Remnant Preservation is Helpful to Obtain Good Clinical Results in Posterior Cruciate Ligament Reconstruction: Comparison of Clinical Results of Three Techniques

Abstract

BackgroundThe purpose of the present study was to compare the clinical results of 3 posterior cruciate ligament reconstruction techniques according to the time from injury to surgery and remnant PCL status and to evaluate the efficiency of each technique.MethodsThe records of 89 patients who underwent primary PCL reconstructions with a posterolateral corner sling were analyzed retrospectively. Thirty-four patients were treated by anterolateral bundle (ALB) reconstruction with preservation of the remnant PCL using a transtibial tunnel technique in the acute and subacute stages of injury (group 1). Forty patients were treated with remnant PCL tensioning and an ALB reconstruction using the modified inlay technique in the chronic stage (group 2), and fifteen patients were treated with double-bundle reconstruction using the modified inlay technique (group 3). The double-bundle reconstruction was performed if there was a very weak or no PCL remnant.ResultsThe mean side-to-side differences in posterior tibial translation on the stress radiographs were reduced from 10.1 ± 2.5 mm in group 1, 10.6 ± 2.4 mm in group 2, and 12.8 ± 3.2 mm in group 3 preoperatively to 2.3 ± 1.4 mm in group 1, 2.3 ± 1.5 mm in group 2, and 4.0 ± 2.5 mm in group 3 at the last follow-up (p < 0.001, p < 0.001, and p < 0.001, respectively). Statistical analyses revealed that group 1 and group 2 were similar in terms of side-to-side difference changes in posterior tibial translation on the stress radiographs; however, group 3 was inferior to group 1 and group 2 at the last follow-up (p = 0.022). The clinical results were not significantly different among the three groups.ConclusionsExcellent posterior stability and good clinical results were achieved with ALB reconstruction preserving the injured remnant PCL in the acute and subacute stages and remnant PCL tensioning with ALB reconstruction in the chronic stage. The PCL injuries could be surgically corrected with different techniques depending on both the remnant PCL status and the interval between the knee trauma and operation.

Clinical Outcome of Posterior Cruciate Ligament Reconstruction With and Without Remnant Preservation

“…29,30 There were many studies that reported the outcomes of PCLR that included patients with posterolateral corner (PLC) injuries. 23,31,32 In PCLR the identification of concomitant injuries of the PLC is important for optimizing the surgical and clinical outcomes. We believed that the role of the PCL remnant would be clarified by comparing isolated PCLR with versus without remnant preservation.…”

No Clinically Important Difference in Knee Scores or Instability Between Transtibial and Inlay Techniques for PCL Reconstruction: A Systematic Review

“…After reading the full texts of the remaining 22 articles, 15 were excluded owing to the absence of usable information regarding clinical and stability outcomes or because they were case series evaluating either the transtibial or tibial inlay technique without direct comparison of the two approaches. After applying these criteria, seven studies [9,13,15,[20][21][22][23] were finally included in this systematic review.…”

Arthroscopic Posterior Cruciate Ligament Reconstruction With Remnant Preservation Using a Posterior Trans-septal Portal

“…This remnant preservation is advantageous to gain postoperative stability, restore proprioception by saving mechanoreceptors, and avoid the killer-turn effect by acting like a cushion. 2 , 7 , 8 , 9 , 10 , 11 If the remnant fibers of the PCL are removed to expose the bony landmark, we have to use at least a 10-mm-diameter graft for PCL reconstruction. However, in the remnant-preservation technique, we have tried to preserve the remnant fibers of the PCL as much as possible, and when performing this technique, we have been able to use a graft and tibial tunnel with an 8-mm diameter, on average, to augment and reinforce the remnant PCL bundles, especially for the anterolateral bundle.…”

“… 2 , 3 , 7 If the remnant PCL fibers are well preserved, this could contribute to knee stability, restoration of proprioception by saving mechanoreceptors, and prevention of the killer-turn effect. 2 , 3 , 7 , 8 , 9 , 10 , 11 …”