• Title/Summary/Keyword: PCL(posterior cruciate ligament)

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Case of Acute Posterior Cruciate Ligament Complete Injury of Knee Improve by Acupuncture Therapy (급성 후방십자인대 완전손상의 침치료 호전 1례)

  • Song, In-kwang;Park, Jun-sung;Kim, Woo-young;Lee, Seung-duk;Kim, Kap-sung
    • Journal of Acupuncture Research
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    • v.20 no.6
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    • pp.210-217
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    • 2003
  • The purpose of this case study is to show a case of acute posterior cruciate ligament(PCL) complete injury improved by conservative acupuncture therapy. The patient was treated for 100 days. The patient received deep interarticular electroacupuncture(EA) stimulation at S35, LE200, LE211 and treated by other acupoint stimulation, herb medication, cupping, physical treatments and exercise. We evaluated through MRI and Lysholm knee score. We suggest to treat acute posterior cruciate ligament(PCL) injury with acupuncture therapy meaning conservative therapy and would like to research acupuncture treatment plan for the further treatments.

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Single Bundle PCL Reconstruction with Remnant Preservation (잔여 조직을 보존한 단일 다발 후방십자인대 보강재건술)

  • Lee, Dong Chul;Kim, Won-Ho
    • Journal of the Korean Arthroscopy Society
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    • v.15 no.2
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    • pp.125-131
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    • 2011
  • Optimal treatment of the torn posterior cruciate ligament (PCL) remains controversial. The type of tibial fixation (transtibial vs inlay), the femoral tunnel position within the femoral footprint (central, eccentric or isometric), and the number of bundles in the reconstruction (single-bundle vs double-bundle) are controversial issues. The PCL has a better chance of spontaneously healing than the anterior cruciate ligament (ACL) because of a rich blood supply (near the branch of the middle genicular artery) and coverage with a thicker synovium. In general, for easier passage of the graft and full visualization of the original ligament attachment site during the precise positioning of the tunnel, the remaining PCL fibers are usually debrided during reconstruction. However, the remaining remnant structures would significantly contribute to the posterior stability of the knee joint, the healing of the graft, preserving proprioceptive function of the mechanoreceptors in the PCL. Double bundle PCL reconstruction may result in some surgical complications because of increased complexity of making tunnel. Therefore, single bundle PCL reconstruction with remnant preservation seems to be an effective procedure.

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The change of the Mechanoreceptor of Posterior Cruciate Ligament after Posterior Cruciate Ligament Injury in the Rabbit (토끼에서 후방십자인대 손상 후 후방십자인대의 기계적 수용기의 변화)

  • Jung Young Bok;Lee Jae sung;Kim Kyoung Hwan
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.1 no.1
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    • pp.55-60
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    • 2002
  • Purpose : To assess the change in the number of mechanoreceptors of posterior cruciate ligament(PCL) after transecting posterior cruciate ligament of the rabbit. Materials and Methods : We selected 10 skeletally-matured New Zealand white rabbits and one of the two posterior cruciate ligaments was transected and the other underwent sham-operation on each rabbit. Afterward, PCLs with synovium were obtained at femoral attach area in both knees in 20 weeks postoperatively, but in one of the cases, the transected PCL did not heal and had to be excluded from this study. Consequently, histologic examination of the ligament for the remaining 9 cases was done after being prepared with modified gold chloride stain. Results : The study showed a little bit more decrease in the number of mechanoreceptors in the transected group compared with that in the sham-operated group, but the number was statistically negligible. Conclusions : It is considered that the knee joint with injured PCL may still maintain proprioception since the decrease in the number of mechanoreceptors is not considerable, but further study on biomechanical role and function of mechanoreceptor of healed PCL is required.

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Isometry of the Posterior Cruciate Ligament (후방 십자 인대의 등장성)

  • Lee, Byung Ill
    • Journal of the Korean Arthroscopy Society
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    • v.2 no.1
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    • pp.15-20
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    • 1998
  • Less has been written about the PCL than the ACL. There has, however, been an increasing amount of the interest in the PCL recently. Surgical reconstructions using grafts are often performed. However, these procesures often fail to provide long-term stability and function. Graft attachment sites are critical determinants of success in the PCL reconstruction. The clinical literature contains conflicting recommendations for graft attachment sites. We present a review of the isometry of the PCL.

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The Clinical Results of Posterior Cruciate Ligament Reconstruction Using Transtibial Tunnel and Posterior Transseptal Portal (경골터널과 후방 경격막 도달법을 이용한 후방십자인대 재건술의 임상적 결과)

  • Cho, Jin-Ho
    • Journal of the Korean Arthroscopy Society
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    • v.12 no.1
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    • pp.45-52
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    • 2008
  • Purpose: The purpose of the study is to provide the clinical results of arthroscopic posterior cruciate ligament(PCL) reconstruction with preservation of the original PCL using transtibial tunnel and posterior transseptal portal. Materials and Methods: 36 patients underwent PCL reconstruction with achilles tendon allografts. We tried to preserve of the original PCL.At the final follow-up, patients were evaluated retrospectively by four measurements: Lysholm knee scores, IKDC grades, Telos stress radiography, and second look arthroscopy.Follow-up periods were from 12 months to 30 months. Results: The average Lysholm knee score improved from $66.0{\pm}8.67$ to $87.9{\pm}5.04$. Preoperative IKDC grades were abnormal in 15(41.7%) and severely abnormal in 21(58.3%), postoperative IKDC grades were normal in 6(16%),nearly normal in 24(66%), abnormal in 5(16%) and severely abnormal in 1(2%).The average side to side difference in Telos stress test decreased from $12.5{\pm}2.61(7{\sim}20)$ mm to $3.9{\pm}1.34(7{\sim}1)$ mm (paired sample T test, p=0.001) Conclusion: Arthroscopic posterior cruciate ligament(PCL) reconstruction with preservation of the original PCL using transtibial tunnel and posterior transseptal portal is useful surgical method.

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Arthroscopic Posterior Cruciate Ligament Reconstruction with Preservation of the Remnant Posterior Cruciate Ligament (남아 있는 후방 십자 인대 다발을 보존한 관절경하 후방 십자 인대 재건술)

  • Ahn Jin Hwan;Ha Kwon Ik;Chung Yoon Sung;Yang Il Soon
    • Journal of the Korean Arthroscopy Society
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    • v.4 no.2
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    • pp.97-104
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    • 2000
  • Purpose : The majority of PCL deficient knees have some intact remnant PCL bundles. In these cases, the remnant PCL bundles were removed fur easy passage of graft(especially in bone-patellar tendon-bone graft). The purpose of study is to report the results of PCL reconstruction by posterior transseptal portal technique and by preserving the remnant posterior cruciate ligament bundles. Materials & Methods : From November 1993 to June 1999, 44 arthroscopic posterior cruciate ligament reconstructions have been performed by one surgeon. We studied 37 knees those were followed up over 1 year among them. The mean age($14\~56$ years) was 31.8 years. The average follow-up period was 17.8 months($12\~61$ months). The graft materials were 29 double-loop hamstring autografts, 4 double-loop hamstring allografts and 4 Achilles tendon-bone allograft. Results : There are significant improvement of the preoperative subjective symptoms. The last follow-up shows that the average Lysholm knee score was markedly improved from 59.8 pre-operation to 89.2 post-operation and the average KT 2000 side difference was decreased from 11.1mm pre-operation to 2.3 mm post-operation. Follow-up MRI showed that the graft was healed with remnant posterior cruciate ligament bundles as one ligament. Conclusion : The posterior trans-septal portal makes it possible to locate the exact tibial tunnel. The arthroscopic PCL reconstruction preserving the remnant of original PCL bundles seems to provide the good result.

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Rationale and Technique of Arthroscopic Primary Repair of Posterior Cruciate Ligament (후방 십자 인대 관절경하 일차수복술의 이론적 근거와 술기)

  • Kim, Jung-Man
    • Journal of the Korean Arthroscopy Society
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    • v.2 no.1
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    • pp.21-24
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    • 1998
  • There are many controversies in managing fresh substance tear of PCL. Conservative treatment of partial tear is generalby accepted idea, and less than 10mm posterior instability is known to be acceptable in terms of funtion. More than 10mm posterior instability and complete fresh tear of the ligament are regarded as candidates of reconstruction of the ligament. However, many authors believe that posterior instability may be a cause of early osteoarthritis in the long run. Author described the rationale and the technique of arthroscopic primary repair of the PCL in case of proximal and mid 1/3 substance tear. Postoperative rehabilitation program and their rationale were also described.

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The Results of Posterior Cruciate Ligament Reconstruction. -Transtibial Two Tunnel Technique vs. Modified Tibial Inlay Technique- (관절경적 후방십자인대 재건술에 있어서 Transtibial Two Tunnel방법과 Modified Tibial Inlay방법의 비교)

  • Jung, Young Bok;Tae, Suk Kee;Yum, Jae Kwang;Koo, Bon Ho
    • Journal of the Korean Arthroscopy Society
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    • v.2 no.2
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    • pp.135-140
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    • 1998
  • From 1989 to 1994, authors have reconstructed the posterior cruciate ligament(PCL) in 51 knees with an autogenous central one-third of the patellar tendon by transtibial two tunnel technique, but there were not a few cases of unfavorable results. So from January 1995, we have reconstructed the PCL deficient knees by "modified tibial inlay technique" to avoid the grafted tendon abrasion at the posterior opening of the tibial tunnel(killer turn). Purpose of this study was to compare the results of two surgical techniques and what its advantages and disadvantages are. We could follow up 39 cases of transtibial two tunnel techique group(group A) more than one year, average being 23.7 months and 21 cases of modified tibial inlay technique group(group B) more than 12 months, average being 14.7 months. The clinical results were evaluated by the OAK knee scoring system ($M{\ddot{u}}ller$'s criteria) and the posteror stress roentgenography (push view) with Telos stress device compared with the uninjured knees. The arthroscopic second-look findings were also evaluated. In group A : The $M{\ddot{u}}ller$'s knee score was average 80.1 points, the posteror displacement in push view was average 4.4mm at the last follow up. There were 17 cases(44%) of unfavorable results which showed unstable posterior displacement more than 4mm compared with the uninjured knee in push view. Among the 19 cases of arthroscopic second look examinations, nearly normal PCL appearances of the grafted tendons were noted only in 9 cases(47%). In group B : The $M{\ddot{u}}ller$'s knee score was average 86.7 points, the posterior displacemnet in push view was average 3.6mm at the last follow up. There were 5 cases(23.8%) of unfavorable results which showed unstable posterior displacement more than 4mm compared with the uninjured knee in push view but 4 out of 5 cases showed 6mm posterior displacement in push views. Among the 7 cases of arthroscopic second-look examinations, 6 cases(86%) showed nearly normal PCL appearances of the grafted tendons. In modified tibial inlay technique of PCL reconstruction, it was easier to pull out the BPTB and in cases of remained laxed meniscofemoral ligament it was easier to preserve the remained structures than transtibial two tunnel technique. We expect the "modified tibial inlay technique" may solve the problem of grafted patellar tendon abrasion at the posterior orifice of tibial tunnel and may contribute to the successful PCL reconstruction.

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The Posterior Cruciate Ligament (PCL) Reconstruction by the Transtibial Tunnel Method using Cadaveric Achilles Tendon Grafts - Evaluation of the Initial Lengthening and the Slippage Ratio due to the Interference Screw Fixation and Double Cross-Pin Fixation - (사체 아킬레스건을 이용한 경골관통터널방식의 후방십자인대 재건술 - 간섭나사 및 이중고정핀 방식에 따른 초기연신 및 활주율 평가 -)

  • Kim, Cheol-Woong;Bae, Ji-Hoon;Oh, Dong-Joon
    • Transactions of the Korean Society of Mechanical Engineers A
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    • v.33 no.4
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    • pp.430-439
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    • 2009
  • Posterior Cruciate Ligament (PCL) plays an important role in knee extension. Rotational instability due to injured PCL can be restored by various PCL reconstruction methods. In this study, the initial lengthening affected by fixation device and location was demonstrated, and furthermore, the slippage and the relationship between lengthening ratio and slippage ratio in the calcaneus and soft tissue fixation methods was newly suggested. Eight specimens of proximal tibia and Achilles tendon grafts were harvested from four cadavers and divided into four groups in regard to the four different types of transtibial fixation techniques. The cyclic load ranged from 50 N to 250 N applied to each graft fixed to proximal tibia in 55 degrees. The initial lengthening ratio to the total elongation has been approximately constant regardless of the fixation methods. The soft tissue fixation method with an interference screw showed about 56.4% slippage ratio to the total elongation and the same method with a double cross-pin presented about 45.4% slippage ratio. The soft tissue fixation method with an interference screw demonstrated approximately 2 mm less total elongation and about 13% more slippage than lengthening because of poor fixation compared to the same method with a double cross-pin.