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Non-hardware Posterior Cruciate Ligament Reconstruction Using... » Isaúde
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Name of the journal:   Volume:   Number:
American Journal of Sports Medicine
2011-05-05 23:07:21

Non-hardware Posterior Cruciate Ligament Reconstruction Using Knot/Press-fit Technique With Periosteum-Enveloped Hamstrings Tendon Autograft

Subject: Knee, Arthroscopy, Operative, Graft fixation

Description: Background: Several posterior cruciate ligament reconstruction procedures have been proposed to manage ruptures. Purpose: This study was intended to present the clinical results of non-hardware reconstruction of posterior cruciate ligament using a knot/press-fit technique with periosteum-enveloped autogenous hamstring tendons. Study Design: Case series; Level of evidence, 4. Methods: This arthroscopically assisted technique was used in 33 patients with posterior cruciate ligament ruptures. In this non-hardware technique, semitendinosus and gracilis tendons were prepared as 2 loops with knots. Each loop was enveloped in periosteum. After passing a bottleneck femoral tunnel, the grafts were fixed with a press-fit method (knotted grafts lodging in the bottleneck of the femoral tunnel). Simultaneously, the intra-articular opening of the tibial tunnel was filled with the periosteum-enveloped portion of the graft. A tie with Mersilene tape over a bone bridge for each tendon loop was used for tibial fixation. Results: The average follow-up was 35 months (range, 24-60 months). Clinical assessments included Tegner score, Lysholm knee score, International Knee Documentation Committee scores, thigh muscle assessment, and radiographic evaluation. The stress radiography results for posterior displacement changed from 13.7 ± 2.1 mm preoperatively to 4.8 ± 1.1 mm postoperatively. Average preinjury Tegner score was 5.9 (range, 3-9), decreasing to 2.9 (range, 2-5) preoperatively and increasing to 5.2 (range, 2-9) postoperatively. The Lysholm score increased from 58.5 ± 5.2 to 94.2 ± 4.1 (P < .01). Finally, 26 patients (89.7%) were assessed as nearly normal by International Knee Documentation Committee guidelines. Conclusion: The study revealed satisfactory clinical subjective and objective results at a minimum of 2 years’ follow-up. Without using hardware, this alternative technique has the advantage of no need for removal of hardware and potentially easier magnetic resonance imaging interpretation and revision surgery.

Identifier: i
Editorial: American Orthopaedic Society for Sports Medicine
Section: research-article
Number: 5
Volume: 39
Page: 1081 a 1089
Author: Chuang, T.-Y., Ho, W.-P., Chen, C.-H., Shieh, M.-H., Liau, J.-J., Huang, C.-H.


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