Enxerto espesso versus técnica de duplo feixe na reconstrução do ligamento cruzado posterior: Estudo experimental biomecânico com cadáveres

Abstract

Objective To evaluate the biomechanical effect of graft thickness compared with the double-bundle technique on posterior cruciate ligament (PCL) reconstruction in human cadaveric knees. Methods A total of 9 human cadaveric knees were tested in 5 conditions: intact knee (INT); single-bundle reconstruction with a 10-mm quadriceps tendon (SB); double-bundle reconstruction with a 10 mm-quadriceps tendon for the anterolateral bundle and a 7-mm doubled semitendinosus tendon for the posteromedial bundle (DB); single-bundle reconstruction with a 10-mm quadriceps tendon plus a 7-mm doubled semitendinosus tendon (SBT); and PCL-deficient (NoPCL). The posterior tibial translation (PTT) was measured in response to a 134-N posterior tibial load at 0 ∘ , 30 ∘ , 60 ∘ e 90 ∘ of knee flexion. Results The PTT values of the DB and SBT techniques were always significantly lower (better stability) than those of the SB technique. The PTT values of the SBT technique were significantly lower than those of the DB technique at 60 ∘ ( p = 0.005) and 90 ∘ ( p = 0.001). Conclusions Graft enlargement improves knee stability in isolated PCL reconstructions, whereas the graft division in the two-bundle technique worsens this stability at 60 ∘ and 90 ∘ of knee flexion. The findings of the present study suggest that knee stability in PCL reconstructions may be improved with the use of thicker grafts in the SB technique rather than performing the DB technique.

Controversies in acute multiligamentary knee injuries (MLKI)

“…In PCL reconstruction surgery, the literature referring to the advantages of some reconstructive technique over another is very poor, however in a systematic review in cadaver studies, Lee et al [62] found that the double bundle gives more posterior stability than a one bundle. Maradei‐et al [69] found that the technique of a one bundle with a thick graft is superior to the double bundle. Xu et al [124] in a prospective comparative study in 59 patients, found no differences between the two techniques.…”