Isolated Posterior Cruciate Reconstruction Results in Improved Functional Outcome but Low Rates of Return to Preinjury Level of Sport: A Systematic Review and Meta-analysis

Abstract

Background:Although isolated posterior cruciate ligament reconstruction (PCLR) has become a more frequently performed procedure, reports of functional outcomes and return-to-sport (RTS) rates to support its use are still limited.Purpose:To systematically review the literature to determine the rates of RTS and the functional outcomes of patients after isolated PCLR.Study Design:Systematic review: Level of evidence, 4.Methods:Two reviewers independently searched 5 databases for patient-based clinical studies with a minimum 2-year follow-up that analyzed functional outcome and RTS following isolated PCLR. Studies with multiligament knee reconstruction were excluded. Risk of bias was performed with a modified Downs and Black checklist. The primary outcomes were Tegner and Lysholm scores, rates of RTS, and International Knee Documentation Committee (IKDC) subjective scores. Secondary outcomes were IKDC objective scores, instrumented knee laxity assessment, and Telos radiographic analysis. Where feasible, these data were pooled via a random effects meta-analysis model.Results:Of the 240 titles identified, 14 studies were included. The median time from injury to surgery was 10.6 months (range, 6 weeks–21 years). The pooled mean postoperative Tegner and Lysholm scores were 5.7 (95% CI, 5.4-6.0) and 87.8 (95% CI, 85.6-90.0), respectively, following isolated PCLR; the pooled effect size between pre- and postoperative values was 2.8 (95% CI, 1.6-4.0) and 3.7 (95% CI, 2.6-4.9), respectively. An RTS rate of 44% (95% CI, 23%-66%) was identified. IKDC subjective scores improved to a pooled mean of 73.5 (95% CI, 62.8-84.1), with an effect size of 3.0 (95% CI, 0.4-5.6). The proportion of patients with postoperative IKDC objective scores of grade A/B was 82%. The pooled postoperative KT-1000/KT-2000 side-to-side difference was 3.4 mm (95% CI, 2.5-4.3 mm), with an effect size of 2.8 (95% CI, 1.1-4.5). The pooled postoperative Telos side-to-side difference measurement was 3.5 mm (95% CI, 2.8-4.3 mm), with an effect size of 3.9 (95% CI, 3.3-4.5).Conclusion:The results of this review demonstrate that while isolated PCLR results in a significant improvement in functional outcome scores and improved knee laxity, there is a low rate of return to preinjury level of sport. The prolonged period from injury to surgery might reduce functional improvement and RTS following reconstruction. Therefore, comparison of the outcomes of isolated PCLR and nonoperative treatment is impracticable owing to the potential for selection bias.

Combined posterolateral knee reconstruction: ACL-based injuries perform better compared to PCL-based injuries

“…However, there is a lack of evidence when comparing sports activity and especially return to work between ACL-based and PCLbased PLC injuries. So far, research on return-to-sport activities has concentrated on results after isolated ACL-R or PCL-R [8,14,23,26,27,46]. However, after isolated ACL-R, return-tosport activities is mostly possible with clear limitations in terms of the post-operative sports activity level [14,26,27].…”

Magnetic resonance imaging of the knee

“…The quadriceps tendon is formed by contributions from the rectus femoris (superficial layer), vastus lateralis and vas-tus medialis (middle layer), and vastus intermedius (deep layer) muscles. The normal quadriceps tendon appears laminated on MRI secondary to this layered configuration and interdigitating fat [68]. Superficial fibres of the rectus femoris extend along the anterior patella to the patellar tendon as the prepatellar quadriceps continuation [80][81][82].…”

“…Frequently, PCL injuries are treated conservatively, unless the patient shows clear instability and ongoing pain. In these cases, some institutions will perform surgical reconstruction of the ligament [ 68 ].…”

Comparative Effectiveness and Safety of Allografts and Autografts in Posterior Cruciate Ligament Reconstruction Surgery: A Systematic Review

“…Certain population subgroups such as high-level athletes 9 might also be more vulnerable to muscle weaknesses following autografts and would benefit from specific, unbiased and well-designed studies.…”

“…Significant improvements were observed in post-PCL reconstruction functional scores and knee stability, although this seems to be valid only for moderate levels of activity and a fair return to sport level. 9 A careful consideration of surgical-intervention decisions should, therefore, include multiple factors, such as the patient's level of activity, the functional demands on the knee, the surgeon's experience, and the presentation of other associated meniscal or ligament injuries. 2 The graft type to be used is a further decision to consider because autografts and allografts are potential sources of PCL reconstructions.…”