Tibiofemoral and Patellofemoral Kinematics After Reconstruction of an Isolated Posterior Cruciate Ligament Injury

Abstract

Background The actual in vivo tibiofemoral and patellofemoral kinematics of the posterior cruciate ligament (PCL)-reconstructed knee joint are unknown. Hypothesis Current single-bundle PCL reconstruction is unable to correct the abnormal tibiofemoral and patellofemoral kinematics caused by rupture of the ligament. Study Design Controlled laboratory study/case series; Level of evidence, 4. Methods Seven patients with an isolated PCL injury in 1 knee and the contralateral side intact were included in the study. Magnetic resonance and dual fluoroscopic imaging techniques were used to compare the tibiofemoral and patellofemoral kinematics between the intact contralateral (control group), PCL-deficient, and PCL-reconstructed knee during physiologic loading with a single-legged lunge. Data were collected preoperatively and 2 years after single-bundle reconstruction. Results The PCL reconstruction reduced the abnormal posterior tibial translation in PCL-deficient knees to levels not significantly different from those of the intact knee. Posterior cruciate ligament deficiency resulted in an increased lateral tibial translation between 75° and 120° of flexion, and reconstruction was unable to restore these values to normal. No differences were detected among the groups in varus-valgus and internal-external rotation. The PCL reconstruction reduced the increased patellar flexion of PCL-deficient knees between 90° and 120° of knee flexion and the lateral shift at 120°. The abnormal patellar rotation and tilt seen in PCL deficiency at flexion angles of 75° and greater persisted after reconstruction. Conclusion Single-bundle PCL reconstruction was successful in restoring normal anteroposterior translation of the tibia, as well as the patellar flexion and shift. However, single-bundle PCL reconstruction was unable to achieve the same success in mediolateral translation of the tibia or in the patellar rotation and tilt. Clinical Relevance The persistent abnormal mediolateral translation of the tibia, as well as decreased patellar rotation and tilt, provide a possible explanation for the development of cartilage degeneration after reconstruction of an isolated PCL injury.

Surgical Technique: Aperture Fixation in PCL Reconstruction: Applying Biomechanics to Surgery

“…Finally, static measurement of AP translation through an arthrometer does not always correlate with AP translation measured during physiological loading of the knee [16,33]. However, the tibiofemoral kinematics of seven of the included patients have been measured as well during weightbearing knee flexion using a combined MR and dual fluoroscopic imaging technique [7]. The combined distal and proximal tibial fixation technique restored the AP tibial translation to levels similar to those of the contralateral knee, indicating the graft fixation indeed provides stable reconstruction during weightbearing flexion.…”

“…The mean ± SD time between injury and surgery was 3.1 ± 5.5 years (range, 1.5 months to 21 years). Seven of the 10 included patients were included in our previous study of the tibiofemoral and patellofemoral kinematics after reconstruction of an isolated PCL injury [7]. The minimum followup was 1 year (mean, 2.5 years; range, 1.0-4.8 years).…”

In vivo patellar tracking and patellofemoral cartilage contacts during dynamic stair ascending

“…MRI has also been used to determine the patellofemoral cartilage contact (Brossmann, et al, 1993; Derasari, et al, 2010; Kujala, et al, 1989; MacIntyre, et al, 2006; Powers, et al, 1998; Sheehan, et al, 1999). Recently, dual-fluoroscopic imaging systems (DFIS) have been used to measure the patellofemoral contact kinematics as well as the cartilage contact deformation during weight-bearing knee flexion (Gill, et al, 2009; Nha, et al, 2008). …”

The Effect of Proximal Tibial Slope on Dynamic Stability Testing of the Posterior Cruciate Ligament– and Posterolateral Corner–Deficient Knee

“…Consequently, recent investigations have sought to describe the effects of combined PCL/PLC injury on knee kinematics as well as the biomechanical consequences of surgical reconstruction of these structures. 2,3,9,14,15 Furthermore, investigators have also developed an interest in other factors that may influence knee stability including femoral and tibial shapes. Previous work has demonstrated that increasing tibial slope via osteotomy can result in an anterior shift of the tibia and reduce tibial sag in the PCL-deficient knee.…”