Posterior Cruciate Ligament Graft Fixation Angles, Part 2

Kennedy, Nicholas I.; LaPrade, Robert F.; Goldsmith, Mary T.; Faucett, Scott C.; Rasmussen, Matthew T.; Coatney, Garrett A.; Engebretsen, Lars; Wijdicks, Coen A.

doi:10.1177/0363546514541226

Cited by 85 publications

(46 citation statements)

References 22 publications

(29 reference statements)

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“…The long-held notion of PCL biomechanics was that the two bundles functioned independently, with the ALB acting primarily during flexion and the PMB in knee extension [1,17]. More recent research, however, suggests that the two bundles function synergistically [18][19][20][21]. Multiple studies have examined knee biomechanics by sectioning the PCL, which collectively demonstrate that an isolated tear of either bundle does not result in a clinically significant increase in posterior translation of the tibia [20,22].…”

Section: Biomechanicsmentioning

confidence: 99%

Posterior Cruciate Ligament: Anatomy and Biomechanics

Logterman¹,

Wydra²,

Frank

2018

Curr Rev Musculoskelet Med

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The PCL is an important restraint of posterior tibial translation relative to the femur. In addition, the PCL acts as a secondary restraint to resist varus, valgus, and external rotation moments about the knee. While less common than ACL injuries, injuries to the PCL can occur from a posterior force directed on the tibia, most common with the knee in a flexed position. The PCL is composed of two functional bundles and has important implications for knee stability. The anterolateral and posteromedial bundles have different patterns of tensioning throughout knee range of motion. The two bundles therefore contribute to resisting posterior tibial translation and rotation at different angles of knee flexion.

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Section: Biomechanicsmentioning

confidence: 99%

Posterior Cruciate Ligament: Anatomy and Biomechanics

Logterman¹,

Wydra²,

Frank

2018

Curr Rev Musculoskelet Med

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“…Sutures for the ALB bone plug of the quadriceps autograft are pulled into the respective femoral tunnel and fixed by a 9 × 20–mm titanium screw (Arthrex); screw placement is shown in Figure 6 . The graft is passed down the tibial tunnel, and the ALB graft is fixed first with the knee flexed to 90° 13 and secured using a 6.5 × 40–mm half-threaded, bicortical cancellous screw (Arthrex) as a post and an 18-mm washer (Arthrex). The PMB graft is then fixed to the tibia through the split tendon graft and with the knee in full extension using the screw and washer; tibial attachment screw placement is shown in Figure 7 .…”

Section: Techniquementioning

confidence: 99%

Autograft Anatomic, Double-Bundle Posterior Cruciate Ligament Reconstruction

Ponzo

Castillo

Fregeiro

et al. 2018

Arthroscopy Techniques

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It is well known that the posterior cruciate ligament (PCL) is the main stabilizer to posterior tibial translation in the knee. Anatomic double-bundle reconstruction has recently been proposed to best restore posterior and rotational tibial instability, especially compared with a single-bundle PCL reconstruction (PCLR). Most publications in the peer-reviewed literature on double-bundle PCLR have used allografts. However, in many countries, allografts are not available. This Technical Note describes an all-autograft arthroscopic technique for PCLR using the quadriceps and semitendinosus tendons.

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“…Describing a new technique with the use of two allografts, Spiridonov et al [ 19 ] reported excellent outcomes both when it comes to objectively measured stability and patient-reported outcomes. Later, biomechanical studies have shown superior results with the same DB PCLR technique compared to SB technique [ 7 , 20 ]. To our knowledge, there are no studies that have looked at the costs of the different treatment algorithms for treating PCL injuries.…”

Section: Introductionmentioning

confidence: 99%

Surgical reconstruction is a cost-efficient treatment option for isolated PCL injuries

Owesen¹,

Aas

Årøen³

2017

Knee Surg Sports Traumatol Arthrosc

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Purpose and hypothesis The main purpose of the study is to put focus on the costs related to treating posterior cruciate ligament (PCL) injuries and the possible implications of chosen treatment strategy to the respective institutions and society.MethodsCosts of treating PCL injuries nonoperatively and for both single-bundle (SB) and double-bundle (DB) reconstruction were estimated. These costs were translated into equivalent quality-adjusted life years (QALY) given a threshold value of Euro (€) 70,000 per QALY. Expected gain in knee osteoarthritis outcome score (KOOS) quality of life (QoL) following surgery based on KOOS data from 112 patients was used as a basis for calculating the cost efficiency ratio.ResultsThe average calculated cost of nonoperative treatment was €3382. Incremental cost for SB PCLR was €8585 (154%) and another increment of €5220 (61%) for DB PCLR using numbers from a European hospital. This is equivalent to increments of 0.074 (SB) and another 0.075 (DB) QALYs given the €70,000 threshold. For DB to be as cost efficient as SB reconstruction, the incremental gain in KOOS QoL has to be at the same level as for SB reconstruction compared to nonoperative treatment.ConclusionThough surgical reconstruction adds a substantial cost to nonoperative treatment alone, it can be considered cost-effective. Double-bundle reconstruction is less cost efficient than SB reconstruction, but should probably still be considered the treatment of choice for certain patient categories. Randomized controlled trials looking at outcome following nonoperative, SB and DB PCL reconstruction are needed. The clinical relevance of this is that surgical reconstruction of PCL injuries is a cost-efficient treatment alternative in patients with an isolated PCL injury. This finding should be taken into consideration when deciding on how to treat these injuries.Level of evidenceIII.

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Posterior Cruciate Ligament Graft Fixation Angles, Part 2

Cited by 85 publications

References 22 publications

Posterior Cruciate Ligament: Anatomy and Biomechanics

Posterior Cruciate Ligament: Anatomy and Biomechanics

Autograft Anatomic, Double-Bundle Posterior Cruciate Ligament Reconstruction

Surgical reconstruction is a cost-efficient treatment option for isolated PCL injuries

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