Database: Ovid MEDLINE(R) <1966 to January Week 3 2004>
Search Strategy:
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exp Posterior Cruciate Ligament/in [Injuries] (381)
2
exp REHABILITATION/ (137928)
3
rehabilitation.af. or 2 (182323)
4
1 and 3 (47)
5
limit 4 to (human and english language) (39)
6
limit 5 to yr=1996-2004 (22)
7
exp posterior cruciate ligament/su (379)
8
method$.af. and 7 (90)
9
limit 8 to (human and english language) (65)
10
limit 9 to review articles (4)
11
limit 9 to yr=1996-2004 (52)
12
limit 11 to yr=1999-2004 (46)
13
from 12 keep 10,12,17-19,26,33,36-37 (9)
14
12 not 13 (37)
15
6 or 14 (55)
16
from 15 keep 1-55 (55)
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<1>
Unique Identifier
8914730
Authors
L'Insalata JC. Harner CD.
Institution
Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania,
USA.
Title
Treatment of acute and chronic posterior cruciate ligament deficiency. New
approaches.[see comment]. [Review] [46 refs]
Comments
Comment in: Am J Knee Surg. 1996 Fall;9(4):171; PMID: 8914728
Source
American Journal of Knee Surgery. 9(4):185-93, 1996 Fall.
<2>
Unique Identifier
9397264
Authors
Noyes FR. Barber-Westin SD.
Institution
Cincinnati Sportsmedicine and Orthopaedic Center, Ohio, USA.
Title
Reconstruction of the anterior and posterior cruciate ligaments after knee
dislocation. Use of early protected postoperative motion to decrease
arthrofibrosis.
Source
American Journal of Sports Medicine. 25(6):769-78, 1997 Nov-Dec.
Abstract
We report a critical rating of results for 11 patients with bicruciate
ligament reconstructions and immediate protected knee motion after knee
dislocations (seven acute and four chronic). Six patients had concurrent repair
or reconstruction of medial ligamentous structures, and six had reconstruction
of the lateral and posterolateral ligaments. All patients returned for followup
at a mean of 4.8 years postoperatively. Follow-up arthrometric testing at 20
degrees of flexion showed 10 knees had less than 3 mm of increased total
anterior-posterior displacement and 1 knee had 7 mm of increase. At 70 degrees
of flexion, 9 knees had less than 3 mm of increased displacement and 2 knees had
more than 6 mm of increase. The failure rates were as follows: 18% of posterior
cruciate ligament reconstructions (2 of 11), 9% of anterior cruciate ligament
reconstructions (1 of 11), 17% of lateral and posterolateral procedures, and 0%
of medial collateral ligament procedures. At followup, five of the seven
patients with acute injuries had no limitations with daily or sports activities.
Three of the four patients with chronic ruptures were asymptomatic with daily
activities, but only one was asymptomatic with light sports. Five patients (all
acute injuries) required treatment for knee motion limitations. Nine patients
had full range of motion at followup. We concluded that simultaneous bicruciate
ligament reconstructions, performed with associated medial or lateral
procedures, are warranted to restore function to all ligament structures. Even
though immediate motion was used, several patients required early manipulation
or arthroscopic debridement, which restored full motion and prevented permanent
arthrofibrosis.
<3>
Unique Identifier
12239009
Authors
Richter M. Bosch U. Wippermann B. Hofmann A. Krettek C.
Institution
Trauma Department, Hannover Medical School, Hannover, Germany.
Title
Comparison of surgical repair or reconstruction of the cruciate ligaments
versus nonsurgical treatment in patients with traumatic knee dislocations.
Source
American Journal of Sports Medicine. 30(5):718-27, 2002 Sep-Oct.
Abstract
BACKGROUND: Studies of traumatic knee dislocations have failed to provide a
consensus regarding the best method of treatment. PURPOSE: Our purpose was to
evaluate the results after surgical repair or reconstruction versus nonsurgical
treatment and to compare the influence of prognostic factors. STUDY DESIGN:
Retrospective study. METHODS: Eighty-nine patients were treated for traumatic
knee dislocation. Surgical repair or reconstruction of the cruciate ligaments
was performed in 63 patients (repair, 49; reconstruction, 14). In 26 patients,
nonsurgical treatment was undertaken. RESULTS: At an average follow-up of 8.2
years, the mean Lysholm and Tegner scores were 75 and 3.7, respectively. The
outcome in the surgical group was better than in the nonsurgical group. The
scores were higher in patients who were 40 years of age or younger, who had
sports injuries rather than motor vehicle accident injuries, and who had
undergone functional rehabilitation rather than immobilization. CONCLUSIONS:
Surgical repair or reconstruction of the cruciate ligaments was superior to
nonsurgical treatment. Functional rehabilitation was the most important positive
prognostic factor. Surgical repair or reconstruction of the cruciate ligaments
is mandatory to achieve sufficient stability for functional rehabilitation. In
cases of cruciate ligament avulsion, repair with transosseous fixation is a
reasonable alternative to reconstruction, provided that it is performed within 2
weeks of trauma. Copyright 2002 American Orthopaedic Society for Sports Medicine
<4>
Unique Identifier
12642252
Authors
Stannard JP. Riley RS. Sheils TM. McGwin G Jr. Volgas DA.
Institution
Department of Surgery, Division of Orthopaedic Surgery, University of Alabama
at Birmingham, Birmingham, Alabama 35294-3295, USA.
Title
Anatomic reconstruction of the posterior cruciate ligament after multiligament
knee injuries. A combination of the tibial-inlay and two-femoral-tunnel
techniques.
Source
American Journal of Sports Medicine. 31(2):196-202, 2003 Mar-Apr.
Abstract
BACKGROUND: Neither operative nor nonoperative treatment of posterior cruciate
ligament rupture after multiligament knee injuries have shown very favorable
outcomes. HYPOTHESIS: Reconstruction of the posterior cruciate ligament by
combining the tibial-inlay and two-femoral-tunnel techniques will result in
improved stability and functional outcomes. STUDY DESIGN: Prospective cohort
study. METHODS: Twenty-nine patients with 30 posterior cruciate ligament
ruptures and multiligament knee injuries treated with the combined technique
were evaluated with clinical, radiographic, and functional outcome measures.
RESULTS: All patients had a clinical examination result indicating joint
stability (0 or 1+) at an average follow-up of 25 months (range, 15 to 39).
Twenty-three knees had no laxity, and seven had 1+ laxity. The KT-2000
arthrometer data documented less than 0.5 mm of side-to-side mean difference for
both posterior displacement and total anterior-posterior displacement at both 30
degrees and 70 degrees of knee flexion. Knee range of motion was a mean
extension of 1 degrees (range, 0 degrees to 10 degrees ) and a mean flexion of
124 degrees (range, 75 degrees to 145 degrees ). Mean Lysholm knee score was
89.4. CONCLUSIONS: Reconstruction with a combination tibial-inlay and twofemoral-tunnel technique provides good results after multiligament knee
injuries. All patients had a stable posterior cruciate ligament at most recent
clinical follow-up, and 77% had no laxity at all. Copyright 2003 American
Orthopaedic Society for Sports Medicine
<5>
Unique Identifier
12860540
Authors
Gill TJ. DeFrate LE. Wang C. Carey CT. Zayontz S. Zarins B. Li G.
Institution
Orthopedic Biomechanics Laboratory, Massachusetts General Hospital, Boston,
USA.
Title
The biomechanical effect of posterior cruciate ligament reconstruction on knee
joint function. Kinematic response to simulated muscle loads.
Source
American Journal of Sports Medicine. 31(4):530-6, 2003 Jul-Aug.
Abstract
BACKGROUND: The effectiveness of posterior cruciate ligament reconstruction in
restoring normal kinematics under physiologic loading is unknown. HYPOTHESIS:
Posterior cruciate ligament reconstruction does not restore normal knee
kinematics under muscle loading. STUDY DESIGN: In vitro biomechanical study.
METHODS: Kinematics of knees with an intact, resected, and reconstructed
posterior cruciate ligament were measured by a robotic testing system under
simulated muscle loads. Anteroposterior tibial translation and internal-external
tibial rotation were measured at 0 degrees, 30 degrees, 60 degrees, 90 degrees,
and 120 degrees of flexion under posterior drawer loading, quadriceps muscle
loading, and combined quadriceps and hamstring muscle loading. RESULTS:
Reconstruction reduced the additional posterior tibial translation caused by
ligament deficiency at all flexion angles tested under posterior drawer loading.
Ligament deficiency increased external rotation and posterior translation at
angles higher than 60 degrees of flexion when simulated muscle loading was
applied. Posterior cruciate ligament reconstruction reduced the posterior
translation and external rotation observed in posterior cruciate ligamentdeficient knees at higher flexion angles, but differences were not significant.
CONCLUSION: Under physiologic loading conditions, posterior cruciate ligament
reconstruction does not restore six degree of freedom knee kinematics. Clinical
Relevance: Abnormal knee kinematics may lead to development of long-term knee
arthrosis.
<6>
Unique Identifier
12016068
Authors
McAllister DR. Markolf KL. Oakes DA. Young CR. McWilliams J.
Institution
Biomechanics Research Section, Department of Orthopaedic Surgery, University
of California at Los Angeles, Center for Health Sciences, Box 956902, Los
Angeles, CA 90095-6902, USA.
Title
A biomechanical comparison of tibial inlay and tibial tunnel posterior
cruciate ligament reconstruction techniques: graft pretension and knee laxity.
Source
American Journal of Sports Medicine. 30(3):312-7, 2002 May-Jun.
Abstract
BACKGROUND: Most posterior cruciate ligament reconstruction techniques use a
tibial bone tunnel, which results in an acute bend in the graft as it passes
over the posterior portion of the tibial plateau. HYPOTHESIS: The tibial inlay
technique will result in lower graft pretensions, less laxity, and less stretchout after cyclic loading. STUDY DESIGN: Controlled laboratory study. METHODS:
Graft pretensions necessary to restore normal laxity at 90 degrees of knee
flexion (laxity match pretension) and anteroposterior laxities at five knee
flexion angles were recorded in 12 fresh-frozen knee specimens with bonepatellar tendon-bone posterior cruciate ligament graft reconstructions using
both techniques and two femoral tunnel positions. RESULTS: When the graft was
placed in a central femoral tunnel, the tibial tunnel reconstruction required an
average 15.6 N greater laxity match pretension than the tibial inlay
reconstruction. There were no significant differences in mean knee laxities
between the tibial tunnel and tibial inlay techniques at any knee flexion angle;
both reconstruction techniques restored mean knee laxity to within 1.6 mm of
intact knee values over the entire flexion range. CONCLUSIONS: There was no
important advantage of one technique over the other with respect to the
biomechanical parameters measured.
<7>
Unique Identifier
12692672
Authors
Zantop T. Rusch A. Hassenpflug J. Petersen W.
Institution
Department of Orthopaedic Surgery, Christian Albrechts University Kiel,
Michaelisstr 1, 24105 Kiel, Germany.
Title
Intra-articular ganglion cysts of the cruciate ligaments: case report and
review of the literature. [Review] [16 refs]
Source
Archives of Orthopaedic & Trauma Surgery. 123(4):195-8, 2003 May.
Abstract
BACKGROUND: A ganglion can arise as a cystic lesion from a tendon sheath or a
joint capsule and contain a glassy, clear, and jelly-like fluid. They can occur
within muscles, menisci, and tendons. Intra-articular ganglion cysts of the knee
joint are rare. We report on three ganglion cysts of the cruciate ligaments: Two
were intercruciate, and one was located around the posterior cruciate ligament.
METHODS: The clinical diagnosis was established using magnetic resonance
imaging. All patients were treated successfully using arthroscopic debridement
by basket punch and shaver. Subsequent histological examination confirmed the
diagnosis. RESULTS: All three patients were asymptomatic at the postoperative
follow-up of 16-36 months. CONCLUSION: A review of the literature reveals a
controversial discussion about the clinical significance as well as the etiology
of ganglion cysts arising from the cruciate ligaments. These case reports show
that an intra-articular ganglion cyst of the cruciate ligaments is difficult to
diagnose. A cyst does not necessarily have to be associated with specific
clinical symptoms or a previous trauma. Preoperatively, MRI is essential when
diagnosing ganglion cysts of the knee joint. An intra-articular ganglion cyst of
the knee joint can be successfully treated by arthroscopy. [References: 16]
<8>
Unique Identifier
12734718
Authors
Schulz MS. Russe K. Weiler A. Eichhorn HJ. Strobel MJ.
Institution
Orthopaedische Gemeinschaftspraxis Straubing, Hebbelstr 14a, 94315, Straubing,
Germany. strobel@ogp.de
Title
Epidemiology of posterior cruciate ligament injuries.
Source
Archives of Orthopaedic & Trauma Surgery. 123(4):186-91, 2003 May.
Abstract
BACKGROUND: The epidemiology of posterior cruciate ligament (PCL) injuries has
not been well clarified. Isolated and combined PCL injuries are a frequently
missed diagnosis. A better understanding of typical injury mechanisms may help
in more accurate diagnosis of these injuries. METHODS: In this study the
epidemiology of PCL insufficiency in 494 patients was retrospectively analysed.
Stress-radiography was used to quantify posterior tibial displacement. RESULTS:
The mean age at the time of injury was 27.5+/-9.9 years. Traffic accidents (45%)
and athletic injuries (40%) were the most common injury causes. Motorcycle
accidents (28%) and soccer-related injuries (25%) accounted for the main
specific injury causes. The most common injury mechanisms were dashboard
injuries (35%) and falls on the flexed knee with the foot in plantar flexion
(24%). The mean side-to-side difference of posterior tibial displacement on
posterior stress-radiographs in 90 degrees of flexion was 13.4+/-4.7 mm.
According to the posterior displacement values, 232 (47%) patients had isolated
PCL ruptures, while 262 (53%) patients with a posterior displacement of >12 mm
were classified as having a combined posterior instability. There were
significantly more combined PCL lesions due to vehicular trauma as compared with
athletic trauma ( p<0.0001). CONCLUSIONS: In many PCL lesions, initiation of an
adequate treatment regimen is delayed despite typical injury mechanisms and
symptoms. In the future, a better understanding of the epidemiology of PCL
injuries should enable us to diagnose the injury more reliably through a
detailed history and a thorough physical and radiographic examination in the
acute setting.
<9>
Unique Identifier
9685095
Authors
Zuhosky JP. Dugan SA. Young JL. Bode RK. Kelly JP.
Institution
Department of Physical Medicine and Rehabilitation, Northwestern University
Medical School, Chicago, IL, USA.
Title
A retrospective review of the incidence and rehabilitation outcome of
concomitant traumatic brain injury and ligamentous knee injury.
Source
Archives of Physical Medicine & Rehabilitation. 79(7):805-10, 1998 Jul.
Abstract
OBJECTIVES: To estimate the incidence of ligamentous knee injuries in patients
with traumatic brain injury (TBI) involved in pedestrian versus motor vehicle
collisions (PVMVC), to identify associated risk factors, and to compare
rehabilitation outcomes and costs in TBI patients with and without ligamentous
knee injury. DESIGN: Retrospective, case control. SETTING: An academic
rehabilitation hospital with a large metropolitan referral base. PATIENTS:
Twenty-three consecutive adolescent and adult subjects admitted for acute
inpatient rehabilitation after a PVMVC from January 1, 1994, to January 1, 1996.
RESULTS: Five subjects (22%) were found to have a ligamentous knee injury, one
with bilateral injuries. Two of these six injuries were diagnosed only after
presentation to the rehabilitation setting. The most common injury was an
anterior cruciate ligament (ACL) disruption in 5 of 6 knees. A coupled ACL and
medial collateral ligament injury was identified in 4 of 6 injured knees. The
risk of ligamentous knee injury was most closely associated with the presence of
a tibial plateau fracture (n=3) (chi2=12.420, p < .001). There was no
statistical difference between groups with and without ligamentous knee injuries
with respect to age, gender, inpatient acute or rehabilitation length of stay,
admission, discharge, or change in motor Functional Independence Measure (FIM)
interval measures, or rehabilitation costs. Four of the 5 patients with
ligamentous knee injuries were successfully managed nonoperatively. A case
illustrating longitudinal management is presented. CONCLUSIONS: TBI and
ligamentous knee injuries, in particular ACL injuries, are common comorbidities
after PVMVC. Physicians must maintain a high index of suspicion for ligamentous
knee injuries in this population, particularly when a tibial plateau fracture is
present. TBI patients with and without ligamentous knee injuries can have
comparable functional outcomes when the ligament injuries are identified and
appropriately managed, without incurring undue cost or length of inpatient
rehabilitation.
<10>
Unique Identifier
12209426
Authors
Wheatley WB. Martinez AE. Sacks T. Schurhoff MR. Uribe JW. Hechtman KS.
Zvijac JE.
Institution
UHZ Sports Medicine Institute, Coral Gables, Florida 33146, USA.
Title
Arthroscopic posterior cruciate ligament repair.
Source
Arthroscopy. 18(7):695-702, 2002 Sep.
Abstract
PURPOSE: We present our technique of arthroscopic repair for femoral avulsion
soft-tissue tears of the posterior cruciate ligament (PCL) and its results. TYPE
OF STUDY: Case series, retrospective review. METHODS: We performed 13
arthroscopic repairs of the PCL and reviewed them retrospectively. Follow-up was
available for 11 (85%) patients. Nonabsorbable monofilament sutures were placed
through the loose fibers of the ligament and tied over a bone bridge. Patients
were evaluated using magnetic resonance imaging, comparative stress views, and
according to the scoring systems of Lysholm and Gillquist and the International
Knee Documentation Committee (IKDC). RESULTS: Mean follow-up was 51.4 months.
IKDC scores revealed 4 (36.4%) patients with normal knee function, and 7 (63.6%)
with nearly normal function. Average Lysholm and Gillquist score was 95.4 (90 to
100). All athletes returned to the same or a higher level of competition.
CONCLUSIONS: Arthroscopic repair of the PCL in patients with a femoral avulsion
is effective in reducing postoperative instability and improving functional
outcome.
<11>
Unique Identifier
12209420
Authors
Shafer BL. Simonian PT.
Institution
Department of Orthopaedics and Sports Medicine, University of Washington,
Seattle, Washington 98195-6500, USA. bshafer@u.washington.edu
Title
Broken poly-L-lactic acid interference screw after ligament reconstruction.
Source
Arthroscopy. 18(7):E35, 2002 Sep.
Abstract
The interference screw is a reliable method used to secure tendon to bone and
bone to bone in ligament reconstruction. Historically, metal interference screws
have been used for this purpose in both anterior cruciate ligament (ACL) and
posterior cruciate ligament (PCL) reconstruction. However, several problems
associated with the use of metal interference screws have led to the increasing
use of bioabsorbable implants. Poly-L-lactic acid (PLLA) biodegradable
interference screws have been used successfully for graft fixation in ligament
reconstruction. Although adverse reactions have been reported with the use of
biodegradable implants, late screw breakage is rare. To our knowledge no case
exists of late screw breakage with bioabsorbable interference screws used in
ligament reconstruction. We present one case in the setting of an ACL
reconstruction and one with combined PCL and posterolateral corner
reconstruction.
<12>
Unique Identifier
12098121
Authors
Chen CH. Chen WJ. Shih CH.
Institution
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan,
Taiwan. afachen@doctor.com
Title
Arthroscopic reconstruction of the posterior cruciate ligament: a comparison
of quadriceps tendon autograft and quadruple hamstring tendon graft.
Source
Arthroscopy. 18(6):603-12, 2002 Jul-Aug.
Abstract
PURPOSE: Considerable controversies remain on the graft choice and fixation
methods in the posterior cruciate ligament (PCL) reconstruction. The purpose of
this study was to compare, at minimal 2-year follow-up, the outcomes of PCL
reconstruction between using quadriceps tendon autograft and using quadruple
hamstring tendon autograft. TYPE OF STUDY: Case series. METHODS: All patients
received only PCL reconstruction without combined severe associated
posterolateral instability. From 1996 to 1998, there were 24 patients who had a
quadriceps tendon autograft, and 30 patients with hamstring tendon autograft.
Twenty-two of the quadriceps tendon group and 27 of the hamstring tendon
autograft group with 2 more years of complete follow-up were included for final
analyses. Clinical assessments consisted of Lysholm knee scores, International
Knee Documentation Committee (IKDC) scores, thigh muscle girth and strength, and
radiographic evaluation. RESULTS: On the Lysholm knee rating, 86% of patients
showed good or excellent results in the quadriceps tendon group and so did 89%
of patients in the hamstring tendon group. Fifty-nine percent of the quadriceps
tendon group and 56% of the hamstring tendon group revealed a 3- to 5-mm
ligament laxity. Two patients with quadriceps tendon grafts and 4 patients with
hamstring tendon grafts revealed grade II laxity. The IKDC rating showed no
significant difference between the 2 groups in terms of activity level, ligament
laxity, and final rating. In the thigh girth side-to-side difference, 82% of the
quadriceps tendon group and 78% of the hamstring tendon group had less than a
10-mm difference. CONCLUSIONS: Comparable satisfactory results between the 2
surgical groups were shown at a minimal 2 years follow-up. We suggested that
both grafts could afford good ligament reconstruction likelihood and that they
are reasonably acceptable graft choices for PCL reconstruction.
<13>
Unique Identifier
12966378
Authors
Huang TW. Wang CJ. Weng LH. Chan YS.
Institution
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Kaohsiung,
Taiwan.
Title
Reducing the "killer turn" in posterior cruciate ligament reconstruction.
Source
Arthroscopy. 19(7):712-6, 2003 Sep.
Abstract
PURPOSE: Graft abrasion caused by sharp graft angulation at the graft-tunnel
margin of the proximal tibia (the "killer turn") may cause graft failure after
posterior cruciate ligament (PCL) reconstruction using the traditional
anteromedial route tibial tunnel. One method to reduce the graft angulation is
to use the anterolateral route tibial tunnel. However, less acute graft
angulation may increase joint translation because of a decrease in graft
compressive force. The purpose of this study was to compare the graft angulation
and joint translation between anteromedial and anterolateral route tibial
tunnels. TYPE OF STUDY: Biomechanical study. METHODS: Twelve above-the-knee
amputation specimens were used in this study. Anteromedial and anterolateral
tibial tunnels were made at the desired locations, and the same femoral tunnel
was used. Graft angulation was measured by inserting a malleable pin into the
tibial and femoral tunnels. Measurements of graft angulation were performed with
the knee in extension and in 90 degrees of flexion. The joint translation was
measured by the posterior translation of the tibia on the femur at 90 degrees of
flexion with a 15-lb posterior force applied to the anterior proximal tibia
after PCL reconstruction through the respective tunnels. RESULTS: The difference
in graft angulation between anterolateral and anteromedial route tibial tunnels
was statistically significant (P <.001); however, the difference in joint
translation showed no statistical significance between the 2 tunnel routes.
CONCLUSIONS: The anterolateral route tibial tunnel significantly reduced the
sharp graft angulation ("killer turn") at the graft tunnel margin of the
proximal tibia, but it did not increase the joint translation as compared with
the traditional anteromedial route tibial tunnel. The anterolateral route tibial
tunnel is thought to be a better choice when arthroscopic PCL reconstruction is
performed with the tunnel technique.
<14>
Unique Identifier
10524821
Authors
Mariani PP. Adriani E. Bellelli A. Maresca G.
Institution
Orthopaedic Clinic, University of Rome La Sapienza, Italy. ppm.las@iol.it
Title
Magnetic resonance imaging of tunnel placement in posterior cruciate ligament
reconstruction.
Source
Arthroscopy. 15(7):733-40, 1999 Oct.
Abstract
The aim of this study was to define a reproducible method for evaluating
posterior cruciate ligament (PCL) reconstructions using magnetic resonance
imaging (MRI). A 2-fold investigation was performed. In part I, the "footprints"
of an intact PCL were located on MRI and their coordinates were defined.
Measurements were made on the images of 50 subjects using axial, coronal, and
sagittal planes. Interobserver variability was calculated by averaging the
measurements of the 2 reviewers and using the Kappa coefficient. Three points of
reference were located: tibial attachment on the tibial axial plane, and two
femoral attachments on the sagittal and coronal oblique planes. In part II,
stability of 20 PCL reconstructions with a bone-patellar tendon-bone (BPTB)
autograft were evaluated and scored using the IKDC evaluation form after a 2year follow-up. Stability was evaluated clinically and instrumentally using a
KT-2000 arthrometer at 89 N with the knee flexed at a neutral quadriceps knee
angle of approximately 70 degrees . Seven cases were graded A (0 to 2 mm), 11
graded B (3 to 5 mm), and 2 graded C (6 to 10 mm). All patients had an MRI after
an average of 16 months (range, 12 to 24 months, 2 SD). The previous
measurements from part I of the study were used to make a correlation between
achieved stability and tunnel location. A 1-factor analysis of variance (ANOVA),
nonparametric ANOVA, and the Fisher Exact test were used to determine if
clinical outcome of the 3 groups was influenced by graft placement. At MRI
evaluation, excessive deep placement was observed in 4 cases and a correlation
between improper femoral tunnel location and stability was statistically
significant (P < .05). A correct placement of tibial tunnel was observed in all
patients. In our analysis, proper location of the femoral tunnel seems to be
more critical and difficult to achieve than tibial tunnel placement, probably
because of the lack of specific anatomic landmarks during surgery.
<15>
Unique Identifier
11774140
Authors
Mariani PP. Margheritini F. Camillieri G. Bellelli A.
Institution
Rome University of Motor Sciences, Department of Diagnostic Radiology, San
Pietro Hospital FBF, Rome, Italy. ppm.las@iol.it
Title
Serial magnetic resonance imaging evaluation of the patellar tendon after
posterior cruciate ligament reconstruction.
Source
Arthroscopy. 18(1):38-45, 2002 Jan.
Abstract
PURPOSE: Our purpose was to prospectively analyze serial changes in magnetic
resonance imaging (MRI) signal of the bone-patellar tendon-bone autograft when
used for posterior cruciate ligament (PCL) reconstruction and to retrospectively
determine at mid-term follow-up the relationship between MRI graft appearance
and clinical stability in patients who have undergone arthroscopic PCL
reconstruction with a bone-patellar tendon-bone autograft. TYPE OF STUDY: One
prospective serial blinded study and 1 retrospective blinded study. METHODS: The
first part of the study focused on MRI scans obtained at 3, 6, 9, and 12 months
postoperatively in a case series of 10 consecutive patients who underwent
arthroscopically assisted PCL reconstruction (group A), and of 10 patients who
underwent combined ACL-PCL arthroscopic reconstruction (group B). For the second
part of the study, MRI scans were obtained in a retrospective series of 10
patients at mid-term follow-up after PCL arthroscopic reconstruction (group C).
Signal intensity of 3 zones, corresponding to the proximal, middle, and distal
intra-articular graft zones, was evaluated according to the Howell et al.
classification. Fiber continuity assessment was performed using a modified Kuhne
et al. score. The signal intensity of the 3 zones was independently scored. Knee
stability was clinically and instrumentally graded according to the IKDC
evaluation form (group 4). A multivariance analysis and grouped t test were used
for statistical evaluation. RESULTS: In group A, the average MRI evaluation
score was 7.65 +/- 1.6 at 3 months, 3.8 +/- 0.6 at 6 months, 4.75 +/- 1 at 9
months and 6.25 +/- 1.2 at 1 year. The portion of graft exiting the femoral
tunnel exhibited increased signal and faster maturation than the tibial tunnel.
In group B (combined ACL-PCL reconstruction), the graft showed slower graft
healing with an average MRI score of 4.85 +/- 0.7 at 3 months, 1.9 +/- 0.7 at 6
months, 3.9 +/- 0.9 at 9 months, and 5.3 +/- 1.1 at 1 year. At 1 year follow-up,
there was no correlation between MRI appearance and stability in group A, even
with MRI findings of fiber continuity. However, at long-term evaluation (group
C), a strict correlation between MRI appearance and achieved stability was
found. CONCLUSIONS: The patellar tendon when used for PCL reconstruction
requires more than 1 year to achieve a low-signal intensity over its entire
course, and the distal zone near the tibial tunnel shows a slower healing
process. MRI graft assessment is useful only 1 year or more following PCL
reconstruction.
<16>
Unique Identifier
11536101
Authors
Kim SJ. Shin SJ. Cho SK. Kim HK.
Institution
Department of Orthopaedic Surgery, Arthroscopic Surgery Unit, Yonsei
University College of Medicine, Seoul, Korea. os@yumc.yonsei.ac.kr
Title
Arthroscopic suture fixation for bony avulsion of the posterior cruciate
ligament.
Source
Arthroscopy. 17(7):776-80, 2001 Sep.
Abstract
We describe a new arthroscopic technique for suture fixation of a posterior
cruciate ligament (PCL) avulsion fracture from the tibia. This technique is
indicated when the size of the avulsed fragment is small and fixation with a
screw or pins is inadequate. Three portals are used: a parapatellar anteromedial
portal, a high posteromedial portal, and a posterolateral portal. Using a PCL
tibial guide, 2 bone tunnels are made from the anterior cortex of the tibia to
the medial and lateral border of the avulsed site. One or 2 strands of 23-gauge
wire or multiple nonabsorbable sutures are used for fixation through the
tunnels. If the bony fragment is small or comminuted, fixation with wires or
sutures leads to rigid fixation and early rehabilitation.
<17>
Unique Identifier
11536088
Authors
Mariani PP. Margheritini F. Camillieri G.
Institution
Rome University of Motor Sciences, Rome, Italy. ppm.las@iol.it
Title
One-stage arthroscopically assisted anterior and posterior cruciate ligament
reconstruction.
Source
Arthroscopy. 17(7):700-7, 2001 Sep.
Abstract
PURPOSE: To retrospectively evaluate 15 consecutive patients who underwent
simultaneous isolated, arthroscopically assisted anterior cruciate ligament
(ACL) and posterior cruciate ligament (PCL) reconstruction. Type of Study: Case
series. METHODS: A bone-patellar tendon-bone autograft was used as the PCL
substitute and doubled hamstring tendons were used as the ACL graft. The IKDC
evaluation form and the HSS, Lysholm, and Tegner clinical rating scales were
used to make clinical evaluations. Anteroposterior translation was measured with
the KT-2000 arthrometer and stress view radiography. RESULTS: At final IKDC
evaluation, 3 patients (20%) were graded A, 7 (46.7%) were graded B, 3 (20%)
were graded C, and 1 patient (6.7%) was graded D. One patient underwent revision
surgery in another hospital for severe postoperative residual laxity. Two Cgraded patients had an unsatisfactory outcome as a result of serious
complications related to knee injuries. All patients with a grade A or B
returned to sports activity. At stress view examination, mean posterior side-toside translation measured at the lateral tibial plateau was 5.8 +/- 1.1 mm and
the mean translation at the medial tibial plateau was 7.3 +/- 1.5 mm; the mean
anterior dislocation was 3.3 +/- 0.4 mm. The preoperative HSS score rated an
average of 32 +/- 9. Postoperatively, the average score reached was 89.6 +/8.3. The preoperative Lysholm score was 65.5 +/- 9.1 (range, 48 to 78) in
patients with chronic lesions and at follow-up was 95.1 +/- 4.5 (range, 88 to
100). The average Tegner activity score decreased in patients with chronic
lesions from 6.9 +/- 1.7 (range, 4 to 9) before injury to 5.5 +/- 1.6 (range, 2
to 9) at follow-up (P =.053 ). At follow-up, 7 patients (50%) returned to their
preinjury level after surgery. CONCLUSIONS: These results show the effectiveness
and safety of simultaneous arthroscopic reconstruction of both cruciate
ligaments using autografts that can adequately restore satisfactory stability,
even in the presence of minimal peripheral laxity (1 degrees or 2 degrees ). We
conclude that the use of autografts can restore ligament function with good
patient compliance and without significant surgical complications.
<18>
Unique Identifier
10976124
Authors
Makris CA. Georgoulis AD. Papageorgiou CD. Moebius UG. Soucacos PN.
Institution
Department of Orthopaedic Surgery, University of Ioannina Medical School,
Ioannina, Greece. grakos@otenet.gr
Title
Posterior cruciate ligament architecture: evaluation under microsurgical
dissection.
Source
Arthroscopy. 16(6):627-32, 2000 Sep.
Abstract
PURPOSE: Our objective was to verify the fiber anatomy of the posterior
cruciate ligament (PCL) and to measure the main dimensions and the femoral and
tibial attachment site distances of the ligament after microsurgical dissection.
We hypothesized that PCL anatomy is more complex than the 2 traditionally
characterized bands. TYPE OF STUDY: This is a purely anatomic description of
microdissections of the PCL, focused on the fine anatomy of the ligament.
MATERIALS AND METHODS: Twenty-four fresh-frozen cadaveric knees were dissected
using magnifying loupes and an operative microscope, being careful to avoid
creating artificially separated bundles. The main dimensions of the PCL were
measured using a micrometer. RESULTS: The anterior, central, posteriorlongitudinal, and posterior-oblique were the 4 fiber regions identified based on
their orientation and the osseous sites of their insertions. These were
partially separable anatomically but were functionally distinct. The anterior
and central fiber regions made up the bulk of the ligament, while the remaining
15% consisted of the posterior fiber regions. During manual joint motion, the
behavior of these fiber regions was observed. The anterior fiber region appeared
to be the most nonisometric and remained in tension mainly between 30 degrees
and 90 degrees of flexion. The posterior fiber regions appeared to be the most
isometric (especially the posterior-oblique) and remained in tension mainly in
extension and partially in deep flexion. The central fiber region appeared to
have an intermediate behavior and remained in tension mainly between 30 degrees
and 120 degrees of flexion. Additionally, it appeared to be the widest of all
fiber regions. CONCLUSIONS: These findings should be of interest and help in
interpreting some of the anatomy encountered during arthroscopic examination of
the PCL, both from the anterior and posterior lateral portals. Furthermore, this
information should prove useful in selecting treatment for the PCL.
<19>
Unique Identifier
10976129
Authors
Espejo-Baena A. Lopez-Arevalo R. Urbano V. Montanez E. Martin F.
Institution
Department of Orthopaedic Surgery, University Hospital of Malaga, Malaga,
Andalucia, Spain.
Title
Arthroscopic repair of the posterior cruciate ligament: two techniques.
Source
Arthroscopy. 16(6):656-60, 2000 Sep.
Abstract
SUMMARY: Isolated posterior cruciate ligament injuries are rare and their
treatment is controversial. These lesions have commonly been treated by open
reduction and internal fixation using a posterior approach. However, this
approach makes it difficult to explore other combined injuries of the knee
joint. We report 2 cases of posterior cruciate ligament avulsion of the tibia
that were arthroscopically reduced and fixed using 2 different methods,
cannulated screws and tension band wire.
<20>
Unique Identifier
11078536
Authors
Brand J Jr. Hamilton D. Selby J. Pienkowski D. Caborn DN. Johnson DL.
Institution
Alexandria Orthopaedics and Sports Medicine, Alexandria, Minnesota, USA.
Title
Biomechanical comparison of quadriceps tendon fixation with patellar tendon
bone plug interference fixation in cruciate ligament reconstruction.
Source
Arthroscopy. 16(8):805-12, 2000 Nov.
Abstract
PURPOSE: The purpose of this study was to use current fixation techniques and
compare the stiffness and ultimate tensile failure of the tendinous end of the
quadriceps tendon (QT) with the bone plug end of the bone-patellar tendon-bone
(BPTB) graft using current techniques of fixation. Type of Study: Randomized
trial of elderly cadaver knees. Materials and Methods: Tibial and femoral
biodegradable interference fixation and femoral EndoButton (Smith & Nephew,
Acufex, Mansfield, MA) fixation in bone tunnels with the QT and the BPTB graft
were compared by using 10 pairs of elderly cadavers and biomechanical testing.
Two groups, fixation at time zero (simulating fixation in the operating room)
and testing after 1, 000 loading cycles (simulating patient rehabilitation
exercises), were used. RESULTS: At time zero fixation, stiffness of the soft
tissue QT tibial tunnel interference fixation was 59% less stiff than the
stiffness of the interference fixation of a BPTB plug in a femoral tunnel (P
=.11). The EndoButton femoral fixation resulted in a decrease in stiffness at
time zero compared with femoral tunnel interference fixation of the soft tissue
QT (P =.03). All groups improved stiffness with cycling the construct to 1,000
cycles. CONCLUSIONS: Placement of the QT tendinous end of the graft in the
femoral bone tunnel when using a interference fixation will approximate the
stiffness of a bone plug in the tibial bone tunnel with interference fixation.
The EndoButton fixation is not as stiff as either of the femoral interference
fixation options. The addition of more than 20 loading cycles could remove
laxity from the graft fixation-graft cruciate ligament complex and improve its
stiffness.
<21>
Unique Identifier
11078535
Authors
Matava MJ. Sethi NS. Totty WG.
Institution
Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri,
USA. matavam@msnotes.wustl.edu
Title
Proximity of the posterior cruciate ligament insertion to the popliteal artery
as a function of the knee flexion angle: implications for posterior cruciate
ligament reconstruction.
Source
Arthroscopy. 16(8):796-804, 2000 Nov.
Abstract
PURPOSE: The purpose of this study was to determine if an optimal knee flexion
angle existed that would minimize the risk of neurovascular injury from the
passage of transtibial hardware during posterior cruciate ligament (PCL)
reconstruction. Type of Study: Cadaveric. Materials and Methods: Fourteen freshfrozen cadaveric knees were mounted in a Plexiglas apparatus that could be set
at 5 different knee flexion angles (0 degrees, 45 degrees, 60 degrees, 90
degrees, and 100 degrees ) while joint distention was maintained. Each knee
underwent magnetic resonance imaging in the axial and sagittal planes at each of
the 5 flexion angles to determine the distance between the PCL tibial insertion
and popliteal artery. RESULTS: The mean distance, over all 5 flexion angles,
between the PCL insertion and the popliteal artery in the axial plane was 7.6
mm, whereas the mean distance in the sagittal plane was 7.2 mm. There was a
significant increase in distance with progressive flexion in both planes.
Maximum mean distances were noted at 100 degrees of flexion in both the axial
(9.9 mm) and sagittal (9.3 mm) planes. An artificial line mimicking the path of
a transtibial drill passed through the popliteal artery in 10 of 10 cases at the
0 degrees, 45 degrees, 60 degrees, and 90 degrees angles, and in 6 of 10 cases
at the 100 degrees angle. CONCLUSIONS: The results of this study suggest that
increasing knee flexion reduces, but does not completely eliminate, the risk of
arterial injury during arthroscopic PCL reconstruction.
<22>
Unique Identifier
12209425
Authors
Brand JC Jr. Cole J. Sumida K. Caborn DN. Johnson DL.
Institution
Alexandria Orthopaedics and Sports Medicine, Alexandria, Minnesota, USA.
Title
Radiographic analysis of femoral tunnel position in postoperative posterior
cruciate ligament reconstruction.
Source
Arthroscopy. 18(7):688-94, 2002 Sep.
Abstract
PURPOSE: The purpose of this study was to test the hypothesis that plain
radiographs are accurate in assessing femoral tunnel positions in posterior
cruciate ligament (PCL) reconstruction. TYPE OF STUDY: Cadaveric study. METHODS:
Femoral tunnels were drilled in cadaveric distal femurs using standard
techniques at the 12 o'clock, 1:30, and 3 o'clock positions in the left femora
and at the 12 o'clock, 10:30, and 9 o'clock positions in the right femora. At
each of the three positions, a 9-mm tunnel was drilled with its anterior edge 2
mm posterior to the articular surface of the medial femoral condyle (MFC).
Posterior or "malpositioned" tunnels were drilled with the anterior edge 11 mm
posterior to the articular surface of the MFC. Four radiographs; a true lateral,
a 10 degrees externally rotated lateral, a 10 degrees internally rotated film in
the sagittal plane, and an anteroposterior (AP) radiograph were then taken of
each tunnel with a radiopaque dilator in the tunnel. All radiographs were
analyzed with the 4-quadrant method (4 is the posterior quadrant) and the ratio
method (0 is anterior and 1 is posterior). The AP radiograph was measured using
a new technique, the intersection of the angle of a line through the center of
the femoral tunnel and a line placed tangential to the femoral condyles.
RESULTS: Means were calculated for each of the 6 tunnel positions on the 4
radiographs (lateral, external rotation, internal rotation, and AP). Of the 15
comparisons among tunnel postions, 13 could be discriminated using the lateral
and AP radiographs. The high-anterior (HA) (12 o'clock position) could not be
differentiated on any radiograph from the high-posterior (HP) (12 o'clock
position). The internally rotated lateral radiograph could discriminate the
midanterior (MA) (1:30 and 10:30 positions) from the low-anterior (LA) (the 3
and 9 o'clock positions). CONCLUSIONS: Three radiographs; the AP, lateral, and
internally rotated lateral, can be used to detect a significant difference in
the majority of tunnel locations. The tunnel positions that could not be
differentiated with these measurements were posterior and may not be clinically
important. We concluded that a plain radiograph is an accurate indicator of PCL
tunnel position.
<23>
Unique Identifier
12861215
Authors
Oakes DA. McAllister DR.
Institution
University of California, Los Angeles, Department of Orthopaedic Surgery, Los
Angeles, California 90095-6902, USA.
Title
Failure of heat shrinkage for treatment of a posterior cruciate ligament tear.
Source
Arthroscopy. 19(6):E1-4, 2003 Jul-Aug.
Abstract
Incomplete tears or traumatic elongations of either the native cruciate
ligaments or cruciate ligament reconstructions represent a therapeutic dilemma
for orthopaedic surgeons. We report a case of a partially torn posterior
cruciate ligament that was treated unsuccessfully with an electrothermal
shrinkage procedure. Although the use of thermal energy to selectively shrink
tissues may ultimately prove to be an invaluable tool, the lack of welldesigned, randomized controlled studies to firmly establish its efficacy in the
treatment of partial cruciate injuries mandates cautious use of this technique
at this time.
<24>
Unique Identifier
12861201
Authors
Stannard JP. Sheils TM.
Institution
McGwin G.
Volgas DA.
Alonso JE.
Department of Orthopaedic Surgery, University of Alabama at Birmingham,
Birmingham, Alabama 35294-3295, USA. James.Stannard@ortho.uab.edu
Title
Use of a hinged external knee fixator after surgery for knee dislocation.
Source
Arthroscopy. 19(6):626-31, 2003 Jul-Aug.
Abstract
PURPOSE: This study documents short-term clinical outcomes in patients with
knee dislocations after blunt trauma and evaluates the compass knee hinge (CKH)
external fixator for their treatment. TYPE OF STUDY: Nonrandomized prospective
functional outcome study. METHODS: Forty patients with 43 knee dislocations were
evaluated. Twelve knees underwent ligament reconstruction followed by placement
of a CKH; this was group A. Group B included 27 knees that underwent the same
treatment and rehabilitation protocol except that an external brace was used
rather than a CKH. RESULTS: Thirty-six patients with 39 knee dislocations
underwent follow-up ranging from 14 to 41 months (mean, 24). Four patients with
4 knee dislocations were lost to follow-up (1 group A, 3 group B). Group A
underwent 27 knee ligament procedures with 2 (7%) failures based on clinical
examination. Group B underwent 102 ligament procedures with 30 (29%) failures (P
<.05). Anterior cruciate ligament (ACL) reconstruction revealed that 7 group A
patients experienced 1 (14%) failure and 25 Group B patients experienced 7 (28%)
failures. Posterior cruciate ligament (PCL) reconstruction in 7 group A patients
included no failures, and 20 PCL reconstructions in group B included 1 failure.
Reconstruction of the posterolateral corner (PLC) yielded no failures in 2 group
A patients and 5 (25%) of 20 in group B. Repair of 8 PLCs in group A yielded 1
(12.5%) failure and 26 PLC repairs in group B had 14 (54%; P =.05). SF-36 data
revealed low mean values with no significant differences between groups with
current enrollment. CONCLUSIONS: Knee dislocation after blunt trauma requires
aggressive surgical treatment and physical therapy. In the short-term
evaluation, the CKH allows aggressive physical therapy without placing repaired
or reconstructed ligaments under high stresses that can result in failure.
<25>
Unique Identifier
14608330
Authors
Lee MC. Park YK. Lee SH. Jo H. Seong SC.
Institution
Department of Orthopaedic Surgery, Seoul National University College of
Medicine, Seoul, South Korea. leemc@snu.ac.kr
Title
Posterolateral reconstruction using split Achilles tendon allograft.
Source
Arthroscopy. 19(9):1043-9, 2003 Nov.
Abstract
Injury to the cruciate ligaments of the knee commonly occurs in association
with posterolateral instability, which can cause severe functional disability
including varus, posterior translation, and external rotational instability.
Failure to diagnose and treat an injury of the posterolateral corner in a
patient who has a tear of the cruciate ligament can also result in the failure
of the reconstructed cruciate ligament. Unlike isolated posterior cruciate
ligament injury, there seems to be a consensus of opinion that injury to the
posterolateral corner, whether isolated or combined, is best treated by
reconstructing the posterolateral corner along with the coexisting cruciate
ligament injury, if combined. Commonly proposed methods of reconstructing the
posterolateral corner have focused on the reconstruction of the popliteus, the
popliteofibular ligament, and the lateral collateral ligament. We introduce a
new technique for reconstructing the posterolateral corner using a split
Achilles tendon allograft. Our method reasonably addresses the several pitfalls
in the reconstruction of the posterolateral corner, including (1) concurrent
reconstruction of important posterolateral structures, (2) regaining the
isometry of the lateral collateral ligament, (3) repositioning the reconstructed
popliteus into its original position, and (4) providing a secure fixation
method.
<26>
Unique Identifier
14608326
Authors
Chen CH. Chen WJ. Shih CH.
Institution
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Kweishan,
Taoyuan, Taiwan. afachen@doctor.com
Title
Double-bundle posterior cruciate ligament reconstruction with quadriceps and
semitendinosus tendon grafts.
Source
Arthroscopy. 19(9):1023-6, 2003 Nov.
Abstract
This study presents a novel arthroscopic technique for double-bundle
reconstruction of the posterior cruciate ligament. A quadriceps tendon-patellar
bone autograft is used to reconstruct the major anterolateral bundle. An
additional double-stranded semitendinosus tendon is used to reconstruct the
posteromedial bundle. In 70 degrees of flexion and full extension with anterior
drawer force, the quadriceps tendon graft and semitendinosus tendon graft are
fixed inside the anterior aspect of the single tibial tunnel, respectively. An
anatomic reconstruction can be achieved by using these 2 autografts.
<27>
Unique Identifier
14608314
Authors
Deehan DJ. Salmon LJ. Russell VJ. Pinczewski LA.
Institution
Freeman Hospital, Newcastle upon Tyne, UK England.
Title
Endoscopic single-bundle posterior cruciate ligament reconstruction: results
at minimum 2-year follow-up.
Source
Arthroscopy. 19(9):955-62, 2003 Nov.
Abstract
PURPOSE: The goal of this study was to evaluate the clinical outcome of
single-bundle posterior cruciate ligament (PCL) reconstruction with retention of
the PCL remnant and hamstring tendon autograft with interference screw fixation
in patients with isolated PCL laxity. TYPE OF STUDY: Prospective case series
with minimum 2-year follow-up evaluation. METHODS: Thirty-one patients for whom
conservative management had failed underwent surgery using a 4-strand hamstring
tendon autograft with interference screw fixation. The median time from injury
to reconstructive surgery was 9 months (range, 4 to 120 months). At a minimum of
2 years after surgery, patients were assessed with the International Knee
Documentation Committee (IKDC) Knee Ligament evaluation, Lysholm knee score, and
KT-1000 instrumented testing. RESULTS: Before surgery, the median Lysholm knee
score was 64 (95% confidence interval, 51 to 67). No patient rated knee function
as normal, and all patients showed at least grade 2 posterior drawer laxity. At
review, the median Lysholm knee score was 94 (95% confidence interval, 83 to
94), 56% rated the knee as normal and only one patient was found to exhibit
grade 2 laxity on posterior drawer testing. Before injury, 94% of patients
participated in moderate or strenuous activity. This figure fell to 26% after
injury and had increased to 63% at review. CONCLUSIONS: Endoscopic
reconstruction of PCL laxity using single-bundle 4-strand hamstring tendon
autograft, without removal of the PCL stump, provides a significant reduction in
knee symptoms and allows 63% of patients to return to moderate or strenuous
activity. This is an effective procedure for symptomatic patients who have
isolated PCL laxity and for whom conservative management has failed.
<28>
Unique Identifier
14551544
Authors
Ohkoshi Y. Nagasaki S. Yamamoto K. Shibata N. Ishida R. Hashimoto T.
Yamane S.
Institution
Department of Orthopaedic Surgery, Hakodate Central General Hospital,
Hakodate, Japan. ohkoshi.myk@nifty.com
Title
Description of a new endoscopic posterior cruciate ligament reconstruction and
comparison with a 2-incision technique.
Source
Arthroscopy. 19(8):825-32, 2003 Oct.
Abstract
PURPOSE: We introduce our technique (a new route for the graft) of endoscopic
posterior cruciate ligament (PCL) reconstruction and describe the advantages in
comparison with the conventional surgical technique. TYPE OF STUDY:
Nonrandomized control study. METHODS: The idea of this surgical technique is to
minimize graft angulation at the inner edge of the bone tunnel. The tibial entry
point of the guide pin is under the tibial lateral subcondylar flare,
approximately 1 to 2 cm anterior to the posterior cortex. This creates less
graft angulation on the posterior aspect of the tibia. A new drill system has
been devised to allow antegrade femoral drilling starting from inside the notch.
This method also allows better femoral tunnel orientation. As a substitute graft
material, we use autogenous hamstring tendons, and we secure them with an
EndoButton (Smith & Nephew, Andover, MA) and post screw. From 1992 to 1995, 43
2-incision PCL reconstructions using autogenous hamstring tendons were
performed. From 1995 to 2001, 90 endoscopic PCL reconstructions using looped
autogenous hamstring tendons and an EndoButton were performed. Cases were
specified according to the inclusion criteria of this study. As a result, 51
patients were included in this study. The 2-incision group comprised 22
patients, and the endoscopic group comprised 29 patients. The clinical
evaluation was performed using the International Knee Documentation Committee
(IKDC) form. The quadriceps strength was measured using Biodex System II
(Biodex, New York, NY). The period of time to achieve 90 degrees flexion after
surgery was also compared. RESULTS: No significant differences were seen between
the 2 groups tested with respect to the overall IKDC rating score. Side-to-side
differences of anteroposterior total laxity (KT-1000, manual maximum) was 3.95
+/- 1.96 mm in the 2-incision group and 2.38 +/- 1.42 mm in the endoscopic group
(P <.05). The average time to achieving 90 degrees of flexion after surgery was
16.6 +/- 8.6 days in the 2-incision group and 12.1 +/- 3.5 days in the
endoscopic group. Achievement of range of motion in the endoscopic group was
significantly shorter. The peak torque of isokinetic contraction in the
endoscopic group was significantly greater than in the 2-incision group 1 year
after surgery. CONCLUSIONS: Better posterior stability and quicker postoperative
recovery of range of motion and muscle strength were advantages of the
endoscopic technique over the 2-incision technique in PCL reconstruction.
<29>
Unique Identifier
9442333
Authors
Choi NH. Kim SJ.
Institution
Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Korea.
Title
Arthroscopic reduction and fixation of bony avulsion of the posterior cruciate
ligament of the tibia.
Source
Arthroscopy. 13(6):759-62, 1997 Dec.
Abstract
Bony avulsion fractures of the posterior cruciate ligament of the tibia have
commonly been treated by open reduction and internal fixation using the
posterior approach. However, this approach, using the prone position, makes it
difficult to investigate and treat other combined injuries of the knee joint. We
report a case of posterior cruciate ligament avulsion of the tibia that was
arthroscopically reduced and firmly fixed with two cannulated screws. The
posterior sag was absent after the operation and the result was excellent. By
arthroscopy, we got rigid fixation of the avulsed fragment for early
rehabilitation, and detection of a concomitant injury was also possible.
<30>
Unique Identifier
12966390
Authors
McGuire DA. Wolchok JC.
Institution
Clinical Faculty, Orthopedics and Sports Medicine, University of Washington,
Seattle, Washington, USA.
Title
Posterolateral corner reconstruction.
Source
Arthroscopy. 19(7):790-3, 2003 Sep.
Abstract
One should suspect a compromise of the lateral structures when presented with
a posterior cruciate ligament (PCL) injury, especially if grade III laxity is
present. In our experience, if a combined injury to the PCL and posterolateral
corner is diagnosed, a combined PCL and posterolateral reconstruction is needed
to restore stability. This article describes a posterolateral reconstruction
procedure. This procedure, when used in combination with an intra-articular PCL
reconstruction, restores rotary and posterior knee stability. This procedure
uses allograft tissue and interference screw fixation, although autograft tissue
may be used.
<31>
Unique Identifier
14551557
Authors
Noyes FR. Medvecky MJ. Bhargava M.
Institution
Cincinnati Sportsmedicine Research and Education Foundation, Cincinnati, Ohio,
USA. sbwestin@csmref.org
Title
Arthroscopically assisted quadriceps double-bundle tibial inlay posterior
cruciate ligament reconstruction: An analysis of techniques and a safe operative
approach to the popliteal fossa.
Source
Arthroscopy. 19(8):894-905, 2003 Oct.
Abstract
The arthroscopically assisted posterior cruciate ligament tibial inlay
technique, frequently used in athletic individuals and in revision cases,
requires a thorough and comprehensive understanding of posterior knee anatomy.
Importantly, variations in the posterior vascular anatomy may be encountered. A
safe and methodical posteromedial approach in a layered fashion to achieve
proper and safe tibial inlay graft placement and fixation is described. The
authors advocate use of a double-bundle quadriceps tendon autograft. Graft
position of the double strands, fixation, and tensioning issues are presented.
<32>
Unique Identifier
10564868
Authors
Hara K. Kubo T. Shimizu C. Suginoshita T. Minami G. Hirasawa Y.
Institution
Department of Orthopaedic Surgery, Kyoto Interdisciplinary Institute Hospital
of Community Medicine, Kyoto, Japan.
Title
A new arthroscopic method for reconstructing the anterior and posterior
cruciate ligaments using a single-incision technique: simultaneous grafting of
the autogenous semitendinosus and patellar tendons.
Source
Arthroscopy. 15(8):871-6, 1999 Nov-Dec.
Abstract
We established a simultaneous reconstruction method for ruptured anterior and
posterior cruciate ligaments (ACL, PCL) using a single-incision technique.
Residual PCL was used to determine the position of bone tunnel for ACL
reconstruction. The bone tunnel position on the tibia for PCL reconstruction was
arthroscopically confirmed by conducting through debridement from the
posteromedial portal. Reconstruction substitutes were patellar-tendon bonetendon-bone for ACL, and semitendinosus tendon for PCL. In the fixation
procedure, the PCL substitute was fixed using the Endobutton (Smith & Nephew,
Andover, MA) and a ceramic button, and the ACL substitute was fixed with an
interference screw. During the surgery, radiographic monitoring and the PCL
guide system were not required.
<33>
Unique Identifier
14551559
Authors
Veselko M. Saciri V.
Institution
Department of Traumatology, University Medical Center, Ljubljana, Slovenia.
matjaz.veselko@mf.uni-lj.si
Title
Posterior approach for arthroscopic reduction and antegrade fixation of
avulsion fracture of the posterior cruciate ligament from the tibia with
cannulated screw and washer.
Source
Arthroscopy. 19(8):916-21, 2003 Oct.
Abstract
Avulsion fracture of the posterior cruciate ligament (PCL) is a rare
condition, and arthroscopically assisted reattachment of the surgical fixation
of the fragment is not always an easy task. Only a few reports describe
techniques for arthroscopic fixation of avulsion of the PCL.We report on a case
treated arthroscopically with reduction and antegrade fixation of an avulsion
fracture of the tibial attachment of the PCL with a cannulated screw and washer
through an additional posterolateral portal. Postoperative morbidity was
reduced, and rehabilitation was accelerated. Fixation with a cannulated screw
and washer is technically simple and allows for stable fixation and immediate
postoperative mobilization and pain-limited weight-bearing, even in cases of a
comminuted fragment. The safe zone for an additional posterolateral portal and
the technique for placing instruments and a guidewire to avoid neurovascular
structures is defined.
<34>
Unique Identifier
12209427
Authors
Fanelli GC. Edson CJ.
Institution
Department of Orthopaedic Surgery, Geisinger Medical Center, Danville,
Pennsylvania 17822, USA. gfanelli@geisinger.edu
Title
Arthroscopically assisted combined anterior and posterior cruciate ligament
reconstruction in the multiple ligament injured knee: 2- to 10-year follow-up.
Source
Arthroscopy. 18(7):703-14, 2002 Sep.
Abstract
PURPOSE: This study presents the 2- to 10-year results of 35 arthroscopically
assisted combined anterior cruciate ligament and posterior cruciate ligament
(ACL/PCL) reconstructions evaluated preoperative and postoperatively using
Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales,
KT-1000 arthrometer testing, stress radiography, and physical examination. TYPE
OF STUDY: Case series. METHODS: This study population included 26 men and 9
women with 19 acute and 16 chronic knee injuries. Ligament injuries included 19
ACL/PCL/posterolateral instabilities, 9 ACL/PCL/medial cruciate ligament (MCL)
instabilities, 6 ACL/PCL/posterolateral/MCL instabilities, and 1 ACL/PCL
instability. All knees had grade III preoperative ACL/PCL laxity and were
assessed preoperatively and postoperatively with arthrometer testing, 3
different knee ligament rating scales, stress radiography, and physical
examination. Arthroscopically assisted combined ACL/PCL reconstructions were
performed using the single-incision endoscopic ACL technique and the single
femoral tunnel-single bundle transtibial tunnel PCL technique. PCLs were
reconstructed with allograft Achilles tendon (in 26 cases), autograft bonepatellar tendon-bone (BPTB) (in 7 cases), and autograft semitendinosus/gracilis
(in 2 cases). ACLs were reconstructed with autograft BPTB (16 cases), allograft
BPTB (12 cases), Achilles tendon allograft (6 cases), and autograft
semitendinosus/gracilis (1 case). MCL injuries were treated with bracing or open
reconstruction. Posterolateral instability was treated with biceps femoris
tendon transfer, with or without primary repair, and posterolateral capsular
shift procedures as indicated. RESULTS: Postoperative physical examination
revealed normal posterior drawer/tibial step-off in 16 of 35 (46%) knees. Normal
Lackman and pivot-shift test results were found in 33 of 35 (94%) knees.
Posterolateral stability was restored to normal in 6 of 25 (24%) knees, and
tighter than normal knee results were found in 19 of 25 (76%) knees evaluated
with the external rotation thigh foot angle test. In this group, 30 degrees
varus stress testing was normal in 22 of 25 (88%) knees, and grade 1 laxity was
found in 3 of 25 (12%) knees. 30 degrees valgus stress testing was normal in 7
of 7 (100%) surgically treated MCL tears, and in 7 of 8 (87.5%) brace-treated
knees. Postoperative KT-1000 arthrometer testing mean side-to-side difference
measurements were 2.7 mm (PCL screen), 2.6 mm (corrected posterior), and 1.0 mm
(corrected anterior) measurements, a statistically significant improvement from
preoperative status (P =.001). Postoperative stress radiographic side-to-side
difference measurements measured at 90 degrees of knee flexion and 32 lb
posteriorly directed proximal force were 0 to 3 mm in 11 of 21 (52.3%) knees, 4
to 5 mm in 5 of 21 (23.8%), and 6 to 10 mm in 4 of 21 (19%) knees. Postoperative
Lysholm, Tegner, and HSS knee ligament rating scale mean values were 91.2, 5.3,
and 86.8, respectively, showing a statistically significant improvement from
preoperative status (P =.001). CONCLUSIONS: Combined ACL/PCL instabilities can
be successfully treated with arthroscopic reconstruction and the appropriate
collateral ligament surgery. Statistically significant improvement is noted from
the preoperative condition at 2- to 10-year follow-up using objective parameters
of knee ligament rating scales, arthrometer testing, stress radiography, and
physical examination. Postoperatively, these knees are not normal, but they are
functionally stable. Continuing technical improvements will probably improve
future results.
<35>
Unique Identifier
10656979
Authors
Toutoungi DE. Lu TW. Leardini A. Catani F. O'Connor JJ.
Institution
Cambridge Consultants Ltd., Science Park, Milton Rd, Cambridge, UK.
Title
Cruciate ligament forces in the human knee during rehabilitation exercises.
Source
Clinical Biomechanics. 15(3):176-87, 2000 Mar.
Abstract
OBJECTIVE: To determine the cruciate ligament forces occurring during typical
rehabilitation exercises.Design. A combination of non-invasive measurements with
mathematical modelling of the lower limb.Background. Direct measurement of
ligament forces has not yet been successful in vivo in humans. A promising
alternative is to calculate the forces mathematically. METHODS: Sixteen subjects
performed isometric and isokinetic or squat exercises while the external forces
and limb kinematics were measured. Internal forces were calculated using a
geometrical model of the lower limb and the "dynamically determinate one-sided
constraint" analysis procedure. RESULTS: During isokinetic/isometric extension,
peak anterior cruciate ligament forces, occurring at knee angles of 35-40
degrees, may reach 0.55x body-weight. Peak posterior cruciate ligament forces
are lower and occur around 90 degrees. During isokinetic/isometric flexion, peak
posterior cruciate forces, which occur around 90 degrees, may exceed 4x bodyweight; the anterior cruciate is not loaded. During squats, the anterior
cruciate is lightly loaded at knee angles up to 50 degrees, after which the
posterior cruciate is loaded. Peak posterior cruciate forces occur near the
lowest point of the squat and may reach 3.5x body-weight. CONCLUSIONS: For
anterior cruciate injuries, squats should be safer than isokinetic or isometric
extension for quadriceps strengthening, though isokinetic or isometric flexion
may safely be used for hamstrings strengthening. For posterior cruciate
injuries, isokinetic extension at knee angles less than 70 degrees should be
safe but isokinetic flexion and deep squats should be avoided until healing is
well-advanced. RELEVANCE: Good rehabilitation is vital for a successful outcome
to cruciate ligament injuries. Knowledge of ligament forces can aid the
physician in the design of improved rehabilitation protocols.
<36>
Unique Identifier
11240057
Authors
Durselen L. Hehl G. Simnacher M. Kinzl L. Claes L.
Institution
Institute of Orthopaedic Research and Biomechanics University of Ulm -Medical Faculty, Helmholtzstr. 14, 89081 Ulm, Germany.
lutz.duerselen@medizin.uni-ulm.de
Title
Augmentation of a ruptured posterior cruciate ligament provides normal knee
joint stability during ligament healing.
Source
Clinical Biomechanics. 16(3):222-8, 2001 Mar.
Abstract
OBJECTIVE: To identify an augmentation technique which would provide
mechanical protection for the healing posterior cruciate ligament. DESIGN: Six
human knee specimens were tested in vitro for posterior knee joint stability
after augmenting the cut posterior cruciate ligament by six different techniques
using a resorbable double strand Polydioxanone augmentation device. BACKGROUND:
A fresh isolated rupture of the posterior cruciate ligament is often treated
conservatively. Results have shown that it can heal, but ligament elongations
occur frequently. Therefore a method is needed to provide posterior knee joint
stability during ligament healing. METHODS: The effect of different femoral
augmentation insertions on posterior knee stability was tested by recording the
antero-posterior (AP) position of the tibia and the augmentation force. Testing
was performed during flexion--extension cycles and under posterior shear loads.
RESULTS: The insertion combination that proved to stabilize the joints best
consisted of one augmentation strand leading along the antero-lateral posterior
cruciate ligament fibres and inserting at the distal end of the Blumensaat line
and one strand leading along the posteriormedial fibres and inserting in the
middle of the Blumensaat line. AP translations similar to those occurring in
healthy knee joints could be achieved. CONCLUSIONS: It is possible to restore
normal posterior knee joint stability by implanting a double strand augmentation
device. This can help a posterior cruciate ligament to heal under non-elongated
conditions.
<37>
Unique Identifier
10512342
Authors
MacLean CL. Taunton JE. Clement DB. Regan WD. Stanish WD.
Institution
School of Human Kinetics, University of British Columbia, Vancouver, Canada.
Title
Eccentric kinetic chain exercise as a conservative means of functionally
rehabilitating chronic isolated insufficiency of the posterior cruciate
ligament.
Source
Clinical Journal of Sport Medicine. 9(3):142-50, 1999 Jul.
Abstract
OBJECTIVE: To determine the efficacy of a home eccentric kinetic chain
exercise program in improving isokinetic strength, knee function, and
symtomatology in athletes with isolated posterior cruciate ligament (PCL)
injury. DESIGN: Experimental design. SETTING: Allan McGavin Sports Medicine
Centre, University of British Columbia, Vancouver, British Columbia, Canada.
PARTICIPANTS: The study included 13 athletes with isolated PCL injury (n = 13)
and 13 healthy sedentary subjects (n = 13). All participants were men and
between 18 and 35 years of age. The group with isolated PCL injury all had been
diagnosed at the Allan McGavin Sports Medicine Centre, all had been treated
without surgery, and had been injured at least 6 months ago. Diagnosis was based
on presentation of a positive posterior sag and posterior drawer. INTERVENTION:
The group with isolated PCL injury (treatment group) underwent 12 weeks of
eccentric kinetic chain exercise. The control group of healthy sedentary
individuals did not undergo any form of rigorous training during the course of
this study. Both groups were tested for isokinetic strength, knee function, and
symptomatology at weeks 0, 6, and 12. Compliance was insured through frequent
phone contact and progressive journal records of completion of daily exercise.
Only those who completely executed the 12-week exercise program were included in
the study. MAIN OUTCOME MEASURES: Hamstring and quadriceps isokinetic torque
(Nm) at constant velocities of 60 and 120 degrees per second (degrees/s), Tegner
Hop Test (meters), and Lysholm Knee Scale scores. RESULTS: A subject-versustreatment data analysis clearly indicated significant increases in eccentric and
concentric torque over the 12-week period in the treatment group. Tegner Hop
Test and Lysholm Knee Scale scores also increased significantly after the
eccentric squat exercise program. Quadriceps eccentric/concentric ratios at both
testing velocities increased significantly after 12 weeks of rehabilitation.
There were no significant differences in strength between extremities in the
treatment group at any time during the course of this study. Before
rehabilitation, there were no significant differences between eccentric and
concentric torque values in either muscle group (quadriceps and hamstrings) of
the treatment group. After the eccentric exercise program, the quadriceps in the
injured extremity did exhibit significantly greater eccentric than concentric
torque. The treatment group was significantly weaker than the control group in
eccentric torque at both testing velocities at week 0. After the 12-week
exercise program, however, there were no significant differences between groups
in eccentric quadriceps strength. CONCLUSION: The results of this investigation
support the eccentric squat program as a viable means of functionally
rehabilitating chronic PCL insufficiency.
<38>
Unique Identifier
10078139
Authors
Kim SJ. Kim HK. Kim HJ.
Institution
Department of Orthopaedic Surgery, Yonsei University College of Medicine,
Seoul, Korea.
Title
Arthroscopic posterior cruciate ligament reconstruction using a one-incision
technique.
Source
Clinical Orthopaedics & Related Research. (359):156-66, 1999 Feb.
Abstract
Thirty-seven patients with a posterior cruciate ligament injury underwent
arthroscopic posterior cruciate ligament reconstruction using a one-incision
technique with bone-patellar tendon-bone autograft or allograft. The tibial
tunnel was started at the distal end of the graft donor site on the proximal
tibia and exited posteriorly at the flat spot 15 mm below the articular margin
and just lateral to the midline. The femoral tunnel was made through the lateral
anterolateral portal. The 25 mm long proximal bone plug was passed easily
through the tibial tunnel using a specially designed suture pusher and guided
into the femoral tunnel by pulling the leading suture with the knee flexed 30
degrees. Firm proximal and distal fixations were achieved with interference
screws. At a minimum 2 year followup (range, 24-68 months), average knee
ligament evaluation scores were 91.1 (range, 67-99) in the Lysholm knee scoring
scale and 89.3 (range, 67-99) in the Hospital for Special Surgery knee ligament
rating form. The average side to side difference of the posterior translation
measured by the KT 2000 arthrometer was 6.08 (range, 5-7 mm) mm preoperatively
and 2.2 (range, 0-6 mm) mm postoperatively. There were no significant
differences between the acute and the chronic cases. The results of the isolated
posterior cruciate ligament injury group were better than the combined
ligamentous injury group. The one-incision technique minimizes injury to the
extensor mechanism, especially the vastus medialis obliquus muscle, and medial
scar. Rigid fixation of the long proximal bone plug allows early rehabilitation.
<39>
Unique Identifier
10918965
Authors
Irrgang JJ. Fitzgerald GK.
Institution
Department of Physical Therapy, University of Pittsburgh School of Health,
Pennsylvania, USA. jirrgang@pitt.edu
Title
Rehabilitation of the multiple-ligament-injured knee. [Review] [40 refs]
Source
Clinics in Sports Medicine. 19(3):545-71, 2000 Jul.
Abstract
Rehabilitation for a patient with a multiple-ligament knee injury should be
designed to reduce pain and swelling, restore range of motion, strength, and
endurance, and to enhance proprioception, and dynamic stability of the knee,
with the goals of restoring function and minimizing disability. The biomechanics
of the knee must be considered when designing a rehabilitation program. General
guidelines for rehabilitation of the multiple-ligament-injured knee include
considerations for promoting tissue healing, decreasing pain and swelling,
restoring full motion, increasing muscular strength and endurance, improving
proprioception, enhancing dynamic stability of the knee, and reducing functional
limitations and disability. A patient's progression through this sequence must
be individualized and depends on the pattern of ligament injury or surgical
procedure that was performed, and the principles of tissue healing. Specific
guidelines for rehabilitation following ACL reconstruction combined with MCL
repair, PCL reconstruction, combined ACL-PCL reconstruction, and reconstruction
of the LCL and posterolateral corner have been provided. [References: 40]
<40>
Unique Identifier
10028122
Authors
St Pierre P. Miller MD.
Institution
Department of Surgery, Madigan Army Medical Center, Tacoma, Washington, USA.
Title
Posterior cruciate ligament injuries. [Review] [62 refs]
Source
Clinics in Sports Medicine. 18(1):199-221, vii, 1999 Jan.
Abstract
Treatment of posterior cruciate ligament (PCL) injuries has received renewed
attention over the past few years. This article reviews the anatomy, natural
history, and pathophysiology of posterior cruciate ligament injuries. Also
described are the physical examination and proper imaging modalities used to
diagnose the injury. Appropriate operative and nonoperative management methods
are discussed. [References: 62]
<41>
Unique Identifier
14519354
Authors
Wang CJ. Chen HS. Huang TW.
Institution
Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Kaohsiung,
Kaohsiung, Taiwan. w281211@adm.cgmh.org.tw
Title
Outcome of arthroscopic single bundle reconstruction for complete posterior
cruciate ligament tear.
Source
Injury. 34(10):747-51, 2003 Oct.
Abstract
PURPOSE: To evaluate the clinical outcome and correlate the results and
degenerative change of the affected knees with the duration of injury, ligament
laxity and follow-up time in 30 patients with 31 knees undergoing arthroscopic
single bundle reconstruction for complete posterior cruciate ligament (PCL) tear
with 2-9-year follow-up. MATERIALS AND METHODS: This series included 22 men and
8 women with an average age of 32 years. High-energy trauma accounts for 93.5%
of PCL injury, while only 6.5% are sports related. Arthroscopic single bundle
PCL reconstruction was performed in all knees. The average follow-up time was 40
(range: 24-108) months. The methods of evaluation included functional
assessment, ligament laxity and radiograph of the knee. RESULTS: The overall
clinical results showed 77.4% satisfactory (61.3% excellent and 16.1% good) and
22.6% unsatisfactory (16.1% fair and 6.5% poor). Complete restoration of
ligament stability was noted in 52% of the knees with one third showing mild (05 mm) and 9.7% moderate (5-10 mm) ligament laxity. The incidence of radiographic
degenerative changes was 52% (16/31), and it correlated with the duration of
injury, severity of ligament laxity and length of follow-up time. CONCLUSION:
Arthroscopic single bundle reconstruction produced 77.4% satisfactory clinical
results in medium term follow-up. Despite good clinical results, complete
restoration of ligament stability was achieved in only 52% of the knees. The
incidence of degenerative changes of the affected knees was 52% that correlated
with the duration of injury, ligament laxity and follow-up time.
<42>
Unique Identifier
12379393
Authors
Wang CJ. Chen HS. Huang TW. Yuan LJ.
Institution
Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Kaohsiung,
123 Ta-Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan. w281211@adm.cgmh.org.tw
Title
Outcome of surgical reconstruction for posterior cruciate and posterolateral
instabilities of the knee.
Source
Injury. 33(9):815-21, 2002 Nov.
Abstract
PURPOSE: To evaluate the clinical outcome and the incidence of degenerative
changes in 25 patients with 25 knees undergoing surgical reconstruction for
combined posterior cruciate ligament (PCL) and posterolateral instabilities of
the knee with 2-5-year follow-up. MATERIALS AND METHODS: This series included 16
men and 9 women with an average age of 28 years. The average time from injury to
surgery was 10 (range 2-24) months, and the average follow-up time was 40 (range
32-60) months. The mechanisms of injury were 88% due to trauma, and 12% sports
related. Arthroscopic single bundle posterior cruciate reconstruction and
reconstruction of the posterolateral structures were performed in all cases.
Clinical evaluations included functional assessment, ligament laxity and
radiograph of the knee. The results were correlated with the duration of injury,
the severity of ligament laxity and the follow-up time. RESULTS: The overall
results were 68% satisfactory (28% excellent and 40% good) and 32%
unsatisfactory (20% fair and 12% poor). Despite functional improvement, complete
restoration of ligament stability was observed in only 44% of the knees, while
36% of the knees showed mild (<5 mm), and 20% moderate (5-10 mm) ligament
laxity. There was no correlation of the clinical outcome with the duration from
injury to surgery. The incidence of degenerative changes of the affected knee
was 44%, and the rate correlated with the severity of ligament laxity, the
duration from injury to surgery and the length of follow-up time. CONCLUSION:
Despite the functional improvement, the currently devised surgical techniques
only have modest success in restoration of ligament stability in knees with
combined PCL and posterolateral instabilities. Further improvement in surgical
technique including a dynamic reconstruction of the popliteus tendon complex
seems necessary. The rate of degenerative changes of the affected knee appeared
proportional to the duration of injury, the severity of ligament laxity and the
length of follow-up time. The results of this study led us to recommend early
surgical reconstruction for knees with combined posterior cruciate and
posterolateral instabilities.
<43>
Unique Identifier
11940609
Authors
Markolf KL. Zemanovic JR. McAllister DR.
Institution
Department of Orthopaedic Surgery, University of California at Los Angeles
90095-6902, USA. kmarkolf@mednet.ucla.edu
Title
Cyclic loading of posterior cruciate ligament replacements fixed with tibial
tunnel and tibial inlay methods.
Source
Journal of Bone & Joint Surgery - American Volume. 84-A(4):518-24, 2002 Apr.
Abstract
BACKGROUND: The optimal method of replacement of the posterior cruciate
ligament with a bone-patellar tendon-bone graft is not known. The purpose of
this study was to compare the mechanical responses to cyclic loading tests of
bone-patellar tendon-bone allograft replacements fixed to the tibia with one of
two methods: a tibial tunnel or a tibial inlay technique. METHODS: The proximal
ends of sixty-two posterior cruciate graft replacements, thirty-one fixed with
the tibial tunnel technique and thirty-one fixed with the tibial inlay technique
in cadaver knees, were subjected to 2000 cycles of tensile force of 50 to 300 N
with the angle of pull at 45 to the tibial plateau. The central 10 mm of the
medial and lateral halves of previously fresh-frozen bone-patellar tendon-bone
preparations from cadaver knees were used as the grafts. Two pairs of tibiae
were used for testing; the two types of fixation and the medial and lateral
halves of the patellar tendons were distributed between the tibial pairs. Graft
thickness was measured at the point of highest anticipated tissue deformation
and at two additional locations at distances from these points. The total change
in graft length after cyclic loading at an applied force level of 200 N was
recorded. Elongation of the graft during loading cycles between 20 and 200 N of
applied tensile force was also measured. A repeated-measures analysis of
variance was used to compare all measurements between the inlay and tunnel
techniques, and between the medial and lateral halves of the graft used for the
inlay method. RESULTS: Ten of the thirty-one grafts that had been passed through
a tibial tunnel failed at the acute angle before 2000 cycles of testing could be
completed; all thirty-one grafts that had been fixed to the tibia with use of
the inlay method survived the testing intact. Evaluation of the twenty-one graft
pairs that survived testing after both fixation techniques revealed that the
grafts that had been fixed with the inlay method had significantly less thinning
at all three measurement sites at the completion of testing; the mean reduction
of thickness was 40.6% (at the acute angle) in the grafts fixed with the tunnel
method and 12.5% (adjacent to the bone block) in those fixed with the inlay
method. After 2000 cycles, the mean lengths of the grafts fixed with the inlay
and tunnel methods increased 5.9 and 9.8 mm, respectively; 38% of this increase
occurred during the first six loading cycles. After both methods of fixation,
the mean graft elongation during a loading cycle decreased approximately 50%
from cycle 1 to cycle 2000, resulting in an effectively stiffer graft construct.
There was no significant difference in any measured parameter between medial and
lateral graft halves. CONCLUSIONS: These tests showed that the inlay technique
of posterior cruciate ligament replacement was superior to the tunnel technique
with respect to graft failure, graft thinning, and permanent increase in graft
length.
<44>
Unique Identifier
12954836
Authors
Markolf KL. O'Neill G. Jackson SR. McAllister DR.
Institution
Department of Orthopaedic Surgery, University of California at Los Angeles,
David Geffen School of Medicine, USA. kmarkolf@mednet.ucla.edu
Title
Reconstruction of knees with combined cruciate deficiencies: a biomechanical
study.
Source
Journal of Bone & Joint Surgery - American Volume. 85-A(9):1768-74, 2003 Sep.
Abstract
BACKGROUND: Clinical results of dual cruciate-ligament reconstructions are
often poor, with a failure to restore normal anterior-posterior laxity. This
could be the result of improper graft tensioning at the time of surgery and
stretch-out of one or both grafts from excessive tissue forces. The purpose of
this study was to measure anterior-posterior laxities and graft forces in knees
before and after reconstructions of both cruciate ligaments performed with a
specific graft-tensioning protocol. METHODS: Eleven fresh-frozen cadaveric knee
specimens underwent anterior-posterior laxity testing and installation of load
cells to record forces in the native cruciate ligaments as the knees were
passively extended from 120 degrees to -5 degrees with no applied tibial force,
with 100 N of applied anterior and posterior tibial force, and with 5 N-m of
applied internal and external tibial torque. Both cruciate ligaments were
reconstructed with a bone-patellar tendon-bone allograft. Only isolated cruciate
deficiencies were studied. We determined the nominal levels of anterior and
posterior cruciate graft tension that restored anterior-posterior laxities to
within 2 mm of those of the intact knee and restored anterior cruciate graft
forces to within 20 N of those of the native anterior cruciate ligament during
passive knee extension. Both grafts were tensioned at 30 degrees of knee
flexion, with the posterior cruciate ligament tensioned first. Measurements of
anterior-posterior knee laxity and graft forces were repeated with both grafts
at their nominal tension levels and with one graft fixed at its nominal tension
level and the opposing graft tensioned to 40 N above its nominal level. RESULTS:
The anterior and posterior cruciate graft tensions were found to be
interrelated; applying tension to one graft changed the tension of the other
(fixed) graft and displaced the tibia relative to the femur. The posterior
cruciate graft had to be tensioned first to consistently achieve the nominal
combination of mean graft forces at 30 degrees of flexion. At these levels, mean
forces in the anterior cruciate graft were restored to those of the intact
anterior cruciate ligament under nearly all test conditions. However, the mean
posterior cruciate graft forces were significantly higher than the intact
posterior cruciate ligament forces at full extension under all test conditions.
Anterior-posterior laxity was restored between 0 degrees and 90 degrees of
flexion with both grafts at their nominal force levels. Overtensioning of the
anterior cruciate graft by 40 N significantly increased its mean force levels
during passive knee extension between 110 degrees and -5 degrees of flexion, but
it did not significantly change anterior-posterior laxity between 0 degrees and
90 degrees of flexion. In contrast, overtensioning of the posterior cruciate
graft by 40 N significantly increased posterior cruciate graft forces during
passive knee extension at flexion angles of <5 degrees and >95 degrees and
significantly decreased anterior-posterior laxities at all flexion angles except
full extension. CONCLUSIONS: It was not possible to find levels of graft tension
that restored anterior-posterior laxities at all flexion positions and restored
forces in both grafts to those of their native cruciate counterparts during
passive motion. Our graft-tensioning protocol represented a compromise between
these competing objectives. This protocol aimed to restore anterior-posterior
laxities and anterior cruciate graft forces to normal levels. The major
shortcoming of this tensioning protocol was the dramatically higher posterior
cruciate graft forces produced near full extension under all test conditions.
<45>
Unique Identifier
12783997
Authors
Simmons R. Howell SM. Hull ML.
Institution
Department of Mechanical Engineering, Bainer Hall, 1 Shields Avenue,
University of California at Davis, Davis, CA 95616, USA.
Title
Effect of the angle of the femoral and tibial tunnels in the coronal plane and
incremental excision of the posterior cruciate ligament on tension of an
anterior cruciate ligament graft: an in vitro study.
Source
Journal of Bone & Joint Surgery - American Volume. 85-A(6):1018-29, 2003 Jun.
Abstract
BACKGROUND: High tension in an anterior cruciate ligament graft adversely
affects both the graft and the knee; however, it is unknown why high graft
tension in flexion occurs in association with a posterior femoral tunnel. The
purpose of the present study was to determine the effect of the angle of the
femoral and tibial tunnels in the coronal plane and incremental excision of the
posterior cruciate ligament on the tension of an anterior cruciate ligament
graft during passive flexion. METHODS: Eight cadaveric knees were tested. The
angle of the tibial tunnel was varied to 60 degrees, 70 degrees, and 80 degrees
in the coronal plane with use of three interchangeable, low-friction bushings.
The femoral tunnel, with a 1-mm-thick posterior wall, was drilled through the
tibial tunnel bushing with use of the transtibial technique. After the graft had
been tested in all three tibial bushings with one femoral tunnel, the femoral
tunnel was filled with bone cement and the tunnel combinations were tested.
Lastly, the graft was replaced in the 80 degrees femoral and tibial tunnels, and
the tests were repeated with excision of the lateral edge of the posterior
cruciate ligament in 2-mm increments. Graft tension, the flexion angle, and
anteroposterior laxity were recorded in a six-degrees-of-freedom loadapplication system that passively moved the knee from 0 degrees to 120 degrees
of flexion. RESULTS: The graft tension at 120 degrees of flexion was affected by
the angle of the femoral tunnel and by incremental excision of the posterior
cruciate ligament. The highest graft tension at 120 degrees of flexion was 169
+/- 9 N, which was detected with the graft in the 80 degrees femoral and 80
degrees tibial tunnels. The lowest graft tension at 120 degrees of flexion was
76 +/- 8 N, which was detected with the graft in the 60 degrees femoral and 60
degrees tibial tunnels. The graft tension of 76 N at 120 degrees of flexion with
the graft in the 60 degrees femoral and 60 degrees tibial tunnels was closer to
the tension in the intact anterior cruciate ligament. Excision of the lateral
edge of the posterior cruciate ligament in 2 and 4-mm increments significantly
lowered the graft tension at 120 degrees of flexion without changing the
anteroposterior position of the tibia. CONCLUSIONS: Placing the femoral tunnel
at 60 degrees in the coronal plane lowers graft tension in flexion. Our results
suggest that high graft tension in flexion is caused by impingement of the graft
against the posterior cruciate ligament, which results from placing the femoral
tunnel medially at the apex of the notch in the coronal plane.
<46>
Unique Identifier
12063327
Authors
Oakes DA. Markolf KL. McWilliams J. Young CR. McAllister DR.
Institution
Biomechanics Research Section, Department of Orthopaedic Surgery, University
of California Los Angeles, 90095-6902, USA.
Title
Biomechanical comparison of tibial inlay and tibial tunnel techniques for
reconstruction of the posterior cruciate ligament. Analysis of graft forces.
Source
Journal of Bone & Joint Surgery - American Volume. 84-A(6):938-44, 2002 Jun.
Abstract
BACKGROUND: The tibial inlay technique of reconstruction of the posterior
cruciate ligament offers potential advantages over the conventional transtibial
tunnel technique, particularly with regard to the graft force levels that
develop over a functional range of knee flexion. Abnormally high graft forces
generated during rehabilitation activities could lead to stretch-out of the
graft during the critical early healing period. The purpose of this study was to
compare graft forces between these two techniques and with forces in the native
posterior cruciate ligament. METHODS: A load cell was installed at the femoral
origin of the posterior cruciate ligament in twelve fresh-frozen cadaveric knees
to measure resultant forces in the ligament during a series of knee loading
tests. The posterior cruciate ligament was then excised, and the femoral ends of
10-mm-wide bone-patellar tendon-bone grafts were attached to the load cell to
measure resultant forces in the grafts. For the tunnel reconstruction, the
distal bone block of the graft was placed into a tibial tunnel and thin
stainless-steel cables interwoven into the bone block were gripped in a split
clamp attached to the anterior tibial cortex. With the inlay technique, the
distal bone block was fixed in a tibial trough with use of a cortical bone screw
with a washer and nut. The proximal ends of all grafts were pretensioned to a
level of force that restored intact knee laxity at 90 degrees of flexion, and
loading tests were repeated. RESULTS: There were no significant differences in
mean graft forces between the two techniques under tibial loads consisting of
100 N of posterior tibial force, 5 N-m of varus and valgus moment, and 5 N-m of
internal and external tibial torque. Mean graft forces with the tibial tunnel
technique were approximately 10 to 20 N higher than those with the inlay
technique with passive knee flexion beyond 95 degrees. Mean graft forces with
both reconstruction techniques were significantly higher than forces in the
native posterior cruciate ligament with the knee flexed beyond approximately 90
degrees for all but one mode of loading. CONCLUSIONS: In this cadaveric testing
model, neither technique for reconstruction of the posterior cruciate ligament
had a substantial advantage over the other with respect to generation of graft
forces.
<47>
Unique Identifier
12634532
Authors
Yang CK. Wu CD. Chih CJ. Wei KY. Su CC. Tsuang YH.
Institution
Department of Orthopedic Surgery, Taiwan Provincial Tao-Yuan General Hospital,
Taoyuan City, Republic of China.
Title
Surgical treatment of avulsion fracture of the posterior cruciate ligament and
postoperative management.
Source
Journal of Trauma-Injury Infection & Critical Care. 54(3):516-9, 2003 Mar.
Abstract
BACKGROUND: Avulsion fractures of the posterior cruciate ligament have long
been regarded as rare injuries. In the past, it was common practice to use cast
immobilization as an external adjunct after open reduction and internal fixation
of fractures. METHODS: Sixteen patients with displaced avulsion fractures of the
posterior cruciate ligament were treated with open reduction and internal
fixation between August 1989 and July 1993. Malleolar screws were chosen as
fixation devices in 14 patients. In the other two, pull-through sutures were
used because the size of the fractured fragments was too small to obtain
purchase of screws. The postoperative management protocol evolved from an
initial regimen of 6 weeks' immobilization in a cast with the knee flexed to 40
degrees for the first five patients (group I), to 4 weeks' immobilization in a
cast for the next six patients (group II), to the present protocol of immediate
postoperative range of motion (40-70 degrees) with muscle-strengthening
exercises in a functional brace for the last five patients (group III). The
average follow-up period was 36 months (range, 24-58 months). Hughston's
criteria were used to assess the clinical results. RESULTS: Overall, there were
12 (75%) good and 4 fair (25%) results. There was no poor result. CONCLUSION:
Avulsion fractures of the posterior cruciate ligament should be treated with
open reduction and stable internal fixation if any displacement is seen on
initial radiographs at presentation. With the use of functional brace and
aggressive postoperative rehabilitation program (i.e., immediate range of motion
of 40-70 degrees with muscle-strengthening exercises), satisfactory results can
be expected and achieved.
<48>
Unique Identifier
11988663
Authors
Chen CH. Chen WJ. Shih CH.
Institution
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Kweishan,
Taoyuan, Taiwan. afachen@doctor.com
Title
Arthroscopic reconstruction of the posterior cruciate ligament with quadruple
hamstring tendon graft: a double fixation method.
Source
Journal of Trauma-Injury Infection & Critical Care. 52(5):938-45, 2002 May.
Abstract
BACKGROUND: Surgical reconstruction is indicated for posterior cruciate
ligament (PCL) reconstruction for a grade III or IV injury, combined ligament or
meniscus injuries, and chronic symptomatic posterior instability. Considerable
controversy continues over the choice of graft tissues. Hamstring tendon has
been popular in recent years. The purpose of this study is to prospectively
assess the outcomes of PCL reconstruction using quadruple hamstring tendon
autograft with a double-fixation technique at minimal 2-year follow-up. METHODS:
Only patients who received PCL reconstruction without combined associated
posterolateral injury reconstruction were included in the series. A hamstring
tendon graft is composed of a quadruple-stranded semitendinosus tendon and
gracilis tendon 10 cm in length. An arthroscopic technique using a two-incision
method and a double-fixation technique were used. Clinical assessments were
performed for 30 patients, of which 27 were available for final outcome
analysis. Clinical review of patients included the Lysholm knee scores,
International Knee Documentation Committee (IKDC) scores, thigh muscle
assessment, and radiographic evaluation. RESULTS: On the Lysholm knee rating,
89% of the patients demonstrated good or excellent results in the final
assessment. In the IKDC rating analyses, 56% of the patients revealed 3- to 5-mm
ligament laxity. Four patients (15%) had grade II laxity. For the IKDC final
rating, 26% were normal and 55% were nearly normal. Seventy-eight percent of the
patients had less than a 10-mm difference in thigh girth between their
reconstructed and opposite limbs. CONCLUSION: Arthroscopic PCL reconstruction
with quadruple hamstring tendon autograft appears to produce acceptable results
at a minimal 2-year follow-up. The four-stranded hamstring tendon graft is
adequate in graft size and associated with minimal harvesting morbidity. The
double-fixation method for the graft could provide a rigid fixation. We believe
that this technique could afford good ligament function after reconstruction and
could be a reasonably acceptable choice for PCL injury.
<49>
Unique Identifier
10217236
Authors
Yeh WL. Tu YK. Su JY. Hsu RW.
Institution
Division of Trauma & Emergency Surgery, Chang Gung Memorial Hospital, Taipei,
Taiwan, ROC.
Title
Knee dislocation: treatment of high-velocity knee dislocation.
Source
Journal of Trauma-Injury Infection & Critical Care. 46(4):693-701, 1999 Apr.
Abstract
BACKGROUND: We report the outcomes of patients treated with a new arthroscopic
treatment modality for knee dislocation after high-velocity trauma. METHODS:
Twenty-three patients (12 men, 11 women; 25 knees) with traumatic knee
dislocation were treated with this technique. Under arthroscopy with gravity
inflow irrigation, the ruptured posterior cruciate ligament was reconstructed
with a patellar bone-tendon-bone graft, and the anterior cruciate ligament was
debrided subacutely. The collateral ligament, meniscus, and capsules were
repaired through additional incisions. RESULTS: The average interval between
injury and surgery was 11.1+/-5 days (range, 5 to 25 days). After a mean followup period of 27.2+/-7.86 months, the mean extension was 1+/-2 degrees and the
average flexion was 129.6+/-4.91 degrees. The mean Lysholm score was 84. There
were no major complications. CONCLUSION: Arthroscopic posterior cruciate
ligament reconstruction seems to be an effective treatment for traumatic knee
dislocation.
<50>
Unique Identifier
12355300
Authors
Nyland J. Hester P. Caborn DN.
Institution
Division of Sports Medicine, Department of Orthopedic Surgery, University of
Louisville, 550 S. Jackson Street, Louisville, KY 40202, USA.
john.nyland@louisville.edu
Title
Double-bundle posterior cruciate ligament reconstruction with allograft
tissue: 2-year postoperative outcomes.
Source
Knee Surgery, Sports Traumatology, Arthroscopy. 10(5):274-9, 2002 Sep.
Abstract
In addition to minimizing graft site morbidity, providing stable fixation, and
enabling early progressive rehabilitation, the ideal PCL reconstruction would
closely simulate natural ligament function. This study retrospectively examined
the 2-year postoperative outcomes of 19 athletically active patients referred
with clinically symptomatic PCL-deficient knees. Preoperatively 18 patients had
severely abnormal knee ligament examination scores, and one had an abnormal
score (IKDC). All but one patient was confirmed negative for observable
posterolateral corner injury via MRI. Eighteen patients had clinical evidence of
posterolateral instability. All patients underwent double-bundle PCL
reconstruction (using allograft tissue) without concomitant posterolateral
corner reconstruction. Two years after surgery 100% of patients had normal (
n=18) or near normal ( n=1) passive knee joint motion. The results were: one-leg
hop test, 58% normal, 37% nearly normal, 5% abnormal; knee ligament examination,
47% normal, 42% nearly normal, 5% abnormal, 5% severely abnormal; knee
arthrometry, 2.4+/-2 mm posterior tibial displacement; IKDC subjective
assessment section, 47% normal, 42% nearly normal, 5% abnormal, 5% severely
abnormal; IKDC symptom-activity level section, 47% normal, 42% nearly normal, 5%
abnormal, 5% severely abnormal; final knee ligament evaluation, 47% normal, 42%
nearly normal, 5% abnormal, 5% severely abnormal; Lysholm knee scoring scale,
63% excellent, 27% good, 5% fair and 5% poor. Improved stability with clinical
ligamentous laxity tests and good IKDC subjective and symptom-activity results 2
years after surgery suggest that for patients with PCL rupture and grade I or II
posterolateral instability the double-bundle procedure alone sufficiently
restores PCL function through a greater range of knee motion than traditional
single-bundle techniques.
<51>
Unique Identifier
11734868
Authors
Harner CD. Fu FH. Irrgang JJ. Vogrin TM.
Institution
Center for Sports Medicine, Department of Orthopaedic Surgery, University of
Pittsburgh Medical Center, South Water Street, Pittsburgh, PA 15223, USA.
harnercd@msx.upmc.edu
Title
Anterior and posterior cruciate ligament reconstruction in the new millennium:
a global perspective. [Review] [8 refs]
Source
Knee Surgery, Sports Traumatology, Arthroscopy. 9(6):330-6, 2001 Nov.
<52>
Unique Identifier
11528346
Authors
Escamilla RF. Fleisig GS. Zheng N. Lander JE. Barrentine SW. Andrews JR.
Bergemann BW. Moorman CT 3rd.
Institution
Michael W. Krzyzewski Human Performance Laboratory, Division of Orthopaedic
Surgery and Duke Sports Medicine, Duke University Medical Center, Durham, NC
27710, USA. rescamil@duke.edu
Title
Effects of technique variations on knee biomechanics during the squat and leg
press.
Source
Medicine & Science in Sports & Exercise. 33(9):1552-66, 2001 Sep.
Abstract
PURPOSE: The specific aim of this project was to quantify knee forces and
muscle activity while performing squat and leg press exercises with technique
variations. METHODS: Ten experienced male lifters performed the squat, a high
foot placement leg press (LPH), and a low foot placement leg press (LPL)
employing a wide stance (WS), narrow stance (NS), and two foot angle positions
(feet straight and feet turned out 30 degrees ). RESULTS: No differences were
found in muscle activity or knee forces between foot angle variations. The squat
generated greater quadriceps and hamstrings activity than the LPH and LPL, the
WS-LPH generated greater hamstrings activity than the NS-LPH, whereas the NS
squat produced greater gastrocnemius activity than the WS squat. No ACL forces
were produced for any exercise variation. Tibiofemoral (TF) compressive forces,
PCL tensile forces, and patellofemoral (PF) compressive forces were generally
greater in the squat than the LPH and LPL, and there were no differences in knee
forces between the LPH and LPL. For all exercises, the WS generated greater PCL
tensile forces than the NS, the NS produced greater TF and PF compressive forces
than the WS during the LPH and LPL, whereas the WS generated greater TF and PF
compressive forces than the NS during the squat. For all exercises, muscle
activity and knee forces were generally greater in the knee extending phase than
the knee flexing phase. CONCLUSIONS: The greater muscle activity and knee forces
in the squat compared with the LPL and LPH implies the squat may be more
effective in muscle development but should be used cautiously in those with PCL
and PF disorders, especially at greater knee flexion angles. Because all forces
increased with knee flexion, training within the functional 0-50 degrees range
may be efficacious for those whose goal is to minimize knee forces. The lack of
ACL forces implies that all exercises may be effective during ACL
rehabilitation.
<53>
Unique Identifier
11528332
Authors
Hooper DM. Morrissey MC. Drechsler WI. McDermott M. McAuliffe TB.
Institution
Department of Health Sciences, Department of Psychology, University of East
London, London E15 4LZ, United Kingdom.
Title
Validation of the Hughston Clinic subjective knee questionnaire using gait
analysis.
Source
Medicine & Science in Sports & Exercise. 33(9):1456-62, 2001 Sep.
Abstract
INTRODUCTION: Subjective questionnaires, completed by the patient, are often
used to document the status of a disabled knee. The purpose of this study was to
validate the Hughston Clinic subjective knee questionnaire by describing how
knee kinematics and kinetics correlated to subjective knee scores after knee
injury and surgery. METHODS: Five groups were studied: patients 2 (N = 37), 6 (N
= 37), and 24 (N = 8) wk after ACL reconstruction (ACLR); patients with a
chronic PCL deficiency (N = 9); and uninjured controls (N = 8). A threedimensional motion analysis system and force platform were used to measure
flexion angles and knee moments during level walking and stair climbing.
RESULTS: Hughston Clinic questionnaire scores were significantly correlated to
mechanical descriptors measured during stair ascent and descent in the 2- and 6wk ACLR groups (P < 0.05). The Hughston Clinic questionnaire score was
correlated to several kinematic variables in the ACL reconstructed knee at 24 wk
postoperative, e.g., knee flexion during walking. In the PCL deficient group,
the Hughston Clinic questionnaire score was correlated with several kinetic
measures, e.g., the peak moment (knee extensors). The Hughston Clinic
questionnaire score was not correlated to knee mechanics in the control group.
CONCLUSION: The Hughston Clinic questionnaire score has been shown to be valid
in this study as it reflects some mechanical descriptors during activities of
daily living in the first 6 wk post ACL reconstruction. The questionnaire also
provides information on gait modifications by people coping with knee injuries.
<54>
Unique Identifier
10623985
Authors
Janousek AT. Jones DG. Clatworthy M. Higgins LD. Fu FH.
Institution
Center for Sports Medicine and Rehabilitation, University of Pittsburgh
Medical Center, Pennsylvania, USA.
Title
Posterior cruciate ligament injuries of the knee joint. [Review] [49 refs]
Source
Sports Medicine. 28(6):429-41, 1999 Dec.
Abstract
Posterior cruciate ligament (PCL) injuries have a reported incidence of
between 3 and 37%, depending on the clinical setting. The most common mechanism
of injury in motor vehicle accidents is a dashboard injury or direct force to
the proximal anterior tibia. Sports related injuries result from hyperflexion of
the knee with the foot typically plantarflexed. The latter mechanism is the most
common cause of isolated PCL injuries, while in the trauma population as many as
95% of patients with knee injuries have combined ligamentous damage. Improved
knowledge at an anatomical, biomechanical and clinical level has provided the
orthopaedist with a more defined treatment algorithm. Isolated, partial PCL
injuries (grades I and II) can best be treated nonoperatively while complete
injuries (grade III) may require operative treatment based on clinical symptoms.
All combined ligamentous injuries usually respond best with surgical management.
[References: 49]
<55>
Unique Identifier
11980502
Authors
Margheritini F. Rihn J. Musahl V. Mariani PP. Harner C.
Institution
Musculoskeletal Research Center, University of Pittsburgh Medical Center,
Pennsylvania 15213, USA. fab.mar@iol.it
Title
Posterior cruciate ligament injuries in the athlete: an anatomical,
biomechanical and clinical review. [Review] [86 refs]
Source
Sports Medicine. 32(6):393-408, 2002.
Abstract
Recently, the posterior cruciate ligament (PCL) has become an increasingly
popular subject of orthopaedic research and debate. In the past several years,
anatomic and biomechanical studies have provided invaluable information
concerning the structure and function of the PCL. However, many aspects of PCL
injury are still not fully understood. Diagnosis of the injury is often missed
because of subtlety of symptoms and clinical findings, and current management
strategies of PCL injury have experienced relatively poor clinical outcomes.
Controversy exists concerning the most appropriate treatment, especially in
cases of isolated PCL injury. The purpose of this review is to present a
complete overview of the current knowledge regarding the basic science and
clinical aspects of PCL injuries, with a specific focus on the athletic
population. [References: 86]