Clinical studies of single-stage combined ACL and PCL reconstruction variably report graft tensioning, fixation sequence, and knee flexion angle at time of fixation

Fayed, Aly M.; Rothrauff, Benjamin B.; de, Darren; Fu, Freddie H.; Musahl, Volker

doi:10.1007/s00167-020-06171-6

Cited by 4 publications

(2 citation statements)

References 43 publications

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“…Conversely, a recent investigation by the Norwegian National Knee Ligament Registry (NKLR) demonstrated lower preoperative PROs in patients with isolated PCL injury compared to patients with isolated ACL injury, indicating the severity of PCL tears [ 2 ]. With regard to bicruciate injuries, several case series with less than 35 patients collectively display significant improvement in clinical and functional outcomes after single-stage combined ACL and PCL reconstruction (ACL/PCL-R) [ 3 , 7 , 9 , 15 , 22 , 28 ]. However, rates of return to sport after bicruciate reconstruction are low and vary considerably between studies, ranging from 19 to 85% [ 7 , 15 , 22 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

Sports activity and quality of life improve after isolated ACL, isolated PCL, and combined ACL/PCL reconstruction

Winkler

Zsidai

Narup

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To compare patient-reported outcomes following isolated anterior cruciate ligament reconstruction (ACL-R), isolated posterior cruciate ligament reconstruction (PCL-R), and combined ACL-R and PCL-R (ACL/PCL-R), at a minimum follow-up of 2 years. Methods This was a prospective observational registry cohort study based on the Swedish National Knee Ligament Registry. Patients undergoing isolated ACL-R, isolated PCL-R, and combined ACL/PCL-R between 2005 and 2019 were eligible for inclusion. Demographic characteristics as well as injury- and surgery-related data were queried from the SNKLR. To evaluate functional outcomes, the Knee Injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1- and 2-year follow-ups and compared between the treatment groups. Results In total, 45,169 patients underwent isolated ACL-R, 192 patients isolated PCL-R, and 203 patients combined ACL/PCL-R. Preoperatively, and at the 1- and 2-year follow-ups, KOOS subscales were highest for the isolated ACL-R group, followed by the isolated PCL-R, and lowest for the combined ACL/PCL-R groups. Significant improvements were observed across all treatment groups in the majority of KOOS subscales between the preoperative, and 1- and 2-year follow-ups. All treatment groups showed the greatest improvements between the preoperative and 2-year follow-ups in the knee-related quality of life (mean improvement: isolated ACL-R, + 28 points; isolated PCL-R, + 23 points; combined ACL/PCL-R, + 21 points) and the function in sport and recreation (mean improvement: isolated ACL-R, + 26 points; isolated PCL-R, + 20 points; combined ACL/PCL-R, + 19 points) subscales. Conclusion Clinically relevant improvements in knee function can be expected after isolated ACL-R, isolated PCL-R, and combined ACL/PCL-R. Functional improvements were particularly pronounced in the KOOS function in sport and recreation subscale, indicating the importance of knee stability for sports activity. This study facilitates more comprehensive patient education about functional expectations after surgical treatment of isolated and combined ACL and PCL injuries. Level of evidence Level 2.

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Section: Introductionmentioning

confidence: 99%

Sports activity and quality of life improve after isolated ACL, isolated PCL, and combined ACL/PCL reconstruction

Winkler

Zsidai

Narup

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…16,23,25,66 In clinical studies looking at the outcomes of multiligament knee reconstruction, most authors seem to prefer to fix the PCL first, usually at around 90 of flexion. 6,16,18,43,55 The ACL graft is often fixed afterward at a low knee flexion angle (0 -30 ). However, there is a lack of underlying research to support this graft tensioning and fixation preference.…”

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confidence: 99%

No Difference in Knee Kinematics Between Anterior Cruciate Ligament–First and Posterior Cruciate Ligament–First Fixation During Single-Stage Multiligament Knee Reconstruction: A Biomechanical Study

Fayed

Kanto

Price

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: For combined reconstruction of both the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL), there is no consensus regarding which graft should be tensioned and fixed first. Purpose: The purpose of this study was to determine which sequence of graft tensioning and fixation better restores normal knee kinematics. The hypothesis was that ACL-first fixation would more closely restore normal knee kinematics, graft force, and the tibiofemoral orientation in the neutral (resting) position compared with PCL-first fixation. Study Design: Controlled laboratory study. Methods: A total of 15 unpaired human cadaveric knees were examined using a robotic testing system under the following 4 conditions: (1) 89.0-N anterior tibial load at different knee angles; (2) 89.0-N posterior tibial load at different knee angles; (3) combined rotational 7.0-N·m valgus and 5.0-N·m internal rotation load (simulated pivot shift) at 0°, 15°, and 30° of flexion; and (4) 5.0-N·m external rotation load at 0°, 15°, and 30° of flexion. The 4 evaluated knee states were (1) intact ACL and PCL (intact), (2) ACL and PCL deficient (deficient), (3) combined anatomic ACL-PCL reconstruction fixing the ACL first (ACL-first), and (4) combined anatomic ACL-PCL reconstruction fixing the PCL first (PCL-first). A 9.0 mm–diameter quadriceps tendon autograft was used for the ACL graft, tensioned with 40.0 N at 30° of flexion. A 9.5 mm–diameter hamstring tendon autograft (gracilis and semitendinosus, quadrupled loop, and augmented with an additional allograft strand if needed), tensioned with 40.0 N at 90° of flexion, was used for the PCL graft. Results: There were no statistically significant differences between ACL-first and PCL-first fixation regarding knee kinematics. ACL-first fixation restored anterior tibial translation to the intact state at all tested knee angles, while PCL-first fixation showed higher anterior tibial translation than the intact state at 90° of flexion (9.05 ± 3.05 and 5.87 ± 2.40 mm, respectively; P = .018). Neither sequence restored posterior tibial translation to the intact state at 30°, 60°, and 90° of flexion. At 15° of flexion, PCL-first fixation restored posterior tibial translation to the intact state, whereas ACL-first fixation did not. Conclusion: There were no differences in knee laxity between ACL-first and PCL-first fixation with the ACL graft fixed at 30° and the PCL graft fixed at 90°. Clinical Relevance: This study showed that there was no evidence to support the use of one tensioning sequence over the other in single-stage multiligament knee reconstruction.

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The Multiligamentous Knee Injury

Herman,

Fox,

Kaarre

et al. 2023

Sports Injuries

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Clinical studies of single-stage combined ACL and PCL reconstruction variably report graft tensioning, fixation sequence, and knee flexion angle at time of fixation

Cited by 4 publications

References 43 publications

Sports activity and quality of life improve after isolated ACL, isolated PCL, and combined ACL/PCL reconstruction

Sports activity and quality of life improve after isolated ACL, isolated PCL, and combined ACL/PCL reconstruction

No Difference in Knee Kinematics Between Anterior Cruciate Ligament–First and Posterior Cruciate Ligament–First Fixation During Single-Stage Multiligament Knee Reconstruction: A Biomechanical Study

The Multiligamentous Knee Injury

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