Return to Sports and Clinical Outcomes After Arthroscopic Anatomic Posterior Cruciate Ligament Reconstruction With Remnant Preservation

Remnant‐Preserving Posterior Cruciate Ligament Reconstruction Over Remnant Fibers Using a Figure‐of‐Four Position and a Posterior Trans‐Septal Portal

“…5). The excellent clinical outcomes of remnant-preserving PCL reconstruction have also been confirmed by many other studies 11,14,15,[21][22][23] . For example, Lee et al 11 revealed that PCLR with remnant fiber preservation resulted in successful functional and morphological outcomes.…”

“…Recently, many authors proposed the concept of preserving the remnant PCL fibers, including Humphrey and Wrisberg ligaments, during PCLR, which was deemed conducive to post-operative knee stability, graft healing, and proprioceptive function [10][11][12] . Several studies have demonstrated that remnant preservation techniques enhanced the revascularization and regeneration of mechanoreceptors and achieved better activity-related outcomes than techniques without remnant preservation [13][14][15][16] .…”

Editorial Commentary: Stump Sparing or Footprint Exposing? Management of the Tibial Remnant During Posterior Cruciate Ligament Reconstruction

“…It is interesting to note that Lee et al 12 show promising results among elite athletes with this single-bundle allograft PCL reconstruction technique. Although their primary outcomes (Lysholm score, 89.4) are not measurably different from those previously reported after traditional PCL reconstruction, 9 their 86% rate of return to preinjury sports significantly deviates from the more bleak rate of 44% described by a recent meta-analysis.…”

“…[9][10][11] Lee, Kim, Yang, and Cho 12 from the Republic of Korea, in their 52-patient case series titled "Return to Sports and Clinical Outcomes After Arthroscopic Anatomic Posterior Cruciate Ligament Reconstruction With Remnant Preservation," have eloquently advocated a remnant-sparing technique in isolated grade III PCL injuries. In contrast to other authors who have suggested exposure of the "champagne glass drop off" point is necessary, 13 Lee et al 12 use a trans-septal approach to detach the posterior capsule from the PCL while preserving a generous distal stump of the PCL for anatomic guidance during tunnel placement. The tibial tunnel is created while viewing through a posterior-medial portal without fluoroscopy.…”

“…Notably, isolated grade III PCL injuries are relatively uncommon, and there may be a continuum between partial and complete injuries, as well as those with irreversible plastic deformation. Although Lee et al 12 characterized isolated grade III injuries as injuries with greater than 10 mm of translation with instrumented stress radiographs and manual examinations, baseline laxity was not explicitly defined as a side-to-side difference. Jackman et al 17 suggested that a side-to-side difference of 8 to 11 mm on kneeling stress radiographs reliably denotes a complete PCL tear whereas 12 mm or greater implies involvement of either the posteromedial or posterolateral corner.…”