ObjectiveTo compare the effectiveness of open reduction of posterior cruciate ligament (PCL) avulsion fracture at tibial insertion of knee joint with absorbable screws fixation and absorbable screw combined with suture anchor fixation. Methods The clinical data of 26 patients with PCL avulsion fracture at tibial insertion who met the selection criteria between March 2015 and October 2021 were retrospectively analyzed. Among them, 14 patients were fixed with simple absorbable screw (group A), and 12 patients were fixed with absorbable screw combined with suture anchors (group B). All patients were confirmed by X-ray film, CT, or MRI preoperatively, and got positive results in preoperative posterior drawer tests. There was no significant difference in gender, age, side of affected limb, time from injury to operation, comorbidities, and preoperative Meyers & McKeever classification, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The operation time and postoperative complications were recorded and compared between the two groups. At last follow-up, Lysholm score and IKDC score were used to evaluate the improvement of knee function. ResultsThere was no significant difference in operation time between the two groups (P>0.05). All incisions healed by first intention, and no complication such as vascular and nerve injury or venous thrombosis occurred. All 26 patients were followed up 9-89 months, with an average of 55.3 months. The follow-up time of group A and group B was (55.7±23.2) and (56.8±29.3) months, respectively, with no significant difference (t=?0.106, P=0.916). Radiographs showed bone healing in both groups at 3 months after operation, and no complication such as infection and traumatic arthritis occurred. At last follow-up, the posterior drawer test was negative in both groups, and the Lysholm score and IKDC score significantly improved when compared with the pre-operative values (P<0.05). However, there was no significant difference in the improvement value between the two groups (P>0.05). ConclusionFor PCL avulsion fracture at tibial insertion of the knee joint, the open reduction and absorbable screw combined with suture anchor fixation can achieve reliable fracture reduction and fixation, which is conducive to the early rehabilitation and functional exercise, and the postoperative functional recovery of the knee joint is satisfactory.
Objective To study the operative procedure and effect of arthroscopic reconstruction of both anterior cruciate l igament (ACL) and posterior cruciate l igament (PCL) with anterior tibial is tendon allograft. Methods From February 2005 to July 2006, 10 cases of both ACL and PCL rupture were reconstructed with anterior tibial is tendon allograft, including 7 men and 3 women, aging 18-45 years with an average of 30.2 years. The locations were left knee in 6 cases and right knee in 4 cases. All of them had identified trauma history. The disease course was about 1-3 weeks (mean 1.8 weeks). Both ACLand PCL were reconstructed under arthroscope with allograft anterior tibial is tendon of 26-28 cm in length and immobil ization with extention position brace was given for 4 weeks after operation. The active flex knee exercise was done from 0-90° at 4 weeks and more than 90° at 6 weeks. Results All operations were finished successfully, there were no blood vessel and nerve injury. The operative time was 90-110 minutes (mean 100 minutes). The wound healed by first intention and no early compl ication occurred. Ten cases were followed up for 12 months to 15 months with an average of 13.5 months. Thier gait was normal, knee activity degree was 0-135°. The anterior drawing tests and media and lateral stress tests were negative after operation in 10 cases; and the posterior drawing tests were negative in 8 cases and 2 cases was at grade I. Hydra arthrosis of knee occurred in 2 cases and was cured after remove of fluid and injection of sodium hyaluronate. The Lysholm knee function score was increases from 24.89 ± 5.39 before operation to 96.00 ± 4.59 at 12 months after operation, showing significant difference (P lt; 0.05). Conclusion Arthroscopic reconstruction of both ACL and PCL with anterior tibial is tendon allograft has the advantages of short operation time, less compl ications and good cl inical effects.
Objective To compare the intraoperative effects of computer navigation-assisted versus simple arthroscopic reconstruction of posterior cruciate ligament (PCL) tibial tunnel. Methods The clinical data of 73 patients with PCL tears who were admitted between June 2021 and June 2022 and met the selection criteria were retrospectively analysed, of whom 34 cases underwent PCL tibial tunnel reconstruction with navigation-assisted arthroscopy (navigation group) and 39 cases underwent PCL tibial tunnel reconstruction with arthroscopy alone (control group). There was no significant difference in baseline data between the two groups, including gender, age, body mass index, side of injury, time from injury to surgery, preoperative posterior drawer test, knee range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The perioperative indicators (operation time and number of guide wire drillings) were recorded and compared between the two groups. The angle between the graft and the tibial tunnel and the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes respectively were measured on MRI at 1 day after operation. The knee ROM, Tegner score, Lysholm score, and IKDC score were evaluated before operation and at last follow-up. Results The operation time in the navigation group was shorter than that in the control group, and the number of intraoperative guide wire drillings was less than that in the control group, the differences were significant (P<0.05). Patients in both groups were followed up 12-17 months, with an average of 12.8 months. There was no perioperative complications such as vascular and nerve damage, deep venous thrombosis and infection of lower extremity. During the follow-up, there was no re-injuries in either group and no revision was required. The results showed that there was no significant difference in the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes between the two groups (P>0.05), but the angle between the graft and the tibial tunnel was significantly greater in the navigation group than in the control group (P<0.05). At last follow-up, 30, 3, 1 and 0 cases were rated as negative, 1+, 2+, and 3+ of posterior drawer test in the navigation group and 33, 5, 1, and 0 cases in the control group, respectively, which significantly improved when compared with the preoperative values (P<0.05), but there was no significant difference between the two groups (P>0.05). At last follow-up, ROM, Tegner score, Lysholm score, and IKDC score of the knee joint significantly improved in both groups when compared with preoperative values (P<0.05), but there was no significant difference in the difference in preoperative and postoperative indicators between the two groups (P>0.05). ConclusionComputer-navigated arthroscopic PCL tibial tunnel reconstruction can quickly and accurately prepare tunnels with good location and orientation, with postoperative functional scores comparable to arthroscopic PCL tibial tunnel reconstruction alone.
Objective To study the method and cl inical results of arthroscopic double-bundle posterior cruciate l igament (PCL) reconstruction using achilles tendon allograft. Methods From September 2005 to September 2006, 17 patients with PCL injuries of grade III received arthroscopic double-bundle PCL reconstruction using achilles tendon allograft. There were 12 males and 5 females with an average age of 31.7 years (range, 19-48 years), including 10 cases of left PCL injuries and 7 cases of right PCL injuries. Injury was caused by sports in 6 cases and traffic accident in 11 cases. The average time from injury to surgery was 16 days (range, 7-30 days). The preoperative knee flexion was (121.8 ± 4.1)°. The posterior drawer test was positive and the varus angulation test was negative in all 17 patients. Lysholm score was 50.8 ± 6.1 and Tegner score was 1.3 ± 0.7. The side-to-side difference was (10.5 ± 1.6) mm by KT-1000 arthrometer. Results The hospital ization were (13.6 ± 2.4) days. The operation time was (67.8 ± 9.4) minutes. The time was (5.4 ± 1.2) days when the body temperature was higher than 37.4 ℃ after operation. All incisions healed by first intention. No compl ication occurred. All 17 patients were followed up 25 months on average (range, 18-30 months). The knee flexion was (116.9 ± 3.1)° at the final follow-up, showing no significant difference when compared with that of preoperation (P gt; 0.05). The posterior drawer test and the varus angulation test were negative in all 17 patients. Lysholm score and Tegner score were 91.6 ± 3.2 and 6.0 ± 0.7, respectively, and the side-to-side difference was (2.7 ± 1.7) mm, showing significant differences when compared with those of preoperation (P lt; 0.05).Conclusion Achilles tendon allograft is fit for PCL reconstruction. Arthroscopic double-bundle posterior cruciate l igament reconstruction using achilles tendon allograft can reconstruct both anterolateral and posteromedial bundles of the PCL. The knee joint function can be restored effectively. The short-term outcome has been proved, but the long-term outcome needs more observations
Objective To compare the single femoral tunnel split-double-bundle posterior cruciate ligament (PCL) reconstruction with the singlebundle PCL reconstruction and to discuss the advantages of the modified reconstruction method. Methods Fourteen donated fresh-frozen human knee specimens were biomechanically tested, which included knee specimens from 12 males and 2 females, and their ages ranged from 20 to 31 years. The specimen length of the femur and the tibia was 20 cm. The tibial posterior translation and the PCL strains were first measured when PCL was in an intact state (the intact group, n=14). Then, PCL was cut (the cut group, n=14). The posterior translation was measured when a posterior load was applied. After that, the specimens were randomly divided into twogroups: the single-bundle group (n=7) and the double-bundle group (n=7). When the posterior load was applied to the tibia, the bundle strain and the tibial posterior translation were measured with the knees flexed at 0, 30, 60, 90 and 120°, respectively. Results While a 100 N posterior force was applied, the posterior tibial displacement of the intact PCL knee ranged from 1.97±0.29 mm to 2.60±0.23 mm at the different knee flexion angles. In the PCL-cutstate, the tibial displacement increased significantly from 11.27±1.06 mm to14.94±0.67 mm (P＜0.05). After the singlebundle reconstruction, the posterior tibial translation ranged from 1.99±0.19 mm to 2.72±0.38 mm at the different knee flexion angles. In the split-double-bundle reconstruction, the posterior tibial translations ranged from 2.27±0.32 mm to 3.05±0.44 mm. The graft of the single-bundle reconstruction was tensioned from 0° to 120°, and the tibial displacement increased significantly at 90° compared with that at theother angles(P＜0.05). In the doublebundle reconstruction, the anterolateral bundle and the posteromedial bundle were tensioned in a reciprocal fashion, and the tibial displacement had no significant difference at the five kinds of the flexion angles. ConclusionThe single femoral tunnel split-double-bundle PCL reconstruction canrestore the posterior tibial displacement at different flexion angles, and the tibial displacement in the single-bundle PCL reconstruction knee can be increased when the knee flexion is at 90°. In the double-bundle reconstruction, the graftcan be tensioned in a reciprocal fashion and the biomechanical features can be nearer to those of the normal PCL bundles.
Objective To study the anatomic reconstruction method of posterolateral complex (PLC) in combination injury of posterior cruciate ligament (PCL) and PLC of knee, and explore its early clinical effect. Methods A total of 16 patients (10 males and 6 females) with PCL and PLC injuries admitted to the Affiliated Hospital of Southwest Medical University between January 2017 and January 2019 were retrospectively analyzed. The PCL was reconstructed with artificial ligament under arthroscopy, and autologous semitendinosus and gracilis muscles were used to reconstruct the PLC using the modified Laprade procedure. We measured the tibia posterior displacement on stress radiographs, lateral compartment gapping on varus stress radiographs, external rotation angle of tibia, and range of motion (ROM) of knee before and after operation, observed and recorded the postoperative complications, and evaluated the joint function according to the score of International Knee Documentation Committee (IKDC) and Lysholm Knee score before and after operation. Results All the 16 patients were followed up for 12 to 25 months, with an average of 17 months. The stress radiographs at the last follow-up showed that the tibia posterior displacement [(18.42±4.93) vs. (3.63±2.37) mm], lateral compartment gapping [(13.70±3.19) vs. (3.28±1.89) mm], external tibial rotation at 30° and 90° of flexion [30°: (14.75±2.84) vs. (2.44±2.06)°; 90°: (15.94±2.52) vs. (2.72±2.14)°] were significantly reduced compared with those before surgery. Lysholm score (45.42±10.94 vs. 85.19±7.11) and IKDC grade were obviously improved compared with those before surgery. All the above indicators showed statistically significant differences (P<0.05). The postoperative ROMs of knees of 13 patients returned to normal, and 0-10° flexural function was limited in 3 patients. None of the patients suffered from infection, loose internal fixation, nerve injury, or other complications. Conclusion Modified Laprade PLC reconstruction combined with arthroscopic reconstruction of PCL can effectively restore the posterior and posterolateral rotatory stability of the knee, and is worthy of clinical promotion.
ObjectiveTo systematically review the effectiveness of double-bundle versus single-bundle for arthroscopic transtibial reconstruction of posterior cruciate ligament (PCL).
MethodsWe searched PubMed, The Cochrane Library, EMbase, VIP and WanFang Data to collect randomized controlled trials (RCTs) of PCL reconstruction treated with double-bundle versus single-bundle arthroscopic transtibial technique. Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies, and then meta-analysis was performed by using RevMan 5.3 software.
ResultsA total of 4 RCTs involving 186 patients were included. The results of meta-analysis showed that double-bundle was superior to single-bundle in Lysholm score (MD=2.17, 95%CI 0.29 to 4.05, P=0.02), Tegner score (MD=0.62, 95%CI 0.09 to 1.16, P=0.02), IKDC objective score (A:RR=1.57, 95%CI 1.09 to 2.26, P=0.02; A+B:RR=1.15, 95%CI 1.01 to 1.32, P=0.04). However, there was no significant difference in the KT-1000 posterior between both groups (MD=-0.65, 95%CI -3.29 to 1.99, P=0.63).
ConclusionThe current evidence shows that the double bundle arthroscopic transtibial is superior to the single bundle PCL reconstruction. Due to the limited quality and quantity of the included studies, more high quality studies with large sample-size are needed to validate the conclusion.
OBJECTIVE To probe the clinical results of a new designed operation-double semitendinous reconstruction of posterior cruciate ligament (PCL) with invasive mini-plate. METHODS The new surgical technique was performed on 28 patients with PCL deficient knee in our department from September 1994 to October 1997. Protection of popliteal nerves and blood vessels was emphasized in the operation, and the femoral and tibial tunnel placement was critical to the procedure’s success. RESULTS All patients were followed up 18 to 36 months, averaged 22 months, they gained stable knees. The knee function of 28 patients recovered to normal after the operation, 1 patients had a small range of limitation of the knee flexion, but no obvious dysfunction. CONCLUSION Double semitendinous reconstruction of PCL with invasive mini-plate has advantages in the operated field exposure, adequate tibial and femoral fixation and excellent results in motion, stability and function of the knee after the operation.
Objective To investigate the effectiveness of arthroscopic suspension fixation with Endobutton in the treatment of tibial insertion avulsion fractures of posterior cruciate ligament (PCL). Methods A retrospective analysis was conducted on the clinical data of 52 patients (52 knees) with tibial insertion avulsion fractures of PCL, who were treated by arthroscopic suspension fixation with Endobutton between June 2017 and October 2022. There were 29 males and 23 females, with an average age of 40.6 years (range, 19-66 years). There were 24 cases of traffic accident injuries, 17 cases of sports injuries, and 11 cases of fall injuries. The time from injury to operation ranged from 6 to 19 days (mean, 13.3 days). According to the Meyers-McKeever classification, there were 30 cases of type Ⅱ and 22 cases of type Ⅲ fractures. All patients exhibited positive posterior drawer test results. Preoperative knee joint function was assessed with Lysholm score (21.3±6.7), International Knee Documentation Committee (IKDC) score (20.7±5.8), and visual analogue scale (VAS) score (5.3±0.7); and knee joint range of motion was (41.73±3.17)°. Based on preoperative CT three-dimensional reconstruction measurements, the longitudinal diameter of the avulsed bone fragment ranged from 13 to 25 mm (mean, 18.1 mm). Operation time and occurrence of complications were recorded, and postoperative imaging was used to assess fracture healing. Knee joint function and pain severity were evaluated using knee joint range of motion, Lysholm score, IKDC score, and VAS score. Results The operation time ranged from 46 to 81 minutes (mean, 56.2 minutes). All patients were followed up 12-28 months (mean, 20.1 months). The iatrogenic fractures of bone fragments occurred during operation in 4 cases; and knee effusion occurred in 2 cases and anterior knee pain in 1 case after operation. All incisions healed by first intention. Imaging evaluations at 3 months after operation showed the fracture healing and no internal fixation failure. All patients demonstrated good knee function and had returned to normal activities at 12 months after operation. At last follow-up, the knee joint range of motion was (133.44±4.17)°, Lysholm score 93.6±3.1, IKDC score 93.4±2.5, and VAS score 1.0±0.6, with significant differences compared to preoperative scores (P<0.05). Conclusion Arthroscopic suspension fixation with Endobutton in the treatment of tibial insertion avulsion fractures of PCL is simple to operate, and the knee joint function recovers well.
Objective
To investigate the effectiveness of posterior cruciate ligament (PCL) reconstruction with remnant preservation and autogenous quadrupled hamstring tendons under arthroscopy.
Methods
Between October 2007 and August 2012, 32 patients with PCL rupture were treated and followed up for more than 1 year. There were 24 males and 8 females, aged 20-53 years (mean, 35.6 years). The causes of injury included traffic accident injury in 21 cases, sports injury in 8 cases, and falling injury from height in 3 cases. The disease duration ranged 1 week to 2 years (median, 6.3 weeks). Nine patients had simple PCL rupture, 23 patients complicated by ligament injury, including 10 cases of anterior cruciate ligament rupture, 11 cases of posterolateral corner injury, and 2 cases of posteromedial corner injury. Preoperative Lysholm score was 53.8 ± 7.1. According to the International Knee Documentation Committee (IKDC) rating criteria, 10 cases were classified as grade C and 22 cases as grade D. PCL was reconstructed with autogenous quadrupled hamstring tendons, the tendons were fixed with EndoButton at the femoral side and with interference screw at the tibial side; floats of stump were cleaned up, and the structural stability and continuity ligament remnants were preserved.
Results
Primary healing was obtained in all incisions; no early complication occurred after operation. Thirty-two patients were followed up 23.4 months on average (range, 12-36 months). All patients had no symptom of knee instability; the results of tibia sags sign, posterior drawer test, and Lachman test were negative. At last follow-up, the knee range of motion (ROM) returned to normal in all cases. The Lysholm score was 92.3 ± 2.0, showing significant difference when compared with preoperative score (t=
—
34.32, P=0.00). According to the IKDC rating criteria, 26 cases were classified as grade A and 6 cases as grade B at last follow-up, showing significant difference when compared with preoperative grade (Z=
—
5.57, P=0.00).
Conclusion
Arthroscopic single-bundle reconstruction of PCL with remnant preservation and quadrupled hamstring tendons has advantages of minimal trauma, simple operation, and good knee function recovery.
