Posterior laxity increases over time after PCL reconstruction

Gwinner, Clemens; Jung, Tobias; Schatka, Imke; Weiler, Andreas

doi:10.1007/s00167-018-5035-y

Cited by 30 publications

(24 citation statements)

References 43 publications

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“…Based on our own clinical findings, we believe that a slope increasing anterior open wedge osteotomy offers an additional powerful tool to further improve outcome after PCL reconstruction in this subset of patients. 27,28 Even though Bernhardson et al have reported on conflicting results about the influence of slope on outcome after PCL reconstruction as compared with our results, 23 we are still encouraged to follow our approach with a larger group of patients and a longer follow-up. However, in contrast to ACL surgery, a clear threshold at which degree of tibial slope, a sole slope increasing osteotomy is indicated, needs to be further defined.…”

Section: Discussionmentioning

confidence: 71%

“…27 Hereinafter, Gwinner et al advocated in 2018 that there is a significant stretch out of PCL reconstructions, as measured in serial stress-radiographs, if the tibial slope deceeds 8 degrees. 28 Furthermore, Bernhardson et al demonstrated that in a population of PCL injured knees, the slope was significantly lower as compared with an uninjured control population. 29 By implication, there is a growing body of clinical as well as biomechanical evidence that in patients with a markedly reduced tibial slope, a slope increasing, or flexion osteotomy might be considered prior to PCL reconstruction, especially in revision cases (►Fig.…”

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confidence: 99%

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Anterior Open-Wedge Osteotomy in Posterior Cruciate Ligament Deficient Knees: From a Historical Perspective to First Clinical Results

Weiler¹,

Dickschas

Gwinner

2021

J Knee Surg

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Recently, the bony anatomy of the proximal tibia has gained strong interest, particularly in the cruciate ligament deficient knee. Regarding the anterior cruciate ligament (ACL), several studies outlined that a steep tibial slope (≥12 degrees) contributes to early failures after ACL reconstruction. As a consequence, the first clinical reports are available on slope reducing osteotomies in revision ACL surgery. Vice versa, biomechanical as well as clinical reports suggest that a flat slope increases the load on the posterior cruciate ligament (PCL) and might contribute to a poor result after PCL reconstruction. Since many decades, slope increasing anterior open wedge osteotomies are used to treat a symptomatic genu recurvatum. The aim of the current report is to describe different surgical techniques and report our first clinical experience of an anterior open wedge osteotomy as a sole procedure in chronic PCL deficient knees with a flat tibial slope. In six cases, a mean preoperative slope of 3.7 degrees (range = 2–5 degrees) was increased to a mean of 11.5 degrees (range = 9–13 degrees). There was one case with a delayed bone healing, which was successfully treated without loss of correction by revision internal fixation and bone grafting.

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Section: Discussionmentioning

confidence: 71%

mentioning

confidence: 99%

Anterior Open-Wedge Osteotomy in Posterior Cruciate Ligament Deficient Knees: From a Historical Perspective to First Clinical Results

Weiler¹,

Dickschas

Gwinner

2021

J Knee Surg

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“…First, it evaluated only radiographic PTT because clinical outcomes scores, such as the Lysholm or Western Ontario and McMaster Universities Osteoarthritis Index score, were not fully available in several cases from the medical records. Second, the PTT was evaluated only in the gravity sag view without comparing a stress radiograph using a Telos device (Telos GmbH) 11 , 12 or with a kneeling technique 19 or comparing the posterior laxity with the KT knee arthrometer (MEDmetric) 1 , 48 ; notably, the posterior tibial load in the gravity sag view, generated by individual patients’ shank weights, could be smaller than those on stress radiographs. A higher BMI with a higher shank weight was also potentially associated with the nonsignificantly larger postoperative PTT.…”

Section: Discussionmentioning

confidence: 99%

“…The current study therefore aimed to investigate sequential changes in the radiographic PTT through PCLR and analyze the risk factors that influence the onset of postoperative residual posterior sagging. It was hypothesized that the PTT would recur in the early postoperative period but not proceed thereafter and that some risk factors, such as a smaller posterior tibial slope, 11 , 12 could affect the postoperative residual PTT.…”

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confidence: 99%

Sequential Changes in Posterior Tibial Translation After Posterior Cruciate Ligament Reconstruction: Risk Factors for Residual Posterior Sagging

Tachibana

Tanaka

Kinugasa

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Residual posterior sagging may occur after posterior cruciate ligament (PCL) reconstruction (PCLR), yet when it mainly occurs is not fully understood. Purpose: To elucidate sequential changes in radiographic posterior tibial translation (PTT) after PCLR. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively investigated the radiographic findings from 22 patients who underwent bisocket double-bundle PCLR for isolated PCL injury with at least 2 years of follow-up (mean, 4.5 years; range, 2-10 years). Injury severity was assessed using PTT on lateral radiographs with gravity sag views and was stratified according to side-to-side difference in the tibial-femoral stepoff: grade 1 (<5 mm), grade 2 (5 to <10 mm), or grade 3 (≥10 mm). Measurements were taken preoperatively and then immediately, 3 months, 6 months, 1 year, and ≥2 years postoperatively. The authors also investigated the risk factors for residual posterior sagging, indicated when PTT was ≥5 mm (grade ≥2) at the minimum 2-year follow-up. Results: Preoperatively, 13 patients had a grade 2 injury, and 9 had grade 3 injury. The PTT, restored immediately after PCLR, significantly increased at 3 months ( P < .001) but remained unchanged thereafter ≥2 years. There were 7 cases of postoperative PTT ≥5 mm on radiographs. Patients with residual posterior sagging had significantly larger mean PTT than did those without residual posterior sagging at all time points except for immediately postoperatively (preoperatively, 9.1 ± 1.6 vs 12.2 ± 2.3 mm; 3-month follow-up, 2.7 ± 1.6 vs 7.0 ± 1.8 mm; ≥2-year follow-up, 3.4 ± 1.0 vs 6.5 ± 1.4 mm; P < .001 for all). Multivariate logistic regression analysis showed that preoperative grade 3 injury was independently associated with residual posterior sagging (OR, 26.809; 95% CI, 1.257-571.963; P < .001). Conclusion: The initially reduced postoperative PTT significantly increased within 3 months using conventional rehabilitation protocols, but no progression was observed up to 4.5 years after PCLR. Preoperative grade 3 injury was independently associated with residual posterior sagging.

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“…[2][3][4][5][6] Although these techniques can achieve minimal posterior translation intraoperatively, joint laxity may recur insidiously after surgery. In a cohort of 46 patients, Gwinner et al 7 showed that, although laxity was improved at 3 months after PCL reconstruction, posterior tibial translation significantly recurred at a final follow-up of 5 years. Loss of stability is thought to be due to sagging of the tibia disturbing the graft during incorporation and possible disruption of the graft at the "killer turn."…”

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confidence: 99%

Anatomic Double Bundle Posterior Cruciate Ligament Reconstruction Using an Internal Splint

Deal

Allen

Bottoni

2020

Arthroscopy Techniques

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Techniques for reconstruction of posterior cruciate ligament (PCL) tears are rapidly evolving. One problem with current techniques is that laxity may develop early in the postoperative period, leading to relapsed posterior translation of the tibia. Therefore, maintaining tibial reduction during graft incorporation is a target for improvement. We describe using an internal splint to optimize the 4-tunnel, double-bundle allograft PCL reconstruction.

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Posterior laxity increases over time after PCL reconstruction

Abstract: Cohort study, Level III.

Cited by 30 publications

References 43 publications

Anterior Open-Wedge Osteotomy in Posterior Cruciate Ligament Deficient Knees: From a Historical Perspective to First Clinical Results

Anterior Open-Wedge Osteotomy in Posterior Cruciate Ligament Deficient Knees: From a Historical Perspective to First Clinical Results

Sequential Changes in Posterior Tibial Translation After Posterior Cruciate Ligament Reconstruction: Risk Factors for Residual Posterior Sagging

Anatomic Double Bundle Posterior Cruciate Ligament Reconstruction Using an Internal Splint

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