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CURATOR

Asst lecturer, Zagazig univ., Egypt

PINBOARD SUMMARY

PCl injury and its ideal subsequent treatment have been a source of controversy for many years. The PCL spans from the posterior aspect of the tibia to the medial femoral condyle. PCL is the strongest ligament about the knee. The function of the PCL is primarily to restrain posterior translation with respect to the femur. The most common mechanism of injury is motor vehicle accidents with direct force to proximal anterior tibia. Long-term follow-up of patients with non-operative treatment experienced a high ratio of poor functional outcomes and osteoarthritis. While improved outcomes after PCL reconstruction have been reported in recent studies. Therefore, in patients with complete PCL tear conservative treatment has not been recommended

Background: The aim of this study is to prospectively evaluate the outcomes of PCL reconstruction by quadruple hamstring tendon autograft using eno button fixation method at minimal 2-year follow-up. Materials and methods: PCL injured patients either isolated or associated with other ligamentous injuries or meniscal lesions were included. Severe degenerative joint disease or limited range of knee motion were excluded. An arthroscopic transtibial single bundle technique, single incision and endobutton fixation method were applied. Clinical evaluations were performed for 16 patients. Assessment of patients included specific tests and International Knee Documentation Committee (IKDC) scores, fuctional hop test, x ray and MRI. 94% of patients were graded normal or nearly normal by posterior drawer test. Conclusion: Arthroscopic PCL reconstruction using quadruple hamstring tendon autograft and endobutton fixation provides acceptable outcomes at a minimum 2-year follow-up. The quadrable hamstring tendon graft provides suitable graft size and results in minimal graft site morbidity. We recommend using quadruple hamstring tendon graft for PCL reconstruction to achieve good ligament reconstruction.

3 ITEMS PINNED

Proprioception and clinical results of anterolateral single-bundle posterior cruciate ligament reconstruction with remnant preservation.

Abstract: To evaluate the clinical and radiological results and proprioception following anterolateral single-bundle posterior cruciate ligament (PCL) reconstruction with remnant preservation for PCL injury.Twenty patients with an isolated PCL injury (16 males and 4 females) were included in this study. The mean follow-up period was 61 months (≥24 months) and the mean age of the patients was 36 years. Knee joint instability was evaluated using posterior drawer stress radiography. Knee function, level of activities, and individual satisfaction were assessed using the Lysholm knee score, Tegner activity score, and 2000 International Knee Documentation Committee (IKDC) score. Knee proprioception was assessed using an isokinetic machine.The mean ligament laxity assessed using the posterior drawer stress radiography was improved from 10.8-3.2 mm. The mean Lysholm knee score was improved from 70.0-88.9 points, and the mean Tegner activity score was improved from 2.7-6.2 points. Individual satisfaction assessed using the IKDC score was improved from 62.7-85.4 points (p<0.05). Knee proprioception was not significantly different between the treated and the uninjured knees.Single-bundle PCL reconstruction with remnant preservation for PCL injury exhibited satisfactory outcomes regarding functional outcome, joint stability, and proprioception.

Pub.: 14 Sep '13, Pinned: 16 Sep '17

[Outcome 4 years after isolated single-bundle posterior cruciate ligament reconstruction].

Abstract: The purpose of this study was to evaluate the clinical and radiological results after isolated reconstruction of the posterior cruciate ligament (PCL) using semitendinosus (ST) and gracilis (GT) tendon grafts with the arthroscopic single-bundle technique.Following PCL reconstruction using the single-bundle technique performed between 2002 and 2005, 14 patients (2 women, 12 men) prospectively underwent a standardized follow-up examination after an average postoperative time of 4 years. All patients included in this study had isolated insufficiency of the PCL and symptomatic instability. The exclusion criteria were the presence of a complex knee joint instability and the implementation of additional stabilizing measures or another method of PCL reconstructive surgery. The mean follow-up time was 47.2 ± 8.7 months. Preoperative and postoperative stress radiographs were taken using the Telos stress instrument in order to evaluate the posterior translation. Knee joint function and degree of activity were recorded using the Tegner activity score, the subjective IKDC score and the overall IKDC score.The posterior tibial translation of 10.1 ± 1.7 mm had an overall average improvement to a postoperative value of 4.6 ± 2.3 mm (p < 0.001). The patients showed a significant improvement in the Tegner activity score from an average 2.7 ± 0.8 points to 5.7 ± 1.3 points (p < 0.001). Evaluation of the subjective IKDC showed a significant improvement from a preoperative score of 41.32 ± 11.23 points to a postoperative score of 65.08 ± 13.51 points (p < 0.001). In total, 10 patients (71.5%) exhibited a normal or nearly normal outcome. According to the objective IKDC score, 4 patients (28.5%) were categorized as moderate.The above mentioned reconstruction technique can achieve a stable knee function in patients with isolated PCL insufficiency. The isolated single-bundle PCL reconstruction offers a medium-term improvement regarding the activity level and stability of the knee joint.

Pub.: 13 Mar '12, Pinned: 16 Sep '17

Isolated AL bundle reconstruction of the PCL.

Abstract: The purpose of this study was to evaluate the clinical and radiologic results after isolated reconstruction of the posterior cruciate ligament (PCL) using the semitendinosus (ST) and gracilis (GR) tendons with the arthroscopic single-bundle technique.All patients upon whom we had performed a single-bundle PCL reconstruction between 2002 and 2005 prospectively underwent a standardized follow-up examination after 2 years. Isolated PCL reconstruction was carried out on 41 patients during the observation period. Pre- and postoperative stress radiographs were taken using the Telos stress device in order to evaluate the dorsal translation. Knee joint function and degree of activity were recorded using the Tegner activity score, the subjective International Knee Documentation Committee (IKDC) score, and the overall IKDC score.33 of 41 patients (80.4%, 17 men, 16 women) completed the study. The posterior tibial translation of -10.1 ± 1.8 mm had an overall average improvement to a postoperative value of -5.0 ± 2.5 mm (p < 0.001). The patients showed a significant improvement in the Tegner activity score from an average 2.8 ± 0.8 points to 5.9 ± 1.2 points (p < 0.001). Evaluation of the subjective IKDC showed a significant improvement from a preoperative score of 41.86 ± 11.49 points to a postoperative score of 69.54 ± 11.39 points (p < 0.001). In total, 24 patients (72.8%) exhibited a normal or nearly normal outcome.The abovementioned reconstruction technique can achieve a stable knee function in patients with isolated PCL insufficiency. The isolated single-bundle PCL reconstruction offers an improvement regarding the activity level and stability of the knee joint.Level IV.

Pub.: 08 Nov '11, Pinned: 16 Sep '17