The quadriceps tendon autograft is an option for primary PCL reconstruction: a systematic review

Gyemi, Lauren; Bednar, E Dimitra; Sheean, Andrew J.; Kuroda, Ryosuke; de, Darren

doi:10.1016/j.jisako.2021.08.002

Cited by 7 publications

(11 citation statements)

References 45 publications

(119 reference statements)

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“…The addition of the medial meniscus ramp repair did not alter the rehabilitation protocol from the PCL reconstruction. 2,5,9,10 For our case presentation, a 6-month follow-up is shown, demonstrating plyometrics being performed on the reconstructed knee. The athlete adequately progressed through strengthening and plyometrics and was started on sport-specific cutting drills at week 26.…”

Section: Surgical Techniquesmentioning

confidence: 79%

“…They are not as commonly associated with PCL tears and there is limited literature looking at the 2 injuries in combination. 1,2,4,6 Diagnosis of a PCL tear is made with physical examination maneuvers, stress radiographs, and MRIs. 3,8,11 On physical examination, the posterior drawer sign is the most accurate, but a posterior sag sign and a dial test can be done.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…PCL injuries account for roughly 3% of all outpatient knee injuries, and 87% of PCL tears occur as part of a multiligamentous knee injury. 2 PCL injuries often occur from trauma to the knee. This can be from car accidents, sports, or other mechanisms.…”

Section: Video Transcriptmentioning

confidence: 99%

“…They are not as commonly associated with PCL tears and there is limited literature looking at the 2 injuries in combination. 1,2,4,6…”

Section: Video Transcriptmentioning

confidence: 99%

“…The addition of the medial meniscus ramp repair did not alter the rehabilitation protocol from the PCL reconstruction. 2,5,9,10…”

Section: Video Transcriptmentioning

confidence: 99%

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Posterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft and Concomitant Meniscal Ramp Repair

Glover,

Mason,

Albertson

et al. 2024

Video Journal of Sports Medicine

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Background: Quadriceps autograft, though well established for anterior cruciate ligament reconstruction, is underutilized in posterior cruciate ligament (PCL) reconstruction largely due to slow adoption. All-inside meniscal ramp repair and quadriceps tendon autograft PCL reconstruction have been described in isolation, but not concomitantly in a video journal. Indications: PCL reconstruction is indicated in grade 3 isolated tears with instability that have not improved with nonoperative management and in instances with associated injuries such as meniscal ramp tears, as observed in this 18-year-old division I football player. Graft selection is dependent upon surgeon and patient preference, with quadriceps autograft delivering a viable option with desirable long-term outcomes. Technique Description: A partial-thickness quadriceps tendon autograft was harvested, the remnant PCL stump was debrided, and a reamer was used to drill the all-inside tibial tunnel for traction suture passage. An accessory low anterolateral portal was utilized to drill the femoral tunnel for passage of the femoral traction stitch. Traction sutures were withdrawn, and the graft was passed into the tibia, docked into the femur, fixated with an interference screw, and tensioned over the tibial button. A medial meniscal ramp tear was also identified and repaired in all-inside fashion with a 90° SutureLasso, polydioxanone suture (PDS), and suturetape via standard arthroscopic knot tying. Following the procedure, the patient began a PCL reconstruction rehabilitation protocol with a PCL rebound brace. Due to the meniscal ramp repair, toe touch weightbearing with the knee in extension during ambulation was completed for 6 weeks. Physical therapy (PT) focused on early quadriceps and patellar mobilization as well as active-assisted range of motion exercises. Results: At 6 months postoperation, the patient continued to progress in PT without major concerns. A full recovery and return to sport are expected approximately 9 to 12 months after surgery, as is consistent with the standard protocol. Discussion/Conclusion: This study describes the treatment of chronic PCL with concomitant meniscal ramp tear in a division I athlete. Further adoption of PCL reconstruction utilizing quadriceps autograft, even in the context of concomitant ligamentous or meniscal reconstruction, such as medial meniscal ramp repair, will aid in the widespread treatment of PCL injuries. 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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Section: Surgical Techniquesmentioning

confidence: 79%

Section: Surgical Techniquesmentioning

confidence: 99%

Section: Video Transcriptmentioning

confidence: 99%

“…They are not as commonly associated with PCL tears and there is limited literature looking at the 2 injuries in combination. 1,2,4,6…”

Section: Video Transcriptmentioning

confidence: 99%

“…The addition of the medial meniscus ramp repair did not alter the rehabilitation protocol from the PCL reconstruction. 2,5,9,10…”

Section: Video Transcriptmentioning

confidence: 99%

See 3 more Smart Citations

Posterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft and Concomitant Meniscal Ramp Repair

Glover,

Mason,

Albertson

et al. 2024

Video Journal of Sports Medicine

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Decreased posterior tibial slope is a risk factor for primary posterior cruciate ligament rupture and posterior cruciate ligament reconstruction failure: A systematic review

Nedaie,

Vivekanantha,

O'Hara

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo determine bony knee morphological factors associated with primary posterior cruciate ligament (PCL) rupture or PCL graft failure after PCL reconstruction.MethodsThree databases, namely MEDLINE, PubMed and EMBASE, were searched on 30th May 2023. The authors adhered to the PRISMA and R‐AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data such as receiver operating characteristic curve parameters, as well as p‐values for comparisons of values between patients with PCL pathology and control patients, were recorded.ResultsNine studies comprising 1054 patients were included. Four studies reported that patients with PCL injury had flatter medial posterior tibial slopes (MTS) than controls, with mean values of 4.3 (range: 3.0–7.0) and 6.5 (range: 5.0–9.2) degrees, respectively. Two studies reported an MTS cutoff value ranging below 3.90–3.93° being a significant risk factor for primary PCL rupture or PCL graft failure. Two studies reported that shallow medial tibial depths were associated with primary PCL rupture, with mean values of 2.1 (range: 2.0–2.2) and 2.6 (range: 2.4–2.7) mm in PCL injury and control groups, respectively. Stenotic intercondylar notches and femoral condylar width were not consistently associated with PCL injuries.ConclusionDecreased MTS is associated with primary PCL rupture and graft failure after PCL reconstruction with values below 3.93° being considered as a significant risk factor. Less common risk factors include shallow medial tibial depth, while femoral condylar width and parameters with regards to the intercondylar notch, such as notch width, notch width index and intercondylar notch volume, demonstrated conflicting associations with primary or secondary PCL injuries.Level of EvidenceLevel III.

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The tibial capsular reflection and septum in posterior compartment are safe and reliable soft‐tissue landmark for tibial tunnel drilling in posterior cruciate ligament reconstruction

Niu,

Li,

Chen

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo investigate the validity of using tibial capsular reflection and septum in the posterior compartment as landmark during posterior cruciate ligament (PCL) reconstruction (PCLR).MethodsAnatomic measurements were obtained for 12 fresh human cadaveric knee specimens to observe the spatial position of the tibial insertion of the PCL in relation to the posterior septum and the capsular reflection in the posterior compartment. Sixty patients who underwent reconstruction of the PCL between 2020 and 2023 were also retrospectively investigated. The tibial tunnel was replaced in all patients using the same method (with reference to the tibial capsular reflection and the posterior septum). The placement of the tibial tunnel was assessed using X‐ray fluoroscopy intraoperatively and computed tomography and three‐dimensional reconstruction postoperatively.ResultsAll fibres in the tibial insertion of the PCL in the 12 cadaveric specimens were located in the posteromedial compartment, adjacent to the posterior septum. The inferior border of the PCL insertion is adjacent to the tibial capsular reflection, which is attached at the champagne glass drop‐off of the posterior tibia. In our previous cases, none of the patients experienced postoperative or intraoperative complications such as neurovascular injury, and the angle between the pin and the PCL facet was 93.1 ± 3.9° as measured on intraoperative radiographs. The mean distance from the centre of the tibial tunnel outlet to the inferior border of the PCL insertion was 5.6 ± 1.1 mm, and the distance from the centre of the tibial tunnel outlet to the outer border of the PCL insertion as a percentage of the length of the inferior border of PCL insertion was 42.2 ± 6.3%.ConclusionThe tibial capsular reflection and septum in the posterior compartment are safe and reliable soft‐tissue landmark for tibial tunnel drilling in PCLR.Level of EvidenceLevel Ⅳ.

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The quadriceps tendon autograft is an option for primary PCL reconstruction: a systematic review

Cited by 7 publications

References 45 publications

Posterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft and Concomitant Meniscal Ramp Repair

Posterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft and Concomitant Meniscal Ramp Repair

Decreased posterior tibial slope is a risk factor for primary posterior cruciate ligament rupture and posterior cruciate ligament reconstruction failure: A systematic review

The tibial capsular reflection and septum in posterior compartment are safe and reliable soft‐tissue landmark for tibial tunnel drilling in posterior cruciate ligament reconstruction

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