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

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Arthroscopic Repair of Acute Posterior Cruciate Ligament Rupture with Autogenous Hamstring Tendon Graft Augmentation - Technical Note (급성 후방 십자 인대 파열의 관절경하 봉합술 및 자가 슬괵 이식건 보강술 - 수술 술기 -)

  • Ahn, Jin-Hwan;Lee, Sang-Hak;Sung, Kee-Lyong
    • Journal of the Korean Arthroscopy Society
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    • v.9 no.1
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    • pp.70-76
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    • 2005
  • Purpose: We describe a new technique of arthroscopic repair with using autogenous hamstring tendon graft augmentation for the acute posterior cruciate ligament rupture. Operative technique: A routine arthroscopic examination of the knee joint is initially performed, then the posterior trans-septal portal is prepared with the using the posteromedial and posterolateral portals. The torn tibial stump that is retracted to the posterior compartment is repaired by a suture hook that is introduced through the anteromedial portal; visualization during this procedure is done with the arthroscope via the posteromedial portal. Using the retrieved suture, both suture ends are brought out to the anteromedial portal. The torn tibial stump is pulled to the intercondylar notch and then repaired with stitches at the anterior compartment. After the tibial and femoral tunnels are prepared without damaging the remnant PCL bundle, the combined torn PCL fibers and the autogenous single-bundle semitendinosus and gracilis tendon grafts are passed through the femoral tunnel and fixed together Conclusion: Arthroscopic repair of the torn tibial stump and autogenous hamstring tendon graft augmentation after preparing the tibial and femoral tunnels by using the trans-septal portal, without damaging the remnant PCL bundle, seems to be a very effective method for the treatment for acute PCL injuries, and especially for tears at the femoral attachment.

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Double Bundle Posterior Cruciate Ligament Reconstruction by the Tibial Inlay Method - Technical note - (경골 내재술식을 이용한 이중 다발 후방 십자 인대 재건술 - 수술 기법 -)

  • Lee, Yeong-Hyun;Nam, Il-Hyun;Moon, Gi-Hyuk;Ahn, Gil-Yeong;Lee, Sang-Chung
    • Journal of the Korean Arthroscopy Society
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    • v.12 no.2
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    • pp.139-146
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    • 2008
  • Purpose: The purpose of this study is to introduce the double bundle posterior cruciate ligament(PCL) reconstruction using Achilles allograft by the tibial inlay method and evaluate the clinical results of 11 cases who had PCL reconstruction using this method and were followed for more than 2 years after surgery. Materials and Methods: Our series consists of 11 cases of PCL reconstruction due to chronic posterior instability of knee and acute PCL rupture. The clinical results were assessed using the IKDC(International Knee Documentation Committee) scoring system, posterior stress radiographs and the maximum posterior displacement using a KT-1000TM arthrometer. Results: The average preoperative posterior displacement in 90 degree flexion stress radiograph was measured 13.4 mm and in 10 degree flexion the average posterior displacement using the KT-1000TM arthrometer was measured 11.4 mm. Postoperatively the 13.4 mm reduced to 4.4 mm and the 11.4 mm reduced to 3.9 mm. According to IKDC scoring system, 9 cases(81.8%) were satisfied. One case showed limitation of flexion with mild stiffness in the knee and another one case was not improved the posterior instability sufficiently and no complication of allograft was noticed. Conclusion: The double bundle PCL reconstruction using Achilles allograft by the tibial inlay method is a useful method for acute PCL rupture and chronic posterior instability of the knee including failed PCL reconstruction, because it will also make the posterior stability in the extension and 90 degree flexion position, and avoid the grafted tendon abrasion by acute turn of tibial tunnel.

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Comparison of Single-Incision, Single-Bundle Posterior Cruciate Ligament Reconstruction Using Allograft Tendon (동종건을 이용한 단일 절개, 단일 다발 후방십자인대 재건술의 비교)

  • Kyung, Hee-Soo;Cheon, Sang-Ho;Park, Kyung-Hyun;Jung, Jae-Wook
    • Journal of the Korean Arthroscopy Society
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    • v.16 no.2
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    • pp.107-113
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    • 2012
  • Purpose: The purpose of this study was to evaluate the posterior cruciate ligament (PCL) reconstruction with single bundle, single-incision technique using Achilles tendon and tibialis anterior allograft with ligament remnant preservation. Materials and Methods: Twenty six patients underwent PCL reconstruction was included. There were 21 males and 5 females. Mean age was 32 years. Used graft was a fresh frozen Achilles tendon allograft (group I, 14 cases) and tibialis anterior allograft (group II, 12 cases). Arthroscopic PCL reconstruction was performed using transtibial, single-incision and single bundle technique with remnant preserving as possible. For clinical evaluation, range of motion, posterior drawer test, Lysholm score, Tegner activity scale, International Knee Documentation Committee (IKDC) grade and posterior stress radiograph were used. The mean follow-up period was 21.6 months (12-40 months). Associated injuries were 5 medial collateral ligament injuries, which were treated by conservative method. Results: Range of motion (ROM) was returned to normal range in 24 cases, but ROM deficit under $10^{\circ}$ flexion was 2 cases at final follow-up period. Preoperative posterior drawer test was 17 cases in grade II and 9 cases in grade III. At final follow-up 13 cases returned within normal grade, 7 cases grade I and 6 cases grade II posterior instability. Lysholm mean score was improved from preoperatively 62 to 90 at final follow-up period. Tegner activity mean scale improved from preoperatively 3.5 to 5.6 at final follow-up period. IDKC grade was grade A was 3 cases, grade B 17 cases, grade C 6 cases. In posterior stress radiograph, posterior displacement was improved from mean 12 mm preoperative to 4.5 mm at final follow-up. There were no statistical differences between two groups in clinical evaluations. There were two cases of re-rupture of graft at the bone-tendon junction in group I. Conclusion: We had successful results of PCL reconstruction with single-incision, single bundle technique using Achilles and tibialis anterior allograft without difference between two groups in patients with PCL injury. There were more re-rupture of graft in Achilles tendon group.

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Combined Reconstruction of Posterior Cruciate Ligament and Posterolateral Corner with a Fresh Frozen Achilles Tendon Allograft (한 개의 신선동결 동종아킬레스건을 이용한 후방십자인대 및 후외방구조의 동시 재건술)

  • Kyung, Hee-Soo;Oh, Chang-Wug;Lee, Hyun-Joo;Ihn, Joo-Chul
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.8 no.2
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    • pp.102-108
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    • 2009
  • Purpose: The purpose of this study is to report a result of the technique that reconstruct posterior cruciate ligament (PCL) and posterolateral corner (PLC) simultaneously using a fresh-frozen Achilles tendon allograft. Materials and Methods: Forty two patients (45 legs) underwent PCL and PLC reconstruction were included. There were 38 males and 4 females. Mean age was 39 years. Used graft was a fresh frozen Achilles tendon allograft, which was divided by two size, larger one (${\emptyset}$ 10 mm) for PCL reconstruction and smaller one (${\emptyset}$ 8 mm) for PLC reconstruction. Arthroscopic reconstruction of the PCL was performed using transtibial, single incision, and single bundle technique with 10mm fresh frozen Achilles allograft tendon first. After PCL reconstruction, reconstruction procedure for posterolateral instability was performed using modified figure of "8" technique using smaller gtaft. For clinical evaluation, range of motion, posterior drawer test, varus stress test, prone external rotation (dial) test, Lysholm score, Tegner activity scale and posterior stress radiograph were used. Mean follow up period was 25 months. Results: Preoperatively posterior drawer test was 5 cases in grade II and 40 cases in grade III posterior instability. At final follow-up 22 cases returned within normal condition, 18 cases grade I and 5 cases grade II posterior instability. Though all patients showed positive result over 10 degrees in dial and varus stress test preoperatively, but only 9 cases showed positive both test at final follow-up. The range of motion deficit over $10^{\circ}$ flexion was 3 cases. Lysholm score was improved from mean 50 preoperatively to mean 83(p<0.05) and Tegner activity scale improved from mean 2.1 preoperatively to mean 4.6(p<0.05). In posterior stress radiographs, posterior displacement was improve from mean 16mm preoperatively to 4.1mm after treatment(p<0.05). All patients had improved compared to their pre-operative status as measured by physical examination such as posterior drawer test, varus stress test, dial test. Conclusion: We had successful results by combined reconstruction of the PCL & PLC with a fresh frozen Achilles tendon allograft in patients with PCL and posterolateral rotatory instability at a time.

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Posterior Cruciate Ligament Augmentation Using an Autogenous Hamstring Tendon Graft and the Posterior-Posterior Triangulation Technique (만성 단독 후방십자인대 파열에서 자가 슬괵건과 후-후 삼각술기를 이용한 만성 후방십자인대 보강술)

  • Kim, Yeung Jin;Chae, Soo Uk;Choi, Byong San;Kim, Jong Yun;Lee, Hwang Yong;Han, Chang Wan;Han, Su Hyoun
    • Journal of the Korean Arthroscopy Society
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    • v.17 no.1
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    • pp.24-30
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    • 2013
  • Purpose: To evaluate the outcome of arthroscopic posterior cruciate ligament (PCL) augmentation using an autogenous hamstring tendon graft and the posterior-posterior triangulation technique with preservation of ligament remnant or elongated ligament. Materials and Methods: From January 2002 to December 2009, we performed PCL augmentation using an autogenous hamstring tendon graft and the posterior-posterior triangulation technique in 32 patients. The mean age was 35.2 years. Twenty two cases were male and 10 cases were female. Average follow-up period was 5 years and 5 months (range: 2-7.9). Subjective and objective parameters were utilized in analyses, such as the mean range of motion, post. drawer test, Lysholm knee score, Tegner activity score, International Knee Documentation Cominittee (IKDC) grade, and second look arthroscopic examination. Results: At last follow up posterior displacement by the Telos stress test decreased from $10.8{\pm}5.1\;mm$ to $2.8{\pm}3.7\;mm$ (p<0.05). The final Lysholm knee score improved from $60.4{\pm}5.8$ to $84.6{\pm}4.8$. Tegner activity score improved from 3.2 to 4.8. The final IKDC grade was A in 18, B in 11, C in 3. Postoperative Lysholm knee score, IKDC grades, Tegner activity scale, and posterior displacement demonstrated statistically significant improvement compared to the preoperative state (p<0.05). Conclusion: Arthroscopic PCL reconstruction using an autogenous hamstring tendon with preservation of ligament remnant showed a good clinical results and posterior stability.

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Transtibial Double Bundle PCL Reconstruction using TransFix Tibial Fixation - Technical Note - (TransFix 경골부 고정을 이용한 경 경골 두 다발 후방십자인대 재건술 - 수술 술기 -)

  • Lee, Yong-Seuk;Jung, Young-Bok;Ahn, Jin-Hwan;Kang, Bun-Jung;Shin, Yun-Chang;Kong, Chae-Gwan
    • Journal of the Korean Arthroscopy Society
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    • v.10 no.2
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    • pp.203-208
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    • 2006
  • Purpose: Previous transtibial double bundle posterior cruciate ligament (PCL) reconstruction methods have several problems in graft length and tibial fixation. We introduce new surgical method that is less restrictive by graft length and is more stable with single tibial fixation. Operative technique: After diagnostic arthroscopy, we prepare the graft, ream the tibial tunnel and perform the procedure for TransFix tibial fixation. Femoral 2 tunnel is made and graft is passed via anteromedial (AM) portal. Tibial fixation is done and femoral 2 graft is fixed sequentially at each knee position. Conclusion: TtransFix tibial single fixation method in double bundle PCL reconstruction provides more stable fixation, more free graft selection and prevents graft damage by passing the graft via AM portal.

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