Use of autograft quadriceps tendon for double-bundle posterior cruciate ligament reconstruction

Richards, Richard S; Moorman, Claude T.

doi:10.1016/s0749-8063(03)00694-7

Cited by 24 publications

(10 citation statements)

References 17 publications

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“…4,16,26,31 This relatively new concept has been initiated because of the varied clinical outcomes seen after PCL reconstruction. 8,22 Studies have documented the importance of femoral tunnel placement 2,23,30 in PCL reconstruction and have shown that nonisometric positioning of the graft best corrects abnormal posterior laxity.…”

Section: Discussionmentioning

confidence: 99%

“…In our review of the current literature, few articles have been published about biomechanical testing of DB PCL reconstructions, 17,23,30 although many technical notes and surgical methods have been described. 4,16,26,31 This relatively new concept has been initiated because of the varied clinical outcomes seen after PCL reconstruction. 8,22 Studies have documented the importance of femoral tunnel placement 2,23,30 in PCL reconstruction and have shown that nonisometric positioning of the graft best corrects abnormal posterior laxity.…”

Section: Discussionmentioning

confidence: 99%

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A Biomechanical Comparison of Posterior Cruciate Ligament Reconstructions Using Single- and Double-Bundle Tibial Inlay Techniques

Graham²,

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Biomechanical Comparison of Posterior Cruciate Ligament Reconstructions Using Single- and Double-Bundle Tibial Inlay Techniques

Graham²,

et al. 2005

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“…Several clinical studies on PCL reconstructions have shown good results with Achilles tendon allografts, 2 , 22 , 29 while only a few studies have described the results of quadriceps tendon autografts in PCL reconstructions. 1 , 6 , 9 , 25 , 27 , 34 Limited biomechanical testing has been performed on quadriceps tendon grafts, 24 , 32 and no study to our knowledge has shown any biomechanical or outcomes data for PCL reconstructions with quadriceps allograft tendons. A recent study by Mabe and Hunter 24 biomechanically compared quadriceps tendon allografts with Achilles tendon allografts in isolation to determine whether the quadriceps might be a viable alternative in reconstructive procedures.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Evaluation of Posterior Cruciate Ligament Reconstruction With Quadriceps Versus Achilles Tendon Bone Block Allograft

Forsythe

Haro

Bogunovic

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:Long-term studies of posterior cruciate ligament (PCL) reconstruction suggest that normal stability is not restored in the majority of patients. The Achilles tendon allograft is frequently utilized, although recently, the quadriceps tendon has been introduced as an alternative option due to its size and high patellar bone density.Purpose/Hypothesis:The purpose of this study was to compare the biomechanical strength of PCL reconstructions using a quadriceps versus an Achilles allograft. The hypothesis was that quadriceps bone block allograft has comparable mechanical properties to those of Achilles bone block allograft.Study Design:Controlled laboratory study.Methods:Twenty-nine fresh-frozen cadaveric knees were assigned to 1 of 3 groups: (1) intact PCL, (2) PCL reconstruction with Achilles tendon allograft, or (3) PCL reconstruction with quadriceps tendon allograft. After reconstruction, all supporting capsular and ligamentous tissues were removed. Posterior tibial translation was measured at neutral and 20° external rotation. Each specimen underwent a preload, 2 cyclic loading protocols of 500 cycles, then load to failure.Results:Construct creep deformation was significantly lower in the intact group compared with both Achilles and quadriceps allograft (P = .008). The intact specimens reached the greatest ultimate load compared with both reconstructions (1974 ± 752 N, P = .0001). The difference in ultimate load for quadriceps versus Achilles allograft was significant (P = .048), with the quadriceps group having greater maximum force during failure testing. No significant differences were noted between quadriceps versus Achilles allograft for differences in crosshead excursion during cyclic testing (peak-valley [P-V] extension stretch), creep deformation, or stiffness. Construct stiffness measured during the failure test was greatest in the intact group (117 ± 9 N/mm, P = .0001) compared with the Achilles (43 ± 11 N/mm) and quadriceps (43 ± 7 N/mm) groups.Conclusion:While the quadriceps trended to be a stronger construct with a greater maximum load and stiffness required during load to failure, only maximum force in comparison with the Achilles reached statistical significance. Quadriceps and Achilles tendon allografts had similar other biomechanical characteristics when used for a PCL reconstruction, but both were inferior to the native PCL.Clinical Relevance:The quadriceps tendon is a viable graft option in PCL reconstruction as it exhibits a greater maximum force and is otherwise comparable to the Achilles allograft. These findings expand allograft availability in PCL reconstruction.

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“…However, for patients wishing to avoid allograft tissue, quadriceps tendon autograft has been described as a useful graft for double-bundle reconstruction of the PCL in both isolated PCL injuries and multiple ligament injured knees. 27 Newer double-bundle and tibial inlay techniques should theoretically offer greater stabilization but the available clinical data is only preliminary. In 1995, Berg 3 described the tibial inlay technique.…”

Section: A 4bmentioning

confidence: 99%

Posterior Cruciate Ligament Reconstruction – Current Trends

Dennis¹,

Fox²,

Alford³

et al. 2010

J Knee Surg

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A survey was conducted of the Herodicus Society membership to assess the current status of treating posterior cruciate ligament (PCL) injuries and compared to a similar survey conducted in 1991. The survey addressed indications, graft choice, surgical technique, graft tensioning, and graft fixation. Seventy-eight active surgeons were sent a 34-question survey pertaining to isolated PCL injuries. The majority of respondents (78%) performed р р10 PCL reconstructions per year. The arthroscopic assisted with posteromedial portal technique was the most commonly used (49%). The tibial inlay/onlay technique was used by 15%, and 68% used the single femoral tunnel technique. The remainder used a double femoral tunnel technique. Allograft Achilles tendon was the most commonly selected graft for acute (43%) and chronic (50%) PCL reconstructions. An interference screw for femoral fixation was used 67% of the time. The majority of respondents (55%) tensioned their single bundle or anterolateral band of a double bundle in 71°-90° of flexion. A significant difference in technique was noted when comparing those who performed р р10 PCL reconstructions per year (group 1) versus Ͼ Ͼ10 PCL reconstructions per year (group 2). In group 1, 25% of surgeons used a double tunnel technique versus 59% of surgeons in group 2. The most common operative treatment for PCL injuries consisted of a single femoral tunnel with an Achilles tendon allograft. When compared to a similar survey conducted in 1991, the notable differences were a trend toward Achilles tendon allograft and the popularization of the double femoral tunnel and tibial inlay/onlay technique. [J Knee Surg. 2004;17:133-139.]

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Use of autograft quadriceps tendon for double-bundle posterior cruciate ligament reconstruction

Cited by 24 publications

References 17 publications

A Biomechanical Comparison of Posterior Cruciate Ligament Reconstructions Using Single- and Double-Bundle Tibial Inlay Techniques

A Biomechanical Comparison of Posterior Cruciate Ligament Reconstructions Using Single- and Double-Bundle Tibial Inlay Techniques

Biomechanical Evaluation of Posterior Cruciate Ligament Reconstruction With Quadriceps Versus Achilles Tendon Bone Block Allograft

Posterior Cruciate Ligament Reconstruction – Current Trends

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