Comparable clinical and radiological outcomes between anatomical and high femoral tunnels in posterior cruciate ligament reconstruction

Abstract

Purpose To compare clinical and radiological outcomes and failure rates between anatomical and high femoral tunnels in remnant-preserving single-bundle posterior cruciate ligament (PCL) reconstruction. Methods 63 patients who underwent remnant-preserving single-bundle PCL reconstruction between 2011 and 2018 with a minimum 2-year follow-up were retrospectively reviewed. Patients were divided into two groups according to the femoral tunnel position: group A (33 patients with anatomical femoral tunnel) and group H (30 patients with high femoral tunnels). The femoral tunnel was positioned at the center (group A) or upper margin (group H) of the remnant anterolateral bundle. The position of the femoral tunnel was evaluated using the grid method on three-dimensional computed tomography. Clinical and radiological outcomes and failure rates were compared between the groups at the 2-year follow-up. ResultsThe position of the femoral tunnel was signiicantly high in group H than in group A (87.4% ± 4.2% versus 76.1% ± 3.7%, p < 0.001). Clinical outcomes were not signiicantly diferent between the two groups in terms of the clinical scores (International Knee Documentation Committee subjective, Lysholm, and Tegner activity scores), range of motion, and posterior drawer test. Radiological outcomes also showed no intergroup diferences in the side-to-side diferences of posterior tibial translation and osteoarthritis progression. Side-to-side diference on the Telos stress radiograph was 5.2 ± 2.9 mm in group A and 5.2 ± 2.7 mm in group H (n.s.). There were four failures in group A (12.1%) and one in group H (3.3%). The diferences between the groups were not statistically signiicant. ConclusionThe clinical and radiological outcomes and failure rates of the high femoral tunnels were comparable with those of the anatomical femoral tunnels at the 2-year follow-up after remnant-preserving single-bundle PCL reconstruction. The indings of this study suggest that high femoral tunnels can be considered an alternative in remnant-preserving single-bundle PCL reconstruction. Level of evidence III.

Good clinical and radiological results following remnant-preserving posterior cruciate ligament reconstruction: a systematic review

“…No additional studies were found upon manually checking the reference lists of the selected articles. Thus, 13 studies were included in the analysis [1, 5, 10, 11, 13–17, 19, 32–34]. Of the 13 included articles, one was level II [32], five were level III [1, 11, 17, 33, 34], and seven were level IV [5, 10, 13–16, 19].…”

“…The data regarding the surgical technique followed in each of the examined studies are displayed in Table 2. The type of graft used in the various studies was as follows: six studies reported the use of Achilles allograft [1,11,13,[32][33][34], five studies autologous hamstrings [1,5,10,16,17], and three studies tibialis allografts (anterior or posterior) [14,15,19]. The femoral graft-fixation construct was performed in 10 studies with a screw [1,5,10,11,13,16,17,[32][33][34], and with the RigidFix System in three studies [14,15,17], while the Endobutton System was employed in one study only [19].…”

Effect of Posterior Tibial Slopes on Graft Survival Rates at 10 Years After Primary Single-Bundle Posterior Cruciate Ligament Reconstruction

“…Graft failure after PCL reconstruction was defined as follows: the need for additional surgery (revision PCL reconstruction, knee arthroplasty, high tibial osteotomy, etc), a complete tear of the PCL graft on MRI, or grade 3 instability on stress radiography (SSD >10 mm). 28 The patients were divided into 2 groups according to failure or nonfailure, and subgroup analysis was performed for the medial PTS and lateral PTS subgroups. The 10-year graft survival rates were calculated and compared between the small and large PTS subgroups of the medial PTS and lateral PTS groups.…”

“…All surgical procedures were performed using the same method by a single experienced surgeon. [26][27][28][29]31 Arthroscopic SB PCL reconstruction was performed with Achilles tendon allografts 10 mm in diameter. The tibial orifice of the PCL tunnel was targeted at a point distal and lateral to the original site of the tibial attachment of the PCL.…”

“…Postoperative rehabilitation was administered using the same method with a cast for a period of 6 weeks postoperatively. [28][29][30][31] The cast was applied with the knee flexed at 5°to avoid excessive tension on the knee. The protocol included quadriceps strengthening and straight leg-raising exercises immediately after surgery.…”