In vivo evaluation of femoral and tibial graft tunnel placement following all-inside arthroscopic tibial inlay reconstruction of the posterior cruciate ligament

Osti, Michael; Krawinkel, Alessa; Benedetto, K. P.

doi:10.1016/j.knee.2014.07.005

Cited by 7 publications

(6 citation statements)

References 22 publications

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“…In addition, correct tunnel placement, graft passage, and implant position are assessed fluoroscopically. The target values for intraoperative fluoroscopic validation of accurate tunnel apertures 24 were 51% of the total mediolateral diameter of the tibial plateau, 8 mm inferior from the anteroposterior tangent of the tibial plateau on lateral images, and exactly at the level of the previous physis line for the tibial tunnel. For the femoral tunnel the corresponding values were 42% of the total intercondylar depth and 13% of the total intercondylar height.…”

Section: Surgical Techniquementioning

confidence: 99%

“…For the femoral tunnel the corresponding values were 42% of the total intercondylar depth and 13% of the total intercondylar height. 24 The tibial footprint of the native PCL is located and dissected under direct arthroscopic view on the posterior tibial slope. A 12 mm tibial bone socket is created using a retrograde cutter over a previously inserted guide wire under arthroscopic and fluoroscopic visualization in accordance with the identified remnants of the native PCL (►Figs.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Evolving trends in PCL surgery include an arthroscopic all-inside tibial-inlay technique, which combines the benefits of biomechanically improved graft position avoiding a transtibial killer turn and of a minimally invasive arthroscopic approach. 7,11,13,15,24 Since reports about the clinical outcome are rare, the objective of the present study was to determine the medium-term functional and radiological results and complication rate following arthroscopic all-inside tibial-inlay single bundle PCL reconstruction.…”

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confidence: 99%

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The Arthroscopic All-Inside Tibial-Inlay Reconstruction of the Posterior Cruciate Ligament: Medium-Term Functional Results and Complication Rate

et al. 2016

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The present study evaluates the medium-term functional and radiological outcome as well as complications following an arthroscopic tibial inlay reconstruction of the posterior cruciate ligament (PCL). A total of 39 patients (mean age: 32.6 ± 12.4 years) with acute and chronic PCL instabilities received a single-bundle all-inside arthroscopic tibial inlay reconstruction with quadriceps tendon autograft and were available for clinical follow-up on average after 3.8 ± 1.8 years. Assessment was conducted utilizing visual analogue scale (VAS), International Knee Documentation Committee (IKDC), Tegner, Lysholm, and knee injury and osteoarthritis outcome (KOOS) scores. VAS, Tegner, Lysholm, and subjective IKDC-scores averaged to 2.75 ± 1.95, 4 (1-9), 77.19 ± 17.54, and 75.18 ± 19.29 points, respectively. Mean KOOS results were 80.66 ± 1.98 for pain, 74.72 ± 17.72 for symptoms, 88.44 ± 13.95 for activities of daily life, 65.35 ± 27.96 for sports and recreation, and 60.01 ± 25.36 for quality of life. Overall IKDC-score rating was A2, B28, C5, and D4. The overall complication rate of 5.4% was caused by one superficial infection, one patellar fracture, and one lesion to the popliteal artery. Arthroscopic tibial inlay reconstruction is a valuable procedure regarding medium-term subjective and objective outcome measures. Return to sports, subjective satisfaction, and objective stability are predictable. The complication rate is acceptable but particular precaution is recommended to protect the popliteal artery and adjacent structures at risk.

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Section: Surgical Techniquementioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

mentioning

confidence: 99%

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The Arthroscopic All-Inside Tibial-Inlay Reconstruction of the Posterior Cruciate Ligament: Medium-Term Functional Results and Complication Rate

et al. 2016

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“…However, to the best of our knowledge, the clinical outcomes of this technique using a lower tibial tunnel have not been reported. Furthermore, although quantitative radiological assessments of the killer turn 15 , 18 , 20 , 27 , 28 , 34 have been reported, the angles were measured on 2-dimensional coronal, sagittal, or axial projections, which yield different results from the true angles in 3-dimensional (3D) space.…”

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confidence: 99%

Lower Tibial Tunnel Placement in Isolated Posterior Cruciate Ligament Reconstruction: Clinical Outcomes and Quantitative Radiological Analysis of the Killer Turn

Lin

Huang

Zhang

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The “killer turn” effect after posterior cruciate ligament (PCL) reconstruction is a problem that can lead to graft laxity or failure. Solutions for this situation are currently lacking. Purpose: To evaluate the clinical outcomes of a modified procedure for PCL reconstruction and quantify the killer turn using 3-dimensional (3D) computed tomography (CT). Study design: Case series; Level of evidence, 4. Methods: A total of 15 patients underwent modified PCL reconstruction with the tibial aperture below the center of the PCL footprint. Next, 2 virtual tibial tunnels with anatomic and proximal tibial apertures were created on 3D CT. All patients were assessed according to the Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Tegner score, side-to-side difference (SSD) in tibial posterior translation using stress radiography, and 3D gait analysis. Results: The modified tibial tunnel showed 2 significantly gentler turns (superior, 109.87° ± 10.12°; inferior, 151.25° ± 9.07°) compared with those reconstructed with anatomic (91.33° ± 7.28°; P < .001 for both comparisons) and proximal (99° ± 7.92°; P = .023 and P < .001, respectively) tibial apertures. The distance from the footprint to the tibial aperture was 16.49 ± 3.73 mm. All patient-reported outcome scores (mean ± SD) improved from pre- to postoperatively: Lysholm score, from 46.4 ± 18.87 to 83.47 ± 10.54 ( P < .001); Tegner score, from 2.47 ± 1.85 to 6.07 ± 1.58 ( P < .001); IKDC sports activities score, from 19 ± 9.90 to 33.07 ± 5.35 ( P < .001); and IKDC knee symptoms score, from 17.87 ± 6.31 to 25.67 ± 3.66 ( P < .001). The mean SSD improved from 9.15 ± 2.27 mm preoperatively to 4.20 ± 2.31 mm postoperatively ( P < .001). The reconstructed knee showed significantly more adduction (by 1.642°), less flexion (by 1.285°), and more lateral translation (by 0.279 mm) than that of the intact knee ( P < .001 for all). Conclusion: Lowering the tibial aperture during PCL reconstruction reduced the killer turn, and the clinical outcomes remained satisfactory. However, SSD and clinical outcomes were similar to those of previously described techniques using an anatomic tibial tunnel.

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“…Early postoperative imaging is increasingly performed to recognize complications of fixation devices and to assess tunnel placement. 24,25,27 Initially the graft has high signal intensity before it undergoes ligamentization (►Fig. 12).…”

Section: Postoperative Imagingmentioning

confidence: 99%

Rupture of the Posterior Cruciate Ligament: Preoperative and Postoperative Assessment

Parkar

Alcalá-Galiano

2016

Semin Musculoskelet Radiol

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Posterior cruciate ligament (PCL) ruptures are not common, but reconstruction is increasing because PCL-deficient knees are prone to develop osteoarthritis. Preoperative MRI may confirm a total or partial disruption of PCL fibers. An overstretched PCL is often mistaken for an intact PCL while the knee is functionally PCL deficient, resulting in false-negative MRI reports. Posterior translation of the medial condyle is a useful indirect sign on imaging. Preoperative stress radiographs are used to quantify the degree of PCL deficiency, and posterior translation determines whether to treat conservatively or with surgery. Early postoperative imaging is performed to evaluate tunnel placement and fixation devices. Late postoperative imaging is performed to assess graft rupture, arthrofibrosis, or tunnel widening. Pre- and postoperative imaging plays an important part in planning and treating functionally PCL-deficient knees and PCL ruptures.

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In vivo evaluation of femoral and tibial graft tunnel placement following all-inside arthroscopic tibial inlay reconstruction of the posterior cruciate ligament

Cited by 7 publications

References 22 publications

The Arthroscopic All-Inside Tibial-Inlay Reconstruction of the Posterior Cruciate Ligament: Medium-Term Functional Results and Complication Rate

The Arthroscopic All-Inside Tibial-Inlay Reconstruction of the Posterior Cruciate Ligament: Medium-Term Functional Results and Complication Rate

Lower Tibial Tunnel Placement in Isolated Posterior Cruciate Ligament Reconstruction: Clinical Outcomes and Quantitative Radiological Analysis of the Killer Turn

Rupture of the Posterior Cruciate Ligament: Preoperative and Postoperative Assessment

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