March 13th, 2004
AOSSM Specialty Day

Two to TEN YEAR FOLLOW-UP of PCL Reconstruction with the Tibial Inlay Fixation Technique

Authors:
  1. Daniel E Cooper MD, WB Carrell Memorial Clinic, Dallas, TX
  2. Donna Stewart RN, WB Carrell Memorial Clinic, Dallas, TX
Objective:  PCL reconstruction (PCLR) using tibial inlay (TIF) is an alternative to the 2 tunnel technique. We evaluated the long term results of PCLR using a one bundle graft and TIF.
Methods:  From 1991-2001, we prospectively studied 43 pts having PCL reconstruction using TIF. 2-10 yr f/u (ave 32 mos) was 95% (41/43). There were 31 M and 10 F;35 primary, 6 revisions. Surgery was performed <8 wks after injury in 34% (14/41) and >8 wks in 66% (27/41). Combined reconstructions were done in 85% (35/41). In all patients preoperative posterior drawer (PD) was >12mm. All PCLR were performed with B-PT-B (16 autograft; 25 allograft). Final follow-up Subj. IKDC, Obj. IKDC and TELOS stress radiography with 20kg post. load applied at 80 were performed. Wilcoxon signed-rank tests were used for comparing the pre- and post-surgery measurements for the whole group. Wilcoxon rank-sum tests were used for comparing the measurement difference between different surgical categories. SAS 8.2 was used for most statistical analysis. PASS 2002 was used for power analysis.
Results:   PD was: normal in 8 patients, 1+ in 26 patients, 2+ in 7 patients and > 2+ in none. Mean improvement in PD was 2.1 grades. 40/41 demonstrated a solid endpoint on clinical posterior drawer testing. TELOS stress radiography demonstrated average SSD of 4.8mm (0-10). Average flexion loss was 5 deg (0-15). Preoperative Obj. IKDC evaluation rated all knees as D. F/u Obj. IKDC distribution was as follows: A or B - 27 knees, C - 11 knees, and D - 3 knees. Ave f/u Subj. IKDC score was 76.3 (21-100). Primary cases were significantly more stable thanrevision cases (p<.05). There was no difference in stability when comparing allograft vs. autograft, but improved IKDC scores were seen withallograft (p<.05). Combined reconstructions tended to be more stable than isolated reconstructions(p<.10). All patients evaluated their knee as improved or greatly improved and would repeat the procedure.
Conclusions:  PCLR with autologous or allograft bone-patellar tendon-bone graft using TIF was shown to be a successful technique at 2-10 year follow-up in a series of complex cases. Near normal stability is restored in about 60% of knees without significant loss of motion. PD improved an ave of 2 grades. Future research is needed to evaluate the use of a double bundle reconstruction with this fixation technique.
References:  
Acknowledgements:  
Keywords:
  1. Ligament
 Categories:
  1. CLINICAL: Knee PCL