Occupational consequences after isolated reconstruction of the insufficient posterior cruciate ligament

Ihle, Christoph; Ateschrang, Atesch; Albrecht, Dirk; Mueller, Johannes; Stöckle, Ulrich; Schröter, Steffen

doi:10.1186/1756-0500-7-201

Cited by 9 publications

(11 citation statements)

References 45 publications

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“…The long return-to-work time after PCL-R might be due to the rehabilitation protocol including strict non-weight bearing with immobilization in full extension and posterior tibial support, followed by functional bracing for up to 6 months [ 19 ]. Our results have strengthened the assumption that, compared to isolated ACL or PCL injuries [ 15 , 44 ], a high return-to-work rate can be expected for patients after PLC-R with additional ACL-R or PCL-R. With our study, an improved patient education regarding return-to-work time and possible changes in work load following such complex ligamentous knee injuries can be achieved.…”

Section: Discussionsupporting

confidence: 74%

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Combined posterolateral knee reconstruction: ACL-based injuries perform better compared to PCL-based injuries

Lutz

Merkle

Winkler

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To compare post-operative physical activity and return to work after combined posterolateral corner (PLC) reconstruction (PLC-R) in anterior cruciate ligament (ACL)- or posterior cruciate ligament (PCL)-based injuries. Methods Patients aged > 18 years undergoing PLC-R using the Larson technique combined with either ACL or PCL reconstruction were included. Outcome was evaluated retrospectively after a minimum follow-up of 24 months using Tegner Activity Scale, Activity Rating Scale (ARS), Knee Injury and Osteoarthritis Outcome Score (KOOS), work intensity according to REFA classification, and a questionnaire about type of occupation and time to return to work. Results A total of 32 patients (11 ACL-based injuries and 21 PCL-based injuries) were included. Mean follow-up was 56 ± 26 months in the ACL-based injury group and 59 ± 24 months in the PCL-based injury group. All patients in the ACL-based injury group and 91% of patients in the PCL-based injury group returned to sports activities. Comparing pre- and post-operative values, a significant deterioration of the Tegner Activity Scale and ARS was observed in the PCL-based injury group, whereas no significant change was observed in the ACL-based injury group. KOOS subscales were generally higher in the ACL-based injury with significant differences in the subscale sports and recreational activities. Patients with ACL-based injuries returned to work significantly earlier compared to patients with PCL-based injuries (11 ± 4 weeks vs. 21 ± 10 weeks, p < 0.05). Conclusion High rates of return to sports and work can be expected after combined PLC-R in both ACL- and PCL-based injuries. However, deterioration of sports ability must be expected in PCL-based injuries. ACL-based injuries led to superior patient-reported outcomes and an earlier return to work, as compared to PCL-based injuries. Level of evidence Level IV.

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Section: Discussionsupporting

confidence: 74%

“…Time to return to work was calculated. Furthermore, work ability was evaluated by the use of questions regarding pre- and post-operative type of occupation and work intensity (according to “REFA” classification) [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Combined posterolateral knee reconstruction: ACL-based injuries perform better compared to PCL-based injuries

Lutz

Merkle

Winkler

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…All patients who were unable to work before surgery due to symptomatic varus knee osteoarthritis were able to return to work with moderate or even very heavy workloads. The duration of the inability to work was 12.2 ± 4.4 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) weeks with an improved pain situation. Based on these results, surgeons can preoperatively assume that patients will return to work following DLO in the short term regardless of the work intensity.…”

Section: Discussionmentioning

confidence: 98%

Work intensity and quality of life can be restored following double-level osteotomy in varus knee osteoarthritis

Ihle

Dorn

Ateschrang

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to assess changes in health-related quality of life (HRQL) and work intensity following double-level knee osteotomy (DLO). It was hypothesized that postoperative HRQL would be comparable to that of the general population and that work intensity can be restored in the short term. Methods Twenty-four patients (28 varus knees; mechanical tibiofemoral angle: −11.0 ± 3.0° (−6.0 to −17.0), age: 49.1 ± 9.5 (31–65) years) who underwent DLO were included. The duration the patients were unable to work was evaluated. HRQL was measured with the SF-36 questionnaire, which consists of a physical (PCS) and mental component summary score (MCS). The pre- to postoperative changes in the PCS and MCS were analysed. The PCS and MCS were also compared to those of the general population, who has a reference score value of 50 points. The work intensity measured with the REFA classification and the Tegner activity scale were assessed preoperatively and at the final postoperative follow-up examination (18.0 ± 10.0 (5–43) months). Results The duration that the patients were unable to work was 12.2 ± 4.4 (6–20) weeks. The PCS improved from 32.1 ± 11.3 (14.5–53.3) preoperatively to 54.6 ± 8.5 (25.2–63.7) (p < 0.001) at the final follow-up, and the MCS improved from 53.9 ± 11.1 (17.1–67.7) to 57.2 ± 3.1 (47.3–61.7) (n.s). The preoperative PCS was significantly lower than the reference score of the general population (p < 0.001), whereas the preoperative MCS was similar between the two groups (n.s.). At follow-up, no significant differences were observed between the PCS and the MCS of the patient group and those of the general population. Five patients who were unable to work prior to surgery due to knee symptoms returned to work with moderate (four patients) or even very heavy (one patient) workloads. The Tegner activity scale increased significantly from a median of 2.0 (0.0–5.0) to 4.0 (2.0–7.0) (p < 0.001). Conclusion Our results demonstrate an improvement in quality of life and return to working activity following DLO in the short term. The HRQL can be improved by DLO in patients with varus knee osteoarthritis to the level of the general population. These results can assist surgeons in discussing realistic expectations when considering patients for DLO. Level of evidence Study type: therapeutic, IV.

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“…Meyer 2 had reported poor functional outcome in patients of bony PCL avulsion treated non-operatively. Earlier studies had used functional assessment tools like musculoskeletal functional assessment (MFA), Gillquist and Lysholm scores for the evaluation of functional results in PCL bony avulsion injuries 23 - 24 . Very few studies had evaluated the PCL avulsion injuries with assessment measures like IKDC scoring 25 and stress radiography.…”

Section: Discussionmentioning

confidence: 99%

Posterior Cruciate Ligament Tibial Avulsion treated with Open Reduction and Internal Fixation through the Burks and Schaffer Approach

Khatri

Sharma

Lakhotia

et al. 2015

MOJ

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Objective: To report functional outcome in Posterior Cruciate Ligament (PCL) tibial avulsion fractures treated with open reduction and internal fixation through Burks and Schaffer approach. The patient specific functional outcome measures like IKDC grading together with objective grading with stress radiographs have rarely been used -to assess PCL tibial avulsion fractures.Material and Methods: Twenty seven patients (21 males and 6 females) were included in the study. The mean follow up duration was 22.30±6.82 months. They were assessed using international knee documentation committee (IKDC) grades, Lysholm scoring and stress radiography. The injury severity scores (ISS) of the patients were also recorded.Results: The mean Lysholm scores at the time of last follow up was 90.85±5.58. The IKDC grades achieved were normal in 20 patients, near normal in five and abnormal in two. The PCL laxity determined on active hamstring contraction stress radiography was grade I in 20 cases and grade II in seven cases. All patients had achieved bony union of tibial avulsion fractures at the time of last follow up. Statistically significant association was found between higher ISS and lower Lysholm scores. (t=3.455, p=0.0019). Good IKDC grades were associated with higher Lysholm scores (analysis of variance, F=32.51, p<.0001). There was no correlation between PCL laxity and functional outcome (t=.857, p = 0.399).Conclusion: PCL tibial avulsion fractures treated through Burk and Schaffer approach with open reduction and internal fixation produces good results. The early rehabilitation without cast immobilisation prevents arthrofibrosis.

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Occupational consequences after isolated reconstruction of the insufficient posterior cruciate ligament

Cited by 9 publications

References 45 publications

Combined posterolateral knee reconstruction: ACL-based injuries perform better compared to PCL-based injuries

Combined posterolateral knee reconstruction: ACL-based injuries perform better compared to PCL-based injuries

Work intensity and quality of life can be restored following double-level osteotomy in varus knee osteoarthritis

Posterior Cruciate Ligament Tibial Avulsion treated with Open Reduction and Internal Fixation through the Burks and Schaffer Approach

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