Revision Posterior Cruciate Ligament Surgery

Fanelli, Gregory C.; Fanelli, Matthew; Fanelli, David G.

doi:10.1097/jsa.0000000000000136

Cited by 13 publications

(9 citation statements)

References 17 publications

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“…However, a systematic review of 14 level II-V studies performed by Qi et al showed no significant differences when looking at clinical outcomes [31]. Furthermore, Fanelli et al performed a prospective randomized trial evaluating strength of repair and post-operative function with single-versus double-bundle repair and found no statistical difference as assessed by KT-1000 arthrometer testing, three knee ligament rating scales, and Telos stress radiography [32].…”

Section: Single-versus Double-bundle Reconstructionmentioning

confidence: 99%

“…In addition to biomechanical evaluation, multiple studies have investigated clinical outcomes comparing single-and double-bundle methods. To date, none of these studies have provided sufficient data proving superiority of one technique over the other in regard to functional scores, patient satisfaction, or radiographic examination [31,32,34,35].…”

Section: Single-versus Double-bundle Reconstructionmentioning

confidence: 99%

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Graft Considerations in Posterior Cruciate Ligament Reconstruction

Johnson

Mitchell

Görtz

2018

Curr Rev Musculoskelet Med

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Recent biomechanical and clinical studies have brought attention to improved surgical techniques and clinical outcomes of PCL reconstruction. In contrast to anterior cruciate ligament (ACL) injuries, isolated posterior cruciate ligament (PCL) injuries occur much less frequently and have traditionally been treated non-operatively. Even when a PCL injury meets operative indications, outcomes of PCL reconstruction historically do not match the success rates of ACL reconstruction procedures. As such, there remains controversy regarding appropriate indications and techniques for surgical repair leading to a paucity of conclusive data regarding surgical outcomes. Recently, however, there has been an increase in focus on the role of the PCL in proper knee biomechanics and negative long-term sequelae of chronic PCL insufficiency. This improved understanding has led to advancements in surgical technique and graft options for PCL reconstruction.

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Section: Single-versus Double-bundle Reconstructionmentioning

confidence: 99%

Section: Single-versus Double-bundle Reconstructionmentioning

confidence: 99%

Graft Considerations in Posterior Cruciate Ligament Reconstruction

Johnson

Mitchell

Görtz

2018

Curr Rev Musculoskelet Med

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“…Backup fixation is usually made on the tibial side using a button, screw and washer or suture anchor. In revision surgery, backup fixation is encouraged and often essential due to compromised bone stock [13]. Double-bundle fixation may be warranted in severe hyperextension.…”

Section: Revision Pcl Techniquesmentioning

confidence: 99%

Revision PCL Reconstruction Review/Update

Gill

Gwathmey

2018

Curr Rev Musculoskelet Med

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Specifically, it is paramount to consider and treat posteromedial and posterolateral instability. Success in revision surgery focuses on appropriate graft choice and precise tunnel placement at anatomical attachment sites. Furthermore, correct tensioning of the graft, secondary or backup fixation and well-designed PT and rehab protocols are integral components. The factors causing failure of the primary reconstruction should be identified, as revision surgery must address the errors and follow strict surgical principals to be successful. There are many variables that play a role in successful revision posterior cruciate ligament (PCL) reconstruction. In general, as in most ligament reconstruction surgery, it is important to identify and address all associated pathology such as lower extremity malalignment and additional instability.

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“…PCL reconstruction has a high failure rate due to incorrect tunnel placement, selection of inappropriate surgical techniques, grafts, timing of postoperative rehabilitation, and the presence of other associated complications (infection, pain, etc.) [ 11 – 16 ]. The results of a previous study showed that only 50–82% of the patients who underwent PCL reconstruction were able to return to the preinjury activity level [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Different femoral tunnel placement in posterior cruciate ligament reconstruction: a finite element analysis

Wang

Yao

et al. 2023

BMC Musculoskelet Disord

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Background At present, there is no consensus on the optimal biomechanical method for Posterior cruciate ligament (PCL) reconstruction, and the “critical corner” that is produced by the femoral tunnel is currently considered to be one of the main reasons for PCL failure. Thus, the purpose of this study was to identify one or several different tunnels of the femur, thereby reducing the influence of the "critical corner" without reducing the posterior stability of the knee. Methods CT and MRI data of the knee joint of a healthy adult man were collected, and computer-related software was used to reconstruct the finite element model of the knee joint, to provide different properties to different materials and to allow for the performance of a finite element analysis of the reconstructed model. The position of the femoral tunnel was positioned and partitioned according to anatomical posture, and three areas were divided (the antero-proximal region, the antero-distal region and the posterior region). In addition, we applied a posterior tibial load of 134 N to the reconstructed model, recorded and compared different tunnels of the femur, conducted peak stress at the flexion of the knee joint of 0°, 30°, 60° and 90°, and elicited the displacement of the proximal tibia. Results Among the 20 different femoral tunnels, the graft peak stress was lower in tunnels 4, 12 and 18 than in the PCL anatomical footpath tunnel 13, especially at high flexion angles (60° and 90°). These three tunnels did not increase the posterior displacement of the proximal tibia compared with the anatomical footpath tunnel 13. Conclusion In summary, among the options for PCL reconstruction of the femoral tunnel, the tunnels located 5 mm distal to the footprint and 5 mm anterior to the footprint could reduce the peak stress of the graft; additionally, it may reduce the "critical corner" and was shown to not reduce the posterior stability of the knee joint.

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Revision Posterior Cruciate Ligament Surgery

Cited by 13 publications

References 17 publications

Graft Considerations in Posterior Cruciate Ligament Reconstruction

Graft Considerations in Posterior Cruciate Ligament Reconstruction

Revision PCL Reconstruction Review/Update

Different femoral tunnel placement in posterior cruciate ligament reconstruction: a finite element analysis

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