The Biomechanical Effect of Posterior Cruciate Ligament Reconstruction on Knee Joint Function

Gill, Thomas J.; DeFrate, Louis E.; Wang, Conrad; Carey, Christopher T.; Zayontz, Shay; Zarins, Bertram; Li, Guoan

doi:10.1177/03635465030310040901

Cited by 80 publications

(66 citation statements)

References 40 publications

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“…An additional force of 8.5 N was added to the ITB, and 21 N to the biceps and the semimembranosus/ semitendinosus tendon, respectively. This distribution of the forces is similar to the force ratios used by other authors [3,19,51]. Each knee was flexed with the quadriceps aligned with the femur (Fig.…”

Section: Osteotomiessupporting

confidence: 81%

Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study

Stoffel

Willers

Korshid

et al. 2007

Knee Surg Sports Traumatol Arthr

120

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Patella infera is a known complication of high tibial osteotomy (HTO) that can cause anterior knee pain due to excessive stresses associated with abnormal patellofemoral (PF) joint biomechanics. However, the translation of these abnormal biomechanics to native cartilage pressure has not been explored. The present study was designed to compare the PF contact pressures of three different HTOs in a human cadaveric model of valgus tibiofemoral correction. Nine fresh cadaveric knees underwent (1) medial opening wedge (OWHTO) with a proximal tuberosity osteotomy (PTO), (2) OWHTO with a distal tuberosity osteotomy (DTO), and (3) a lateral closing wedge (CWHTO). The specimens were mounted in a custom knee simulation rig, with muscle forces being simulated using a pulley system and weights. The PF contact pressure was recorded using an electronic pressure sensor at 15 degrees , 30 degrees , 60 degrees , 90 degrees , and 120 degrees of knee flexion, with results of the intact knees obtained as relative control. Compared to the intact knee, the DTO OWHTO and CWHTO did not significantly (P > 0.05) influence PF pressure at any flexion angle. On the other hand, PTO OWHTO lead to a significant elevation in PF cartilage pressure at 30 degrees (P < 0.05), 60 degrees (P < 0.005), and 90 degrees (P < 0.0005) knee flexion. We conclude from these results that DTO OWHTO maintains normal joint biomechanics and has no significant effect on PF cartilage pressure. In patients who complain of pre-existing anterior knee pain, DTO OWHTO or CWHTO should be considered.

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Section: Osteotomiessupporting

confidence: 81%

Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study

Stoffel

Willers

Korshid

et al. 2007

Knee Surg Sports Traumatol Arthr

120

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“…[20][21][22] Sensitivity analyses Table 3 indicated that the double bundle technique was significantly superior in patients with PCL isolated injuries (n ¼ 244; P ¼ 0.001 for all studies; P < 0.001 for RCTs; Table 3). 9,20,[22][23][24]29 There were no significant between-group differences in knee stability at 30 (n ¼ 138) 9,21,26,27 or ROM (Table 4) (n ¼ 88). 20,21 Studies using the Lysholm test found no significant between-group difference in outcome (n ¼ 372; Figure 3).…”

Section: Resultsmentioning

confidence: 99%

“…Studies were considered eligible for inclusion if they met the following criteria: (i) comparative studies (randomised controlled trials [RCTs] or non-RCTs); (ii) patients with PCL tear with or without other knee injuries; (iii) comparison of arthroscopic single bundle and double bundle PCL reconstruction; (iv) outcomes at !12-month follow-up -knee 90 posterior stability, knee 30 posterior stability, range of knee motion (ROM) and clinical functional outcomes. The main endpoints for the meta-analysis were knee posterior stability and subjective outcome (Lysholm knee function score 16 …”

Section: Study Criteriamentioning

confidence: 99%

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Outcome of posterior cruciate ligament reconstruction using the single- versus double bundle technique: A meta-analysis

et al. 2015

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Objective: To test the hypothesis that double bundle posterior cruciate ligament (PCL) reconstruction yields better improvement in stability and functional recovery of the knee than the single bundle technique. Methods: PubMed Õ , Embase Õ , the Cochrane Library, CNKI, Wanfang and CBM disc databases were searched for comparative trials of PCL reconstruction using the single-versus double bundle technique. Data were extracted and meta-analysis was performed for stability improvement and functional recovery. Results: The meta-analysis included 435 patients in three randomized controlled trials (RCTs) and eight non-RCTs. Double bundle reconstruction provided significantly better 90 posterior stability than the single bundle technique (weighted mean difference 0.81, 95% confidence interval, [CI] 0.2, 1.42). Double bundle reconstruction resulted in a significantly higher likelihood of International Knee Documentation Committee (IKDC) examination grade A than the single bundle technique (odds ratio 0.41, 95% CI 0.24, 0.72). Conclusions: The small amount of data available indicates that double bundle reconstruction is superior to the single bundle technique after isolated PCL injury. These findings should be interpreted with caution due to the low quality and limited sample size of the studies concerned.

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“…This may be that singlebundle reconstruction cannot anatomically rebuild the injured PCL, and the posterior stress force of the affected knee joint cannot uniformly be loaded to the grafts, leading to grafts laxity [14]. Moreover, in single-bundle reconstruction, the posterior stability of the affected knee joint is maximum in knee flexion 90° and is small in knee flexion <30°, and the rotational stability of the affected knee joint is also small in knee flexion more than 90° [11,25]. Doublebundle PCL reconstruction may avoid these problems [36].…”

Section: Discussionmentioning

confidence: 99%

Comparison of hamstring tendon autograft and tibialis anterior allograft in arthroscopic transtibial single-bundle posterior cruciate ligament reconstruction

Wang

et al. 2014

Knee Surg Sports Traumatol Arthrosc

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The Biomechanical Effect of Posterior Cruciate Ligament Reconstruction on Knee Joint Function

Abstract: Abnormal knee kinematics may lead to development of long-term knee arthrosis.

Cited by 80 publications

References 40 publications

Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study

Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study

Outcome of posterior cruciate ligament reconstruction using the single- versus double bundle technique: A meta-analysis

Comparison of hamstring tendon autograft and tibialis anterior allograft in arthroscopic transtibial single-bundle posterior cruciate ligament reconstruction

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