Revision Posterior Cruciate Ligament Reconstruction using a Modified Tibial Inlay Double Bundle Technique
Background: Revision of a posterior cruciate ligament (PCL) reconstruction is a complicated and delicate clinical procedure whose results, theoretically, are less satisfactory than those of the first operation. The purpose of this study is to evaluate the reasons for failure of primary PCL reconstruction and to determine the clinical outcomes of revision PCL reconstruction after a minimum 2-year follow-up period. Methods: One surgeon performed 28 revision surgeries. Four cases with different operative procedure and 2 cases with a follow-up period of less than 24 months were excluded. 22 cases satisfied the inclusion criteria and were followed up for at least 24 months. All revision surgery involved the double femoral tunnel and modified tibial inlay technique and an Achilles tendon allograft. Nineteen patients (86％) underwent PLC reconstruction simultaneously. Stability was measured by posterior stress radiography and a maximum manual displacement test with a KT-1000 arthrometer. The subjective and objective International Knee Documentation Committee (IKDC) and Orthopǎdische Arbeitsgruppe Knie (OAK) scoring systems served for clinical evaluation. Results: The failures of nine operations (40.9％) might have been characterized by a single factor, while those of remaining 13 operations (59.1％) supposed to have multifactorial causes. The most common probable causes of failure were PLRI (17 knees, 77％) and improper graft tunnel placement (9 knees, 41％). Posterior stress radiography revealed improvements from 9.9±2.8 mm preoperatively to 2.8±1.8 mm at last follow-up (P<0.001). At the last follow up evaluation, the subjective and objective clinical scores improved significantly compared with preoperative evaluation scores (P<0.001). Conclusions: Revision PCL reconstruction with the arthroscopic tibial inlay double bundle technique improved posterior instability by objective measurements and achieved possible improvement in clinical stability and outcomes. Associated posterolateral ligament deficiencies should be surgically corrected during PCL reconstruction to prevent graft failure from abnormal lateral tibiofemoral joint opening.
posterior cruciate ligament posterolateral corner reconstruction revision
国际会议
北京
英文
73-83
2011-06-10（万方平台首次上网日期，不代表论文的发表时间）