Tunnel Enlargement Correlates With Postoperative Posterior Laxity After Double-Bundle Posterior Cruciate Ligament Reconstruction

Abstract

Background: There exists little information in the relevant literature regarding tunnel enlargement after posterior cruciate ligament (PCL) reconstruction (PCLR). Purpose: To sequentially evaluate tunnel enlargement and radiographic posterior laxity through double-bundle PCLR using autologous hamstring tendon grafts. Study Design: Case series; Level of evidence, 4. Methods: We prospectively analyzed 13 patients who underwent double-bundle PCLR for an isolated PCL injury. Three-dimensional computed tomography images were obtained at 3 weeks, 6 months, and 1 year postoperatively, and the tunnel enlargement was calculated by sequentially comparing the cross-sectional areas of the bone tunnels. We also sequentially measured radiographic posterior laxity. The correlation between the tunnel enlargement ratio and the postoperative increase in posterior laxity was evaluated. Results: The cross-sectional area at the aperture in each tunnel significantly increased from 3 weeks to 6 months ( P < .003), but it did not continue doing so thereafter. The 6-month tunnel enlargement ratios of the femoral anterolateral tunnel, the femoral posteromedial tunnel, the tibial anterolateral tunnel, and the tibial posteromedial tunnel were 31.6% ± 23.5%, 90.3% ± 54.7%, 30.5% ± 26.8%, and 49.6% ± 37.0%, respectively, while the corresponding ratios at 1 year were 28.1% ± 19.8%, 83.1% ± 56.9%, 26.8% ± 32.8%, and 47.6% ± 39.0%, respectively. The posterior laxity was 9.0 ± 4.0 mm, −1.5 ± 2.3 mm, 3.4 ± 2.0 mm, and 3.9 ± 1.9 mm, preoperatively, immediately after surgery, 6 months and 1 year postoperatively, respectively. From the immediate postoperative period, the posterior laxity significantly increased at 6 months postoperatively ( P < .001), but it did not thereafter. The postoperative increase in posterior laxity had a significant positive correlation with the anterolateral tunnel enlargement ratio in both femoral and tibial tunnels at 6 months (ρ = 0.571-0.699; P = .011-.041) and 1 year (ρ = 0.582-0.615; P = .033-.037). Conclusion: Tunnel enlargement after PCLR mainly occurred within 6 months, with no progression thereafter. The anterolateral tunnel enlargement positively correlated with postoperative increase in posterior laxity.

Application of CT‐MRI Fusion‐Based Three‐Dimensional Reconstruction Technique in the Anatomic Study of Posterior Cruciate Ligament

“…No matter which intervention is used, there are considerable defects. The direct vision of arthroscopy largely depends on the doctor's experience 22 . Therefore, it is necessary to establish a knee PCL Abbreviations: LT1, The distance from the center of the PCL footprint to the medial edge of the tibial plateau; LT2, The distance from the center of the PCL footprint to the anterior edge of the tibial plateau; LT3, The vertical distance from the center to the lowest plane of the tibial plateau; PCL, Posterior cruciate ligament; PT1, The width of the tibial plateau; PT2, The anterior and posterior diameter of the tibial plateau; PT3, The length of the rotation angle of the tibial plateau to the medial tibial plateau.…”

“…No matter which intervention is used, there are considerable defects. The direct vision of arthroscopy largely depends on the doctor's experience 22 . Therefore, it is necessary to establish a knee PCL imaging model, which can provide more clinically valuable and personalized anatomical information.…”

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

“…The intraobserver intraclass correlation coefficient (ICC) of the PTT has been assessed previously. 40 For the assessment of intraobserver reliability in this study, a single orthopaedic surgeon (Y. Tachibana) measured the PTT in all patients 3 times, with an interval of 14 days between measurements, by considering all lateral plain radiographs at all time points; ultimately, the intraobserver ICC of the PTT was 0.975. For the assessment of interobserver reliability, 2 other orthopaedic surgeons (Y. Tanaka and K.K.)…”