March 13th, 2004
AOSSM Specialty Day

PCL Revision With Double-Bundle Quadriceps Tendon Autograft: Analysis of Failure Mechanisms

Authors:
  1. Frank R. Noyes MD, Cincinnati Sportsmedicine Research and Education Foundation, Cincinnati, OH
  2. Sue D. Barber-Westin BS, Cincinnati Sportsmedicine Research and Education Foundation, Cincinnati, OH
Objective:  The purpose of this study was to detect the causes of failure after PCL surgery. Secondly, to determine the results 2-7 years postoperatively of a consecutive series of knees that had double-bundle quadriceps tendon-patellar bone PCL revision reconstructions.
Methods:  41 knees were seen after 51 unsuccessful PCL operations including 31 graft reconstructions, 13 primary repairs, 4 synthetic grafts, and 3 thermoplasties. Twenty-seven knees had other ligament ruptures that had also been reconstructed. We performed PCL revision reconstruction in 22 knees; 6 with single-bundle patellar tendon autografts and 16 with double-bundle quadriceps tendon-patellar bone autografts. Thirteen knees were treated conservatively due to joint arthrosis, 4 had not chosen revision, and 2 had total knee replacement.
Results:  Multiple causes of PCL failure were identified. Associated postlateral ligament deficiency was found in 21 knees (41%); improper tunnel placement, in 20 knees (39%); varus malalignment, in 14 knees (27%); primary repair, in 13 knees (25%). A subset of 13 patients that had double-bundle quadriceps tendon revision were followed 2 to 7 years. During the revision operation, 6 required associated ligament reconstructions. Symptoms and daily activities improved (p < .05) and 7 patients returned to sports. PCL graft function at 20° was normal/nearly normal in 11 knees, partially functional in 1, and failed in 1. At 70°, PCL graft function was nearly normal in 6, partially functional in 4, and failed in 2.
Conclusions:  We report for the first time factors that attributed to failed PCL procedures. PCL revision reconstruction using a double-bundle quadriceps tendon autograft and tibial inlay technique produced acceptable results.
References:  
Acknowledgements:  
Keywords:
  1. Ligament
 Categories:
  1. CLINICAL: Knee PCL