Revision PCL Reconstruction Review/Update

Gill, Gurchetan; Gwathmey, F. Winston

doi:10.1007/s12178-018-9493-0

Cited by 10 publications

(9 citation statements)

References 19 publications

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“…17,22 Compared with primary PCL reconstruction, revision PCL reconstruction is more complicated, and its outcomes tend to be less satisfactory. 6,17 However, in a recent retrospective study on revision PCL reconstruction, it seemed that using the double-bundle tibial inlay technique potentially provided stable fixation. 17,22 Nevertheless, because of less graft choice and tissue fibrosis during revision surgery, the double-bundle technique is difficult in this situation.…”

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confidence: 99%

Midterm Outcomes After Revision Posterior Cruciate Ligament Reconstruction With a Single-Bundle Transtibial Autograft

Chen

Yang

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: There is a lack of consensus regarding the optimal technique for revision posterior cruciate ligament (PCL) reconstruction. Purpose: To evaluate midterm outcomes after revision PCL reconstruction using a single-bundle transtibial autograft. Study Design: Case series; Level of evidence, 4. Methods: We reviewed 17 patients who underwent revision PCL reconstruction performed in our medical center by a single surgeon from 2003 to 2016. The cohort included 12 male and 5 female patients with a mean age of 31.3 years (range, 17-48 years). All of the patients underwent single-bundle transtibial reconstruction using the same surgical technique and were reviewed at a minimum of 4 years postoperatively. Preoperative and postoperative posterior stress radiography was performed. The preoperative tibial slope and tibiofemoral angle were also measured. Preoperative and postoperative functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) subjective and objective scores as well as the Lysholm score. Results: The most common factor that contributed to the failure of primary surgery was misplaced tunnels, especially on the femoral side. There were 2 patients who had grade 2 laxity preoperatively, and 15 patients had grade 3 laxity preoperatively. At the latest follow-up, all 17 patients had grade 1 laxity. On posterior stress radiography, posterior displacement improved from 10.8 ± 2.1 mm preoperatively to 2.9 ± 1.1 mm at the latest follow-up ( P < .001). The IKDC subjective score improved from 34.9 ± 6.8 preoperatively to 75.3 ± 15.7 postoperatively ( P < .001), and the Lysholm score improved from 38.1 ± 10.0 preoperatively to 88.5 ± 7.6 postoperatively ( P < .001). All patients reached the minimal clinically important difference (MCID) for the Lysholm score, and 94% reached the MCID for the IKDC subjective score, with 65% reaching the Patient Acceptable Symptom State. Conclusion: According to the findings of this study, arthroscopic revision PCL reconstruction with a single-bundle transtibial autograft offered satisfactory outcomes at midterm follow-up.

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confidence: 99%

Midterm Outcomes After Revision Posterior Cruciate Ligament Reconstruction With a Single-Bundle Transtibial Autograft

Chen

Yang

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…Lee et al showed that there were advantages and disadvantages of transseptal portal procedure [9]. This procedure improves exposure of PCL attachment site on the tibia, preserves maximal amount of remnant PCL, minimalize neurovascular injury and killer-turn effect [13,14].…”

Section: Discussionmentioning

confidence: 99%

Revision of failed-posterior cruciate ligament (PCL) reconstruction due to tibial tunnel misplacement: A case report

Lubis

Kuncoro

2019

Annals of Medicine and Surgery

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IntroductionPosterior cruciate ligament (PCL) reconstruction failure is a rare condition found. The failure caused by some factors, including improper graft tunnel placement. Although the proper tibial tunnel placement in PCL reconstruction is still controversial, make the tunnel placement anatomically essential to decrease the risk of failure. The use of PCL jig only to guide the direction of tibial tunnel does not always give good results.Presentation of caseWe report a case of 29 year old male with total rupture of ACL and PCL that underwent reconstruction for both ligaments. We found the failure of the PCL graft 2 years after the surgery was related to the tibial tunnel placement which was placed not in proper anatomical site. We performed revision PCL surgery with transseptal portal technique to ensure the tibial tunnel is placed in appropriate position.DiscussionThe cause of failure was associated with misposition of tibial tunnel. The tibial tunnel performed in previous surgery was too anterior than the anatomical foot print. This condition might be caused by surgical technique which depending only on PCL jig to guide the tibial tunnel direction and location. We performed transseptal portal technique get better visualization on the posterior aspect of the knee to achieve the proper direction of tibial tunnel.ConclusionThe use of PCL jig as the only tools for guiding tibial tunneling should be avoided. Additional tool such as transseptal portal is required to ensure the proper anatomical tibia tunnel in order to achive good PCL graft placement.

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“…Satisfactory results with 75% of patients returned to preinjury Tegner activity level 2,4 Significant relief in pain, stability, and function 5 Significant improved side-to-side differences on stress Xrays and improved subjective and objective clinical scores 7 Finally, keep in mind the following:…”

Section: Surgical Techniquesmentioning

confidence: 99%

Revision Posterior Cruciate Ligament Reconstruction Technique

Mouarbes,

Ripoll,

Vari

et al. 2023

Video Journal of Sports Medicine

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Background: Revision posterior cruciate ligament reconstruction (PCLR) is challenging, especially in existing semi-anatomic tunnels, whereas there is an increased risk of overlapping with a new positioned anatomic tunnel. Few cases were published with no consensus regarding the optimal operative technique. Indications: A 22-year-old male patient, with failed PCLR with hamstring autograft in 2020 due to improper tunnels placement, presented for pain and instability of his right knee. Physical examination revealed a positive posterior drawer and reverse Pivot-Shift test, with no varus-valgus or rotational laxity. Radiograph showed no signs of arthritis, normal tibial slope, and normal long-leg standing axis. Magnetic resonance imaging showed rupture of the PCL graft with no meniscal, chondral, or concomitant ligament injuries. Technique Description: We described a single-bundle transtibial technique with a posterior transeptal portal approach to reconstruct the PCL. We started by preparing the allograft with an internal brace augmentation and an adjustable button (Arthrex) placed on the femoral side for cortical fixation. The old semi-anatomical femoral tunnel was drilled and grafted using an allograft bone dowel (Biobank), and a new anatomic femoral tunnel was drilled inside-out. Under direct visualization via posterior transeptal portals, a new anatomic tibial tunnel was drilled posterior to the existing nonanatomic tunnel. Using a shuttle suture, the transplant was passed and fixed by an adjustable button at the femur and by two interference screws and a backup fixation using a Swive-lock anchor at the tibia (Arthrex). Results: Favorable functional and clinical outcomes with improvement of anteroposterior stability. Significant improved side-to-side differences on posterior stress radiography and improved subjective and objective clinical scores. Satisfactory outcomes with 75% of patients returned to preinjury Tegner activity scale level of function. Discussion/Conclusion: The use of the posterior transeptal portals approach protects the vital neurovascular structures and ensures proper PCL tibial tunnel placement by providing direct visualization of the tibial attachment. Allograft bone dowels facilitate PCL revision in a one-stage procedure by filling the existing semi-anatomic tunnels and allowing to drill the new anatomic tunnels without tunnel overlap. The use of the internal brace augmentation strengthens the construct to protect the graft during the revascularization and remodeling process by facilitating tissue ingrowth and incorporation. In revision surgery, backup fixation is encouraged and often essential due to the compromised bone stock. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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Revision PCL Reconstruction Review/Update

Cited by 10 publications

References 19 publications

Midterm Outcomes After Revision Posterior Cruciate Ligament Reconstruction With a Single-Bundle Transtibial Autograft

Midterm Outcomes After Revision Posterior Cruciate Ligament Reconstruction With a Single-Bundle Transtibial Autograft

Revision of failed-posterior cruciate ligament (PCL) reconstruction due to tibial tunnel misplacement: A case report

Revision Posterior Cruciate Ligament Reconstruction Technique

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