzed. Within this cohort, 15 patients received a reconstruction using the LARS (LARS group) and 21 using the hamstring tendon autograft (HT group). RESULTS The pre- and post-operative subjective scores and knee stability were evaluated and the patients were followed up for a period of 2 to 10.5 years (4.11±2.0 years on average). The last follow-up showed that functional scores and knee stability were significantly improved in both groups (P<0.05). Six months after operation, Lysholm scores and IKDC subjective scores were higher in the LARS group than in the HT group (P<0.05). Nonetheless, the last follow-up showed no significant differences in the functional scores or the posterior drawer test between the two groups (P>0.05). In the LARS and HT groups, 12 and 9 patients, respectively exhibited KT1000 values <3 mm, with the difference being statistically significant (P<0.05). In the HT group, the diameter of the four-strand hamstring tendon was positively correlated with height (P<0.05), which was 7.37±0.52 mm in males and 6.50±0.77 mm in females (P<0.05). CONCLUSION Both LARS and hamstring tendon approaches achieved good efficacy for PCL reconstruction, but patients in the LARS group exhibited faster functional recovery and better knee stability in the long term. LARS is especially suitable for those who hope to resume activities as early as possible.
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Affiliation(s)
- Yang Luo
- Department of Orthopedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhi-Gang Wang
- Department of Orthopedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhi-Jiang Li
- Department of Orthopedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, China
| | - Min Wei
- Department of Orthopedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, China.
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Scarcella MJ, Yalcin S, Scarcella NR, Saluan P, Farrow LD. Outcomes of Pediatric Posterior Cruciate Ligament Reconstruction: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211032539. [PMID: 34604428 PMCID: PMC8485165 DOI: 10.1177/23259671211032539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background Little has been reported in the literature regarding surgical treatment of posterior cruciate ligament (PCL) injuries in pediatric patients. Purpose/Hypothesis The purpose was to evaluate presentation, injury pattern, outcomes, and complications of surgically managed PCL injuries in pediatric patients. It was hypothesized that pediatric patients would have good patient-reported outcomes and no significant radiographic changes or complications. Study Design Systematic review; Level of evidence, 4. Methods A literature search was performed using PubMed, Medline, EMBASE, Scopus, and Cochrane databases between 1975 and December 16, 2019. Search terms included "posterior cruciate ligament," "peel-off injury," "avulsion," "PCL," "pediatric," "skeletally immature," and "adolescent." Included were studies on pediatric patients with PCL injuries managed operatively. Exclusion criteria included case reports, studies not reporting clinical results, reviews, abstract or conference papers, or papers not in the English language. Quality assessment was performed on all included studies using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Results Four articles comprising 43 knees in 42 patients met the criteria and were included. Motor vehicle accidents were the most common mechanism of injury (39.5%; n = 17/43), followed by sports-related injuries (35%; n = 15/43). All studies commented on tear pattern, with the following distribution: 42% (n = 18/43) midsubstance tears, 37% (n = 16/43) tibial avulsions, and 21% (n = 9/43) femoral avulsions. Overall, good patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score and Pediatric International Knee Documentation Committee, Tegner, and Lysholm scores) and return to activity, as well as satisfactory posterior stability (KT-1000 arthrometer, posterior drawer test, and kneeling radiographs) and range of motion, were reported. There was no significant leg-length discrepancy or angular deformity reported. Arthrofibrosis was reported in 7% of postoperative knees and was the most commonly reported complication. Osteoarthritis was reported in 21% (n = 9/43) of knees. The average MINORS score was 7 (range, 6-8) for noncomparative studies and 10 for comparative studies. Conclusion Good patient-reported outcomes and return to activity can be obtained using repair or reconstruction. This evidence was limited by the quality of the included studies and overall small sample size; however, this review serves as a baseline for futures studies on PCL repair/reconstruction in pediatric patients.
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Affiliation(s)
| | - Sercan Yalcin
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
| | | | - Paul Saluan
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
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Wilms LM, Radke KL, Abrar DB, Latz D, Schock J, Frenken M, Windolf J, Antoch G, Filler TJ, Nebelung S. Micro- and Macroscale Assessment of Posterior Cruciate Ligament Functionality Based on Advanced MRI Techniques. Diagnostics (Basel) 2021; 11:1790. [PMID: 34679487 PMCID: PMC8535058 DOI: 10.3390/diagnostics11101790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 12/18/2022] Open
Abstract
T2 mapping assesses tissue ultrastructure and composition, yet the association of imaging features and tissue functionality is oftentimes unclear. This study aimed to elucidate this association for the posterior cruciate ligament (PCL) across the micro- and macroscale and as a function of loading. Ten human cadaveric knee joints were imaged using a clinical 3.0T scanner and high-resolution morphologic and T2 mapping sequences. Emulating the posterior drawer test, the joints were imaged in the unloaded (δ0) and loaded (δ1) configurations. For the entire PCL, its subregions, and its osseous insertion sites, loading-induced changes were parameterized as summary statistics and texture variables, i.e., entropy, homogeneity, contrast, and variance. Histology confirmed structural integrity. Statistical analysis was based on parametric and non-parametric tests. Mean PCL length (37.8 ± 1.8 mm [δ0]; 44.0 ± 1.6 mm [δ1] [p < 0.01]), mean T2 (35.5 ± 2.0 ms [δ0]; 37.9 ± 1.3 ms [δ1] [p = 0.01]), and mean contrast values (4.0 ± 0.6 [δ0]; 4.9 ± 0.9 [δ1] [p = 0.01]) increased significantly under loading. Other texture features or ligamentous, osseous, and meniscal structures remained unaltered. Beyond providing normative T2 values across various scales and configurations, this study suggests that ligaments can be imaged morphologically and functionally based on joint loading and advanced MRI acquisition and post-processing techniques to assess ligament integrity and functionality in variable diagnostic contexts.
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Affiliation(s)
- Lena Marie Wilms
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (D.B.A.); (J.S.); (M.F.); (G.A.); (S.N.)
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany; (D.L.); (J.W.)
| | - Karl Ludger Radke
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (D.B.A.); (J.S.); (M.F.); (G.A.); (S.N.)
| | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (D.B.A.); (J.S.); (M.F.); (G.A.); (S.N.)
| | - David Latz
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany; (D.L.); (J.W.)
| | - Justus Schock
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (D.B.A.); (J.S.); (M.F.); (G.A.); (S.N.)
| | - Miriam Frenken
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (D.B.A.); (J.S.); (M.F.); (G.A.); (S.N.)
| | - Joachim Windolf
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany; (D.L.); (J.W.)
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (D.B.A.); (J.S.); (M.F.); (G.A.); (S.N.)
| | - Timm Joachim Filler
- Institute for Anatomy I, Heinrich-Heine-University, D-40225 Dusseldorf, Germany;
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital of Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (D.B.A.); (J.S.); (M.F.); (G.A.); (S.N.)
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Moser LB, Prabhakar P, Hess S, Hirschmann MT. Diagnostic Algorithm in Patients with Flexion Instability after Cruciate-Retaining Total Knee Arthroplasty: A Case Report. Clin Pract 2021; 11:687-93. [PMID: 34563013 DOI: 10.3390/clinpract11030084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
A posterior flexion instability due to insufficiency of the posterior cruciate ligament (PCL) in cruciate retaining (CR) total knee arthroplasty (TKA) is an important but underdiagnosed problem. We hereby suggest a diagnostic algorithm, as demonstrated by a case report of a male patient suffering from anterior knee pain and instability after CR TKA. Clinical examination was followed by standard anterior–posterior and lateral radiographs. Stress radiographs in 30° and 90° posterior drawer position enabled a dynamic examination of the instability. SPECT/CT was used to determine the TKA component position in all planes and investigate bone tracer uptake (BTU) patterns. At revision surgery, an absent PCL after CR TKA was noted and a semi-constrained TKA was implanted.
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Tu KC, Shih HT, Tang SC, Lee CH, Liao WJ, Wang SP. The Disproportionate Increase of the Intraoperative Flexion and Extension Gap Space after Posterior Cruciate Ligament Resection in Total Knee Arthroplasty. J Clin Med 2021; 10:jcm10184228. [PMID: 34575339 PMCID: PMC8472620 DOI: 10.3390/jcm10184228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose: Maintaining gap balance is critical for total knee arthroplasty (TKA). This study aimed to elucidate if the extension–flexion gaps would be changed with posterior cruciate ligament (PCL) intact (PI) and PCL resection (PR) during TKA. The flexion gaps were measured using two methods, open-(Fo) and closed-chain position (Fc), based on the definition of kinetic chain position, respectively. Methods: This retrospective study enrolled a total of 33 patients who underwent posterior-stabilized (PS) TKA for symptomatic advanced osteoarthritis of knees. After bone cuts were completed, the extension–flexion gaps before and after PCL resection during TKA were measured using a calibrated tensioning device set at a 100 Nm distraction force. To further differentiate the effect of thigh weight on the 90° flexion gap, two varied methods of examination, either in closed chain (Fc) or open chain (Fo) were performed. Results: The increases in the 90° knee flexion gap after PCL resection were measured by both methods, i.e., ΔFc (PR-Fc—PI-Fc): 2.04 ± 2.06 mm, p < 0.001; and mean ΔFo (PR-Fo—PI-Fo): 1.64 ± 1.36 mm, p < 0.001. However, there were no differences between ΔFc and ΔFo before and after PCL resection. A greater amount of flexion gap was identified in open chain than in closed chain after PCL resection, and the PR-Fo and PR-Fc were 14.36 ± 3.13 and 11.40 ± 3.47 (p < 0.001), respectively. Conclusions: The resection of PCL during TKA distinctly increased the flexion gap, but not the extension gap. This disproportionate increase of the gap will cause a gap balance mismatch. The tensioning maneuver in open-chain was more effective to detect the gap differences than in closed-chain before and after PCL resection during TKA.
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Affiliation(s)
- Kao-Chang Tu
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-C.T.); (H.-T.S.); (S.-C.T.); (C.-H.L.); (W.-J.L.)
| | - Han-Ting Shih
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-C.T.); (H.-T.S.); (S.-C.T.); (C.-H.L.); (W.-J.L.)
| | - Shih-Chieh Tang
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-C.T.); (H.-T.S.); (S.-C.T.); (C.-H.L.); (W.-J.L.)
| | - Cheng-Hung Lee
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-C.T.); (H.-T.S.); (S.-C.T.); (C.-H.L.); (W.-J.L.)
- Department of Food Science and Technology, Hungkuang University, Taichung 433304, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Wei-Jen Liao
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-C.T.); (H.-T.S.); (S.-C.T.); (C.-H.L.); (W.-J.L.)
| | - Shun-Ping Wang
- Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-C.T.); (H.-T.S.); (S.-C.T.); (C.-H.L.); (W.-J.L.)
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Sports Recreation and Health Management Continuing Studies-Bachelor’s Degree Completion Program, Tunghai University, Taichung 40704, Taiwan
- Correspondence: ; Tel.: +886-4-2359-2525 (ext. 5101); Fax: +886-4-2359-5046
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50
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Bravi M, Santacaterina F, Bressi F, Papalia R, Campi S, Sterzi S, Miccinilli S. Does Posterior Cruciate Ligament Retention or Sacrifice in Total Knee Replacement Affect Proprioception? A Systematic Review. J Clin Med 2021; 10:jcm10163470. [PMID: 34441765 PMCID: PMC8396862 DOI: 10.3390/jcm10163470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Proprioception is an important part of the somatosensory system involved in human motion control, which is fundamental for activities of daily living, exercise, and sport-specific gestures. When total knee arthroplasty (TKA) is performed, the posterior cruciate ligament (PCL) can be retained, replaced, or discarded. The PCL seems to be responsible for maintaining the integrity of the joint position sense (JPS) and joint kinesthesia. The aim of this review was to assess the effect of PCL on knee joint proprioception in total knee replacement. Methods: This systematic review was conducted within five electronic databases: PubMed, Scopus, Web of Science, Cochrane, and PEDro with no data limit from inception to May 2021. Results: In total 10 publications were evaluated. The analysis was divided by proprioception assessment method: direct assessment (JPS, kinesthesia) and indirect assessment (balance). Conclusions: The current evidence suggest that the retention of the PCL does not substantially improve the joint proprioception after TKA. Due to the high heterogeneity of the studies in terms of design, proprioception outcomes, evaluation methods, further studies are needed to confirm the conclusions. In addition, future research should focus on the possible correlation between joint proprioception and walking function.
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Affiliation(s)
- Marco Bravi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
- Correspondence:
| | - Fabio Santacaterina
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
| | - Federica Bressi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.P.); (S.C.)
| | - Stefano Campi
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.P.); (S.C.)
| | - Silvia Sterzi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
| | - Sandra Miccinilli
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
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