Long-term Results of Isolated Anterolateral Bundle Reconstructions of the Posterior Cruciate Ligament

Abstract

Arthroscopically assisted reconstructions of the anterolateral bundle of the PCL in patients with symptomatic isolated grade II to IV PCL-deficient knees lead to significantly improved functional results at long term if there is no cartilage damage at time of surgery. Nonoperative treatment should not be extended more than 1 year from injury. Graft choice did not significantly influence the functional outcome at long term.

Surgical Technique: Aperture Fixation in PCL Reconstruction: Applying Biomechanics to Surgery

“…Isolated PCL tears are less common injuries and it would be difficult to gather enough patients for a comparative study. Second, a historical comparison of our data with those available in the literature is challenging, because numerous surgical variables such as graft tensioning and material, tunnel placement, screw parameters (diameter, length, material), or the position of the screw within the tunnel as well as clinical variables including associated injury at the time of injury or time between injury and surgery [9] could influence the outcome of the procedure. Nonetheless, our observations in these 10 PCLreconstructed patients after a combined distal and proximal fixation technique compared favorably with the observations by others ( Table 2) with no differences in activity level between the preoperative level and postoperatively and no difference in ROM between the PCL-reconstructed and contralateral normal knees.…”

“…Several studies show nonoperative treatment will restore the functional activity level in some individuals with an isolated PCL injury [5,13,26,27]. Other studies suggest patients with more severe (Grade II or III) posterior laxity may experience chronic instability and associated pain [3,13,32] and have worse functional scores and increased articular degeneration on radiographic assessment as the time from injury increases [9,13]. Therefore, it is important to identify in a timely manner those patients in whom the injury is likely to result in persistent instability, knee pain, and degenerative arthritis.…”

Nonoperative Treatment and Natural History of Posterior Cruciate Ligament Injuries

“…At a mean of 17 years after nonoperative treatment, Shelbourne et al [28] found that patients had a mean IKDC score of 73 points, which compares to IKDC scores of 75 and 87 found by studies of operative treatment that had much less follow-up times of 9-10 years [45].…”

“…With a mean of 9 years after PCL reconstruction, Hermans et al [45] found medial joint line narrowing in 59 % of their patients and the IKDC ratings of radiographs were normal for 9 of 22 patients (41 %), nearly normal for 10 (45 %), and abnormal for 3 (9 %). Jackson et al [34] found evidence of OA in 8 of 22 patients at 10 years after PCL reconstruction; 4 patients had osteophytes but normal joint space width, and 4 (18 %) had moderate degenerative changes.…”

Estudo para validação de um referencial anatômico para controle fluoroscópico na preparação do túnel tibial em cirurgia de reconstrução do ligamento cruzado posterior

“…As lesões do LCP, com maior instabilidade, geralmente se associam a déficit funcional, dor crônica e degeneração condral, evidenciada nos exames radiográficos (BOYNTON;TIETJENS, 1996;DANDY;PUSEY, 1982;HERMANS;CORTEN;BELLEMANS, 2009;KELLER et al, 1993;PAROLIE;BERGFELD, 1986;PATEL et al, 2007;DAVIS;PATEL, 1999). A evidência, portanto, indica que o tratamento cirúrgico deve ser considerado em casos selecionados em que seja identificada instabilidade moderada, incapacidade funcional e limitação das atividades da vida cotidiana.…”