Objective To analyze the effect of the posterior cruciate ligament (PCL) retaining or not on knee-joint proprioception by comparing the proprioceptive difference between PCL retaining and no PCL retaining in total knee arthroplasty (TKA). Methods Between June 2009 and June 2010, 38 osteoarthritis patients meeting the inclusion criteria were divided into PCL retaining group (group A, n=19) and PCL-substituting group (group B, n=19) according to the random number table. There was no significant difference in gender, age, disease duration, the range of motion of the knee between 2 groups (P gt; 0.05). The effectiveness and the knee-joint proprioception were separately assessed by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score and the passive angle reproduction test (30, 60, and 90° of knee flexion) preoperatively and 12 months postoperatively. Results All incisons healed by first intention, without complications of infection, fracture, and deep vein thrombosis of lower limb. The patients were followed up 12-17 months (mean, 14.1 months). The knee function after operation was obviously improved when compared with preoperative one; significant differences were observed in the WOMAC scores and the results of passive angle reproduction test between at preoperation and at 12 months after operation (P lt; 0.05), but no significant difference was found between group A and group B (P gt; 0.05). Conclusion Whether PCL retaining or not in TKA both can improve knee-joint proprioception, and no obvious difference between them.
Objective To compare the intraoperative effects of computer navigation-assisted versus simple arthroscopic reconstruction of posterior cruciate ligament (PCL) tibial tunnel. Methods The clinical data of 73 patients with PCL tears who were admitted between June 2021 and June 2022 and met the selection criteria were retrospectively analysed, of whom 34 cases underwent PCL tibial tunnel reconstruction with navigation-assisted arthroscopy (navigation group) and 39 cases underwent PCL tibial tunnel reconstruction with arthroscopy alone (control group). There was no significant difference in baseline data between the two groups, including gender, age, body mass index, side of injury, time from injury to surgery, preoperative posterior drawer test, knee range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The perioperative indicators (operation time and number of guide wire drillings) were recorded and compared between the two groups. The angle between the graft and the tibial tunnel and the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes respectively were measured on MRI at 1 day after operation. The knee ROM, Tegner score, Lysholm score, and IKDC score were evaluated before operation and at last follow-up. Results The operation time in the navigation group was shorter than that in the control group, and the number of intraoperative guide wire drillings was less than that in the control group, the differences were significant (P<0.05). Patients in both groups were followed up 12-17 months, with an average of 12.8 months. There was no perioperative complications such as vascular and nerve damage, deep venous thrombosis and infection of lower extremity. During the follow-up, there was no re-injuries in either group and no revision was required. The results showed that there was no significant difference in the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes between the two groups (P>0.05), but the angle between the graft and the tibial tunnel was significantly greater in the navigation group than in the control group (P<0.05). At last follow-up, 30, 3, 1 and 0 cases were rated as negative, 1+, 2+, and 3+ of posterior drawer test in the navigation group and 33, 5, 1, and 0 cases in the control group, respectively, which significantly improved when compared with the preoperative values (P<0.05), but there was no significant difference between the two groups (P>0.05). At last follow-up, ROM, Tegner score, Lysholm score, and IKDC score of the knee joint significantly improved in both groups when compared with preoperative values (P<0.05), but there was no significant difference in the difference in preoperative and postoperative indicators between the two groups (P>0.05). ConclusionComputer-navigated arthroscopic PCL tibial tunnel reconstruction can quickly and accurately prepare tunnels with good location and orientation, with postoperative functional scores comparable to arthroscopic PCL tibial tunnel reconstruction alone.
Objective To investigate the effectiveness of posterior cruciate ligament (PCL) reconstruction with remnant preservation and autogenous quadrupled hamstring tendons under arthroscopy. Methods Between October 2007 and August 2012, 32 patients with PCL rupture were treated and followed up for more than 1 year. There were 24 males and 8 females, aged 20-53 years (mean, 35.6 years). The causes of injury included traffic accident injury in 21 cases, sports injury in 8 cases, and falling injury from height in 3 cases. The disease duration ranged 1 week to 2 years (median, 6.3 weeks). Nine patients had simple PCL rupture, 23 patients complicated by ligament injury, including 10 cases of anterior cruciate ligament rupture, 11 cases of posterolateral corner injury, and 2 cases of posteromedial corner injury. Preoperative Lysholm score was 53.8 ± 7.1. According to the International Knee Documentation Committee (IKDC) rating criteria, 10 cases were classified as grade C and 22 cases as grade D. PCL was reconstructed with autogenous quadrupled hamstring tendons, the tendons were fixed with EndoButton at the femoral side and with interference screw at the tibial side; floats of stump were cleaned up, and the structural stability and continuity ligament remnants were preserved. Results Primary healing was obtained in all incisions; no early complication occurred after operation. Thirty-two patients were followed up 23.4 months on average (range, 12-36 months). All patients had no symptom of knee instability; the results of tibia sags sign, posterior drawer test, and Lachman test were negative. At last follow-up, the knee range of motion (ROM) returned to normal in all cases. The Lysholm score was 92.3 ± 2.0, showing significant difference when compared with preoperative score (t= — 34.32, P=0.00). According to the IKDC rating criteria, 26 cases were classified as grade A and 6 cases as grade B at last follow-up, showing significant difference when compared with preoperative grade (Z= — 5.57, P=0.00). Conclusion Arthroscopic single-bundle reconstruction of PCL with remnant preservation and quadrupled hamstring tendons has advantages of minimal trauma, simple operation, and good knee function recovery.
ObjectiveTo study the results of high tibia osteotomy (HTO) combined with posterior cruciate ligament (PCL) reconstruction for osteoarthritis (OA) of the medial compartment with PCL injury. MethodsBetween March 2008 and June 2014, 11 patients with OA of the medial compartment and PCL injury underwent HTO combined with PCL reconstruction. There were 5 males and 6 females, aged 43-55 years (mean, 50.3 years). All patients had a trauma history, and the duration of injury was 3-5 years (mean, 3.7 years). At preoperation, Hospital for special surgery (HSS) score was 54.73±8.60, Lysholm score was 56.91±4.51, KT-1000 test was (5.71±1.13) mm, and knee range of motion (ROM) was (125.21±4.77)°. The preoperative femoral tibia angle (FTA) and posterior slope angle (PSA) of the tibia plateau were (184.82±2.40)° and (7.18±1.17)° on the X-ray film. ResultsIncisional fat liquefaction occurred in 1 case, and wound healed after dressing change; primary healing of wound was obtained in the other cases. All 11 cases were followed up 12-28 months (mean, 17 months). Bone union was observed at osteotomy site within 6 months, without delayed union or nonunion. After operation, genu varus deformity was corrected with different degrees; the stability of knees was improved in all patients; and the pain of medial knee was released significantly. At 12 months after operation, the FTA was significantly reduced to (176.64±1.96)°; at last follow-up, the HSS score was significantly increased to 88.27±4.76, KT- 1000 test was significantly reduced to (3.18±0.87) mm, and Lyholm score was significantly increased to 86.45±2.34, all showing significant differences when compared with preoperative ones (P<0.05). At last follow-up, the knee ROM was (124.63±2.98)° and the PSA was (7.91±1.30)°, showing no significant difference when compared with preoperative ones (P>0.05). ConclusionThe PSA will not be changed when a combination of HTO and PCL reconstruction is used to treat OA of the medial compartment with PCL injury if the right osteotomy site and reasonable bone graft are selected. The short-term effectiveness is good because of good recovery of the lower extremity force line and knee stability, but the long-term effectiveness remains to be further followed up.
Objective To compare the single femoral tunnel split-double-bundle posterior cruciate ligament (PCL) reconstruction with the singlebundle PCL reconstruction and to discuss the advantages of the modified reconstruction method. Methods Fourteen donated fresh-frozen human knee specimens were biomechanically tested, which included knee specimens from 12 males and 2 females, and their ages ranged from 20 to 31 years. The specimen length of the femur and the tibia was 20 cm. The tibial posterior translation and the PCL strains were first measured when PCL was in an intact state (the intact group, n=14). Then, PCL was cut (the cut group, n=14). The posterior translation was measured when a posterior load was applied. After that, the specimens were randomly divided into twogroups: the single-bundle group (n=7) and the double-bundle group (n=7). When the posterior load was applied to the tibia, the bundle strain and the tibial posterior translation were measured with the knees flexed at 0, 30, 60, 90 and 120°, respectively. Results While a 100 N posterior force was applied, the posterior tibial displacement of the intact PCL knee ranged from 1.97±0.29 mm to 2.60±0.23 mm at the different knee flexion angles. In the PCL-cutstate, the tibial displacement increased significantly from 11.27±1.06 mm to14.94±0.67 mm (P＜0.05). After the singlebundle reconstruction, the posterior tibial translation ranged from 1.99±0.19 mm to 2.72±0.38 mm at the different knee flexion angles. In the split-double-bundle reconstruction, the posterior tibial translations ranged from 2.27±0.32 mm to 3.05±0.44 mm. The graft of the single-bundle reconstruction was tensioned from 0° to 120°, and the tibial displacement increased significantly at 90° compared with that at theother angles(P＜0.05). In the doublebundle reconstruction, the anterolateral bundle and the posteromedial bundle were tensioned in a reciprocal fashion, and the tibial displacement had no significant difference at the five kinds of the flexion angles. ConclusionThe single femoral tunnel split-double-bundle PCL reconstruction canrestore the posterior tibial displacement at different flexion angles, and the tibial displacement in the single-bundle PCL reconstruction knee can be increased when the knee flexion is at 90°. In the double-bundle reconstruction, the graftcan be tensioned in a reciprocal fashion and the biomechanical features can be nearer to those of the normal PCL bundles.
Objective To explore the best flexion angle of the transplantation tendon for fixing joint in simultaneously reconstructing of the anterior cruciate l igament (ACL) and posterior cruciate l igament (PCL) using semitendinosus tendon as autologous graft. Methods Twenty-four clean level New Zealand White rabbits [(aged 6-8 months, male or female, and weighing (2.5 ± 0.2) kg] were selected and divided randomly into 3 groups (n=8) according to fixation angle of the reconstructed l igaments. The bilateral semitendinosus tendons of hind legs were used to reconstruct the PCL and ACL of right hind leg, and the reconstructed l igaments were fixed at knee flexion angles of 90° (group A), 60° (group B), and 30° (group A). The rabbit general situation was observed after operation, and the specimens of the knee joints (including 10 cmdistal end and 10 cm proximal end) were harvested for testing extension and flexion, displacement, and internal and external rotation at 3 months after operation. Results All the rabbits survived to the end of experiment. There was no significant difference in maximal displacements of ACL and PCL among 3 groups (P gt; 0.05). The anterior and posterior displacements of shift in 3 groups were less than 1 mm, suggesting good stabil ity. The anterior displacement and the posterior displacement at 30° flexion and 90° flexion in group A were significantly larger than those in group C (P lt; 0.05). There were significant differences in internal rotation angle and external rotation angle between group A and group C (P lt; 0.05), and there was no significant difference among other groups (P gt; 0.05). Conclusion When simultaneously reconstructing ACL and PCL, the knee flexion angle of 60° for fixing the reconstructed l igaments can achieve the best effect.
ObjectiveTo introduce the arthroscopic single bundle posterior cruciate ligament (PCL) reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers, and to evaluate the clinical results. MethodsBetween June 2010 and April 2014, 57 patients with PCL rupture were treated with arthroscopic single bundle PCL reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers. There were 41 males and 16 females, aged 19-42 years (mean, 27.7 years). All the patients had history of injury. The results of posterior drawer test were positive, including 9 cases of grade Ⅱ and 48 cases of grade Ⅲ. The disease duration ranged from 2 weeks to 25 months (mean, 13 months). The Lysholm score and the range of motion of knee joint were used to evaluate the knee function. ResultsThe operation performed smoothly, and no complications of blood vessel and nerve injuries and infection occurred. Primary healing was obtained in all incisions; no early complication occurred after operation. The patients were followed up 16.6 months on average (range, 12-20 months). At last follow-up, the knee range of motion returned to normal in all cases (120-130° in flexion). MRI at last follow-up showed good continuity of the PCL graft and complete healing of the remnant PCL tissues between the femoral and tibial attachments. The Lysholm score was significantly improved when compared with preoperative score (t=-27.429, P=0.000). ConclusionArthroscopic single bundle PCL reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers has the advantages of firm fixation, simple operation, and good knee function recovery.
Objective To observe the posterior condylar offset (PCO) changes and anteroposterior femorotibial translation, to investigate the influence of them on the maximum knee range of flexion (ROF) in patients with posterior cruciatesacrificingself al ignment bearing total knee arthroplasty (TKA). Methods The cl inical data were analyzed retrospectively from 40 patients (40 knees) undergoing primary unilateral TC-PLUSTM SB posterior cruciate-sacrificing self al ignment andbearing TKA for osteoarthritis between January 2007 and June 2009. There were 18 males and 22 females with an average age of 70.6 years (range, 56-87 years). The disease duration was 5-14 years (mean, 9.1 years). The locations were the left side in 11 cases and the right side in 29 cases. Preoperative knee society score (KSS) and ROF were 48.0 ± 5.5 and (77.9 ± 9.0)°, respectively. The X-ray films were taken to measure PCO and anteroposterior femorotibial translation. Multi ple regression analysis was performed based on both the anteroposterior femorotibial translation and PCO changes as the independent variable, and maximum knee flexion as the dependent variable. Results All incisions healed by first intention. The patients were followed up 12-19 months (mean, 14.7 months). At last follow-up, there were significant differences in the KSS (91.9 ± 3.7, t=— 77.600, P=0.000), the ROF [(102.0 ± 9.3)°, t=— 23.105, P=0.000] when compared with preoperative values. Significant difference was observed in PCO (t=3.565, P=0.001) between before operation [(31.6 ± 5.5) mm] and at last follow-up [(30.6 ± 5.9) mm]. At ast follow-up, the anteroposterior femorotibial translation was (— 1.2 ± 2.1) mm (95%CI: — 1.9 mm to — 0.6 mm); femoral roll forward occurred in 27 cases (67.5%), no roll in 1 case (2.5%), and femoral roll back in 12 cases (30.0%). By multiple regression analysis (Stepwise method), the regression equation was establ ished (R=0.785, R2=0.617, F=61.128, P=0.000). Anteroposterior femorotibial translation could be introducted into the equation (t=7.818, P=0.000), but PCO changes were removed from the equation (t=1.471, P=0.150). Regression equation was y=25.587+2.349x. Conclusion Kinematics after TC-PLUSTM SB posterior cruciate-sacrificing self al ignment bearing TKA with posterior cruciate l igament-sacrificing show mostly roll forwardof the femur relative to the tibia, which have a negative effect on postoperative range of motion. There is no correlation between PCO changes and postoperative change in ROF in TC-PLUSTM SB posterior cruciate-sacrificing self al ignment bearing TKA.
Objective To investigate whether the outlet of the femoral tunnel will cause iatrogenic injury to the medial collateral ligament (MCL) during posterior cruciate ligament reconstruction (PCLR) and estimate the safe angle of femoral tunnel placement. MethodsThirteen formaldehyde-soaked human knee joint specimens were used, 8 from men and 5 from women; the donors’ age ranged from 49 to 71 years, with an average of 61 years. First, the medial part of the femur was carefully dissected to clearly expose the region of the MCL course and attachment on the femoral medial aspect and to outline the anterior margin of the region with a marked line. The marked line divided the medial femoral condyle into an area with an MCL course and a bare bone area which is regarded relatively safe for no MCL course. Then, the posterior cruciate ligament (PCL) was cut to identify the femoral attachment of the PCL. After the knee joint was fixed at a 120° flexion angle, the process of femoral tunnel preparation for the PCL single-bundle reconstruction was simulated. The inside-out technique was used to drill the femoral tunnel from the PCL femoral footprint inside the knee joint with an orientation to exit the medial condyle of the femur, and the combination angle of the two planes, the axial plane and the coronal plane, was adapted to the process of drilling femoral tunnels at different orientations. The following 15 angle combinations were used in the study: 0°/30°, 0°/45°, 0°/60°, 15°/30°, 15°/45°, 15°/60°, 30°/30°, 30°/45°, 30°/60°, 45°/30°, 45°/45°, 45°/60°, 60°/30°, 60°/45°, 60°/60° (axial/coronal). The positional relationship between the femoral tunnel outlet on the femoral medial condyle and the marked line was used to verify whether the tunnel drilling angle was a risk factor for MCL injury or not, and whether the shortest distance between the femoral exit center and the marked line was affected by the various angle combinations. Furthermore, the safe orientation of the femoral tunnel placement would estimated. ResultsWhen creating the femoral tunnel for PCLR, there was a risk of damage to the MCL caused by the tunnel outlet, and the incidence was from 0 to 100%; when the drilling angle of the axial plane was 0° and 15°, the incidence of MCL damage was from 69.23% to 100%. There was a significant difference in the incidence of MCL damage among femoral tunnels of 15 angle combinations (χ2=148.195, P<0.001). By comparison between groups, it was found that when drilling femoral tunnels at 5 combinations of 45°/45°, 45°/60°, 60°/30°, 60°/45°, and 60°/60° (axial/coronal), the shortest distances between the tunnel exit and the marked line were significantly different than 0°/45°, 0°/60°, 15°/45°, 15°/60°, and 30°/30° (axial/coronal) (P<0.05). Additionally, after comparing the median of the shortest distance with other groups, the outlets generated by these 5 angles were farther from the marked line and the posterior MCL. ConclusionThe creation of the femoral tunnel in PCLR can cause iatrogenic MCL injury, and the risk is affected by the tunnel angle. To reduce the risk of iatrogenic injury, angle combinations of 45°/45°, 45°/60°, 60°/30°, 60°/45°, and 60°/60° (axial/coronal) are recommended for preparing the femoral tunnel in PCLR.
Objective To compare the effectiveness between lower tibial tunnel placement combined with internal tension relieving suture and simple lower tibial tunnel placement for posterior cruciate ligament (PCL) reconstruction. MethodsThe clinical data of 83 patients with simple PCL injury who met the selection criteria between January 2014 and February 2022 were retrospectively analyzed. Among them, 44 patients underwent PCL reconstruction through lower tibial tunnel placement combined with internal tension relieving suture (tension relieving suture group), and 39 patients underwent PCL reconstruction through simple lower tibial tunnel placement (control group). Baseline characteristics, including gender, age, body mass index, side of injury, cause of injury, preoperative side-to-side difference (SSD) in posterior tibial translation, visual analogue scale (VAS) score, knee range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) scores (including symptom, daily activities, and knee function scores) were compared between the two groups, showing no significant difference (P>0.05). The operation time and intraoperative blood loss were recorded and compared between the two groups. The effectiveness was evaluated by Lysholm score, IKDC scores, Tegner score, VAS score, knee ROM, SSD in posterior tibial translation before operation and at last follow-up, the patient satisfaction at last follow-up, and the postoperative graft recovery was evaluated by MRI. ResultsThere was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). All patients were followed up 12-60 months, and there was no significant difference between the two groups (P>0.05). Postoperative MRI showed that the graft was in good condition, and the reconstructed PCL graft had good signal, continuity, and tension. During the follow-up, there was no complication such as re-rupture or donor site discomfort in both groups. At last follow-up, the Lysholm score, IKDC scores, Tegner score, VAS score, knee ROM, and SSD in posterior tibial translation significantly improved in both groups when compared with those before operation (P<0.05). The changes of Lysholm score, Tegner score, IKDC knee symptom score, and SSD in posterior tibial translation between pre- and post-operation were significantly superior in the tension relieving suture group compared to the control group (P<0.05). However, no significant difference was found between the two groups in the changes of VAS score, knee ROM, IKDC daily activities score or knee function score between pre- and post-operation, and the satisfaction score (P>0.05). ConclusionLower tibial tunnel placement combined with internal tension relieving suture PCL reconstruction represents a more effective surgical approach for improving postoperative laxity of PCL and knee function recovery comparing to simple lower tibial tunnel placement PCL reconstruction.