Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons

Stähelin, Andreas C.; Südkamp, Norbert P.; Weiler, Andreas

doi:10.1053/jars.2001.20661

Cited by 64 publications

(27 citation statements)

References 48 publications

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“…Other studies have reported the transverse lengths at the femoral insertion, central portion and tibial insertion levels (Triantafyllidi et al;Fanelli et al;Sheps et al, 2005;Margheritini et al, 2004;Cosgarea & Jay, 2001;Stähelin et al, 2001). Harner et al (1999) discovered that the AL fascicle is greater than the PM, which differs from data reported by Takahashi The most relevant finding of this study was that the PCL did not have the same dimension for the entirety of its length, replicating the "sand clock" form with wide bases and a thin center, particularly in its anteroposterior length.…”

Section: Discussioncontrasting

confidence: 82%

Anthropometric Landmarks for Posterior Cruciate Ligament Reconstruction in Anatomical Position

Compeán-Martínez¹,

Morales-Ávalos²,

Vílchez-Cavazos³

et al. 2015

Int. J. Morphol.

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COMPEÁN-MARTÍNEZ, G. A.; MORALES-AVALOS, R.; VÍLCHEZ-CAVAZOS SUMMARY:To determine viable anatomical landmarks allowing for accurate femoral and tibial tunnel placement in anatomical position during posterior cruciate ligament (PCL) reconstruction. Ten knees were dissected to analyze femoral and tibial PCL insertion measurements and the features specific to the PCL and its fascicles. The clock hands system was used to measure femoral insertions. The meniscus and anterior cruciate ligament (ACL) were used as landmarks to measure tibial insertions. The PCL and its corresponding fascicle characteristics were determined by its femoral insertion, central portion and tibial insertion. The mean lengths between the central point of the PCL footprint and the articular cartilage border at 12:00 h were 17.23 mm (±3.94) and 17.73 mm (±4.11) for the right and left knees, respectively. The anterior-posterior mean lengths for the PCL were 11.94 mm (±5.08) between the posterior PCL border and the anterior PCL border. The mean lengths were 33.52 mm (±3.49) from the medial border of the lateral meniscus to the lateral PCL border and 32.24 mm (±2.28) from the medial border of the medial meniscus to the medial PCL border. From the anteroposterior viewpoint, the anterolateral fascicle is greater than the posteromedial one in its femoral and tibial insertions and in its central portion. A quantitative data collection summary was conducted with different PCL variables, along with its fascicles and their various femoral and tibial bony landmarks. Various measurements were obtained, indicating the high functionality shared by the PCL fascicles. Lengths reported for insertions are practical landmarks for the locations of femoral and tibial tunnels during posterior cruciate ligament plasty. We must take into account native PCL form to avoid oversizing the graft during reconstruction and to avoid a possible clamping of the graft with the surrounding structures.

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Section: Discussioncontrasting

confidence: 82%

Anthropometric Landmarks for Posterior Cruciate Ligament Reconstruction in Anatomical Position

Compeán-Martínez¹,

Morales-Ávalos²,

Vílchez-Cavazos³

et al. 2015

Int. J. Morphol.

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“…These PCL reconstruction techniques (single graft and double graft reconstructions) have been compared in previous experimental studies (Bergfeld et al, 2001;Hagemeister et al, 2002;Mannor et al, 2000;Race and Amis, 1996;Race and Amis, 1998;Stahelin et al, 2001). Harner et al (2000b) have shown that the kinematics behavior of a knee with a ''native'' PCL and a knee with double graft reconstructed PCL were similar.…”

Section: Introductionmentioning

confidence: 99%

Effects of the posterior cruciate ligament reconstruction on the biomechanics of the knee joint: a finite element analysis

Ramaniraka

Terrier

Theumann

et al. 2005

Clinical Biomechanics

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Background. Previous experimental studies have been conducted to evaluate the biomechanical effects of posterior cruciate ligament reconstruction; but no consensus has been reached on the preferred method of reconstruction.Methods. The 3D finite element mesh of a knee joint was reconstructed from computed tomography and magnetic resonance images. The ligaments were considered as hyperelastic materials. The tibiofemoral and patellofemoral joints were modeled with large sliding contact elements. The 3D model was used to simulate knee flexion from 0°to 90°in four cases: a knee with a ''native'' posterior cruciate ligament, a resected posterior cruciate ligament, a reconstructed single graft posterior cruciate ligament, and a reconstructed double graft posterior cruciate ligament.Findings. A resected posterior cruciate ligament induced high compressive forces in the medial tibiofemoral and patellofemoral compartments. The pressures generated in the tibiofemoral and patellofemoral compartments were nearly the same for the two reconstruction techniques (single graft and double graft). The single graft resulted in lower tensile stresses inside the graft than for the double graft.Interpretation. Firstly, a resected posterior cruciate ligament should be replaced to avoid excessive compressive forces, which are a source of cartilage degeneration. Secondly, the two types of posterior cruciate ligament reconstruction techniques partially restored the biomechanics of the knee in flexion, e.g. contact pressures were restored for pure flexion of the knee. The reconstruction techniques therefore partially restore the biomechanics of the knee in flexion. A double graft reconstruction is subjected to the highest tensile stresses.

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“…Restrictions relating to the limits on knee flexion gains are discussed in the literature, with divergences between the rehabilitation protocols presented. Some authors have prioritized limiting the range of angles to between 0 and 60º (7)(8)(9)(10) , 0 and 70º (11) , 0 and 90º (12)(13)(14)(15) or 0 and 120º (16) , or without any stimulated limit (17) or according to the patient's tolerance (18) . Quelard et al (19) recommended a gradual protocol for gaining passive mobility of the knee, such that a range of 0-60° would be achieved in the first six weeks, 0-90° from the sixth to the eighth week and 0-120° from the eighth week onwards.…”

Section: Points Relating To Rommentioning

confidence: 99%

“…However, other studies are divergent. Some authors have recommended that weight-bearing should be introduced according to the patient's tolerance and should be started in the first week (7,8,15,17,20,27,28) , while one study restricted weight-bearing until the sixth week (16) and others until the eighth week (11,18) . In some protocols, weight-bearing is not recommended during the first days after reconstruction.…”

Section: Release For Weight-bearing (Walking)mentioning

confidence: 99%

Protocolo de reabilitação para as reconstruções isoladas do ligamento cruzado posterior

Cury¹,

Kiyomoto²,

Rosal³

et al. 2012

Rev. bras. ortop.

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To create a rehabilitation protocol following reconstruction of the posterior cruciate ligament (PCL), through a literature review. The literature review was conducted in the Medline and Embase databases, to search for data on biomechanical concepts and analyses relating to the posterior cruciate ligament of the knee. The search strategy was set up using the following rules: problem or injury in association with anatomical location terms; or surgical intervention procedure in association with rehabilitation terms. We began the process in this manner and subsequently introduced restrictions on certain terms to improve the search specificity. To design the protocol, a table was created for better data assessment, basedRev Bras Ortop. 2012;47(4):421-7 on the time that elapsed between surgery and the start of physiotherapy. A rehabilitation protocol was created to improve weight-bearing control in the initial weeks after surgery, with the aid of a knee brace. Our aim was to achieve gains in total range of motion of the knee, which should be attained by the third month, thereby avoiding contractures resulting from the tissue healing process. Strengthening exercises and sensory-motor training were guided accordingly, thus avoiding overload on the graft and respecting the healing phases. The protocol proposed through this review was based on the current evidence relating to this subject.

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Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons

Cited by 64 publications

References 48 publications

Anthropometric Landmarks for Posterior Cruciate Ligament Reconstruction in Anatomical Position

Anthropometric Landmarks for Posterior Cruciate Ligament Reconstruction in Anatomical Position

Effects of the posterior cruciate ligament reconstruction on the biomechanics of the knee joint: a finite element analysis

Protocolo de reabilitação para as reconstruções isoladas do ligamento cruzado posterior

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