Arthroscopic Standard Anterior and Posteromedial Portal Posterior Cruciate Ligament Reconstruction With Remnant Preservation : 2-Year Follow-up

Sholahuddin Rhatomy; Erwin Saspraditya; Riky Setyawan

doi:10.3889/oamjms.2020.3368

Authors

Sholahuddin Rhatomy Department of Orthopaedics and Traumatology, Sport and Adult Reconstructive Division, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia; Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
Erwin Saspraditya Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Riky Setyawan Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia; Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.3368

Keywords:

PCL, posteromedial portal, posterior cruciate ligament, pcl reconstruction

Abstract

BACKGROUND: Grade 3 posterior cruciate ligament (PCL) injury needs surgical intervention, but there is no consensus on the optimal technique in PCL reconstruction. The old technique always removes the remnant for good visualization of tunnel replacement. Recently, many studies proposed the concept of preservation of PCL remnant with achieve good visualization.

AIM: The aim of the study is to evaluate PCL reconstruction with remnant preservation using the standard anterior and posteromedial portal at 2-year follow-up.

METHODS: We conducted a cohort retrospective study between January 2013 and December 2015. In this study, 25 patients underwent PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation. We used quadrupled hamstring autograft. The patients were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm Knee Score, Modified Cincinnati Score, and knee society score (KSS) at pre-operative and 2-year post-operative. Range of motion (ROM) and complications were evaluated postoperatively.

RESULTS: The mean diameter of the quadruple hamstring graft was 8 mm. Clinical outcomes enhanced significantly (p < 0.05). The average of Lysholm activity scale improved from 65.12 ± 10.48 to 94.96 ± 4.80. The IKDC score improved from 60.50 ± 15.10 to 95.60 ± 3.44. Modified Cincinnati score improved from 62. 28 ± 13.6 to 96.04 ± 1.62. The KSS also improved from 60.12 ± 18.01 to 94.88 ± 6.36. Twenty-two patients had 0–135° full ROM and three patients had 0–110° ROM. Two patients had surgical site infection but recovered with local debridement.

CONCLUSION: PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation at 2-year follow-up resulted in satisfactory clinical and functional outcomes.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Chernchujit B, Samart S, Nakorn PN. Remnant-preserving posterior cruciate ligament reconstruction: Arthroscopic transseptal, rod and pulley technique. Arthrosc Tech. 2017;6(1):e15-20. https://doi.org/10.1016/j.eats.2016.08.031 PMid:28373934

Lee SH, Jung YB, Lee H. Remnant preservation is helpful to obtain good clinical results in posterior cruciate ligament reconstruction: Comparison of clinical results of three techniques. Clin Orthop Surg. 2013;5(4):278-86. https://doi. org/10.4055/cios.2013.5.4.278 PMid:24340147

Jung Y, Jung H, Song K, Kim JY, Lee HJ, Lee J. Remnant posterior cruciate ligament-augmenting stent procedure for injuries in the acute or subacute stage. Arthroscopy. 2010;26(2):223-9. https:// doi.org/10.1016/j.arthro.2009.07.017 PMid:20141985

Eguchi A, Adachi N, Nakamae A, Usman MA, Deie M, Ochi M. Proprioceptive function after isolated single-bundle posterior cruciate ligament reconstruction with remnant preservation for chronic posterior cruciate ligament injuries. Orthop Traumatol Surg Res. 2014;100(3):303-8. https://doi.org/10.1016/j. otsr.2013.12.020 PMid:24679366

Alentorn E, Joseph G, James JS, Alison C, Moorman CT, Dean II. Posterolateral portal tibial tunnel drilling for posterior cruciate ligament reconstruction: Technique and evaluation of safety and tunnel position. Knee Surg Sports Traumatol Arthrosc. 2017;25(8):2474-80. https://doi.org/10.1007/ s00167-015-3958-0 PMid:26718637

Ahn JH, Ha CW. Posterior trans-septal portal for arthroscopic surgery of the knee joint. Arthroscopy. 2000;16(7):774-9. https:// doi.org/10.1053/jars.2000.7681 PMid:11027767

Voos JE, Mauro CS, Wente T, Warren RF, Wickiewicz TL. Posterior cruciate ligament: Anatomy, biomechanics, and outcomes. Am J Sports Med. 2012;40(1):222-31. https://doi. org/10.1177/0363546511416316 PMid:21803977

Chen T, Liu S, Chen J. All-anterior approach for arthroscopic posterior cruciate ligament reconstruction with remnant preservation. Arthrosc Tech. 2016;5(6):e1203-7. https://doi. org/10.1016/j.eats.2016.07.011 PMid:28149714

Katonis PG, Assimakopoulos AP, Agapitos MV, Exarchou EI. Mechanoreceptors in the posterior cruciate ligament. Histologic study on cadaver knees. Acta Orthop Scand. 1991;62(3):276-8. https://doi.org/10.3109/17453679108993609 PMid:2042472

Ahn JH, Chung YS, Oh I. Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal. Arthroscopy. 2003;19(1):101-7. https://doi.org/10.1053/ jars.2003.50017 PMid:12522410

Fowler P, Messieh S. Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med. 1987;15(6):553-7. https:// doi.org/10.1177/036354658701500606 PMid:3425783

Shelbourne KD, Davis TJ, Patel DV. The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries. A prospective study. Am J Sports Med. 1999;27(3):276- 83. https://doi.org/10.1177/03635465990270030201 PMid:10352760

Makris CA, Georgoulis AD, Papageorgiou CD, Moebius UG, Soucacos PN. Posterior cruciate ligament architecture: Evaluation under microsurgical dissection. Arthroscopy. 2000;16(6):627-32. https://doi.org/10.1053/jars.2000.9238 PMid:10976124

Kim Y, Lee CA, Matava MJ. Clinical results of arthroscopic single-bundle transtibial posterior cruciate ligament reconstruction: A systematic review. Am J Sports Med. 2011;39(2):425-34. https://doi.org/10.1177/0363546510374452 PMid:20702860

Ohishi T, Takahashi M, Suzuki D, Matsuyama Y. Arthroscopic approach to the posterior compartment of the knee using a posterior transseptal portal. World J Orthop. 2015;6(7):505-12. https://doi.org/10.5312/wjo.v6.i7.505 PMid:26301179

Bach BR Jr., Aadalen KJ, Mazzocca AD. An accessory portal for posterior cruciate ligament tibial insertion visualization. Arthroscopy. 2004;20(6):155-8. https://doi.org/10.1016/j. arthro.2004.04.029 PMid:15243451

Mcginnis MD, Gonzalez R, Nyland J, Caborn DN. The posteromedial knee arthroscopy portal: A cadaveric study defining a safety zone for portal placement. Arthroscopy. 2011;27(8):1090-5. https://doi.org/10.1016/j.arthro.2011.02.031 PMid:21620634

Lee DW, Jang HW, Lee YS, Oh SJ, Kim JY, Song HE, et al. Clinical, functional, and morphological evaluations of posterior cruciate ligament reconstruction with remnant preservation: Minimum 2-year follow-up. Am J Sports Med. 2014;42(8):1822- 31. https://doi.org/10.1177/0363546514536680 PMid:24944294

Sim JA, Yoon YC, Kim TW, Kim BK, Lee BK. Comparison of clinical and radiological results between posteromedial portal technique and posterior transseptal portal technique in making a tibial tunnel in single bundle posterior cruciate ligament reconstruction with remnant preservation. J Korean Orthop Assoc. 2016;51(2):165-72. https://doi.org/10.4055/ jkoa.2016.51.2.165