March 13th, 2004
AOSSM Specialty Day

Combined Posterior Cruciate Ligament/Posterolateral Reconstructions with Achilles Tendon Allograft and Biceps Femoris Tendon Tenodesis. TWO to TEN Year Follow-Up in 41 Chronic Knee Injuries

Authors:
  1. Gregory C. Fanelli MD, Danville, PA
  2. Craig J. Edison MS, PT, ATC, Geisinger Medical Center, Danville, PA
Objective:  This study presents the 2-10 year (24-120 month) results of 41 arthroscopically assisted combined PCL/posterolateral reconstructions evaluated pre and postoperatively using Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales, KT 1000 arthrometer testing, stress radiography, and physical examination.
Methods:  The population included 31 males, 10 females, 24 left, and 17 right chronic PCL/posterolateral knee injuries.Knees were assessed pre and postoperatively with arthrometer testing, 3 different knee ligament rating scales, stress radiography, and physical examination. Arthroscopically assisted PCL reconstructions were performed using the arthroscopically assisted single femoral tunnel-single bundle transtibial tunnel posterior cruciate ligament reconstruction techniqueusing fresh frozen Achilles tendon allografts in all 41 cases. In all 41 cases, posterolateral instability was treated with combined biceps femoris tendon transfer, and posterolateral capsular shift procedures.
Results:  Postoperative physical exam revealed normal posterior drawer/tibial step off in 29/41 (70%) of knees. Posterolateral stability was restored to normal in 11/41 (27%) of knees, and tighter than the normal knee in 29/41(71%) of knees evaluated with the external rotation thigh foot angle test. 30` varus stress testing was normal in 40/41 (97%) of knees, and grade 1 laxity in 1/41 (3%) of knees. Postoperative KT 1000 arthrometer testing mean side to side difference measurements were 1.80mm (PCL screen), 2.11mm (corrected posterior), and 0.63mm (corrected anterior) measurements. This is a statistically significant improvement from preoperative status for the PCL screen and the corrected posterior measurements (p ¡Ü 0.001). The postoperative stress radiographic mean side to side difference measurement measured at 90` of knee flexion, and 32 lb. of posterior directed proximal tibial force using the Telos device was 2.26 mm, a statistically significant improvement from preoperative measurements (p¡Ü 0.001). Postoperative Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scale mean values were 91.7, 4.92, and 88.7, respectively, demonstrating a statistically significant improvement from preoperative status (p ¡Ü 0.001).
Conclusions:  Statistically significant improvement is noted from pre-op to post-op at two to ten 10 year follow-up using objective parameters.
Keywords:
  1. Ligament
 Categories:
  1. CLINICAL: Knee PCL