Mid-term results of multi-ligament posterior and anterior cruciate ligament reconstruction using a modified method of bone tunnels drilling

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The problem of diagnosis and treatment of chronic anterior-posterior instability of the knee joint in multi-ligamentous injuries remains relevant, both medically and socially. Conservative treatment of patients with this pathology is ineffective due to severe instability and gross violation of the biomechanics of the knee joint. Currently, there is no consensus on the tactics of surgical treatment of this disease, and on the method of plastic replacement of the lost ligamentous apparatus. Objective. To evaluate the clinical results of the modified technique of arthroscopic plastic surgery of both cruciate ligaments of the knee joint. Patients and methods. Based on previous anatomical studies, the authors formulated the basic principles of safe formation of bone tunnels in simultaneous arthroscopic plastic surgery of the anterior (PKS) and posterior (ZKS) cruciate ligaments. An original method of surgery aimed at minimizing the risk of injury to the popliteal artery during the formation of the tibial bone tunnel is proposed. In the period from 2010 to 2017, the Department of endoscopic surgery treated 20 patients with damage to the SCS and SCS using this technique. The results were evaluated 6 and 12 months after surgery. Clinical examination, IKDC and Lisholm-Gillqist questionnaires and the visual analog pain assessment scale (VAS) were used to evaluate clinical results. Results. The average score on the IKDC questionnaire was 34.16±13.31 points before surgery, and 34.89±18.37 points on the lisholm - Gillqist questionnaire. 6 months after surgery - 58.75±6.38 and 69.78±14.10 points according to IKDC and Lisholm-Gillqist, respectively, which is statistically significant (p<0.05) higher than before surgery. A year after the operation, the positive dynamics was observed even more clearly (p<0.01): 76.83±9.26 and 82.00±6.38 points, respectively. The final result of the evaluation according to the IKDC Protocol: 11 (55.0%) patients were assigned to group A (good result), 6 (30.0%) to group B (close to good result), 2 (10.0%) to group C (satisfactory result) and 1 (5.0%) patient to group D (unsatisfactory result). Conclusion. The obtained clinical results allow to evaluate the proposed method as effective. In this case, the method of forming bone tunnels has a number of advantages compared to the classical technique, including minimizing the risk of intraoperative damage to the structures of the popliteal neurovascular bundle.

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About the authors

D. A Shulepov

Russian Scientific Research Institute of Traumatology and Orthopedics after RR Vreden

Saint-Petersburg, Russia

M. R Salihov

Russian Scientific Research Institute of Traumatology and Orthopedics after RR Vreden

Saint-Petersburg, Russia

O. V Zlobin

Russian Scientific Research Institute of Traumatology and Orthopedics after RR Vreden

Saint-Petersburg, Russia


  1. LaPrade C.M., Civitarese D.M., Rasmussen M.T., LaPrade R.F. Emerging Updates on the Posterior Cruciate Ligament: A Review of the Current Literature. Am J Sports Med. 2015;43(12):3077-92.
  2. Hopper G.P., Heusdens C.H.W., Dossche L., Mackay G.M. Posterior Cruciate Ligament Repair with Suture Tape Augmentation. Arthrosc Tech. 2018;8(1):e7-e10.
  3. Clancy W.G. Jr, Sutherland T.B. Combined posterior cruciate ligament injuries. Clin Sports Med. 1994;13(3):629-47.
  4. Parolie J.M., Bergfeld J.A. Long term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med. 1986;14:35-8.
  5. Sanders T.L., Johnson N.R., Levy N.M. et al. Effect of Vascular Injury on Functional Outcome in Knees with Multi-Ligament Injury: A Matched-Cohort Analysis. J Bone Joint Surg Am. 2017;99(18):1565-71.
  6. Owesen C., Røtterud J.H., Engebretsen L., Årøen A. Effect of Activity at Time of Injury and Concomitant Ligament Injuries on Patient-Reported Outcome After Posterior Cruciate Ligament Reconstruction. Orthop J Sports Med. 2018;6(12):2325967118817297. https://doi.org/10.1177/2325967118817297.
  7. Yoon K.H., Kim E.J., Kwon Y.B., Kim S.G. Minimum 10-Year Results of Single-Versus Double-Bundle Posterior Cruciate Ligament Reconstruction: Clinical, Radiologic, and Survivorship Outcomes. Am J Sports Med. 2019;47(4):822-7.
  8. MacGillivray J.D., Stein B.E., Park M. et al. Comparison of tibial inlay versus transtibial techniques for isolated posterior cruciate ligament reconstruction: minimum 2-year follow-up. Arthroscopy. 2006;22:320-8.
  9. Kang S.H., Sohn K.M., Lee D.K. et al. Arthroscopic Posterior Cruciate Ligament Reconstruction: The Achilles Tendon Allograft versus the Quadriceps Tendon Allograft. J Knee Surg. 2019. https://doi.org/10.1055/s-0039-1681029.
  10. Xu M., Zhang Q., Dai S. et al. Double Bundle versus Single Bundle Reconstruction in the Treatment of Posterior Cruciate Ligament Injury: A Prospective Comparative Study. Indian J Orthop. 2019;53(2):297-303.
  11. Makino A., Costa-Paz M., Aponte-Tinao L. et al. Popliteal artery laceration during arthroscopic posterior cruciate ligament reconstruction. Arthroscopy. 2005;21(11):1396.
  12. Kieser C. A review of the complications of arthroscopic knee surgery. Arthroscopy. 1992;8:79-83.
  13. Nemani V.M., Frank R.M., Reinhardt K.R. et al. Popliteal venotomy during posterior cruciate ligament reconstruction in the setting of a popliteal artery bypass graft. Arthroscopy. 2012;28(2):294-9.
  14. Кузнецов И.А., Фомин Н.Ф., Шулепов Д.А. Топографо-анатомические подходы к разработке системы защиты подколенной артерии при проведении артроскопической пластики задней крестообразной связки. Травматология и ортопедия России. 2012;4 (66):26-32.
  15. Шулепов Д.А., Салихов М.Р., Кузнецов И.А., Злобин О.В. Выбор оптимального сухожильного аллотрансплантата для артроскопической пластики задней крестообразной связки коленного сустава. Вестник Волгоградского государственного медицинского университета. 2018;1(65):34-9.
  16. Denti M., Tornese D., Melegati G. et al. Combined chronic anterior cruciate ligament and posterior cruciate ligament reconstruction: functional and clinical results. Knee Surg. Sports Traumatol. Arthrosc. 2015;23(10):2853-8.
  17. Hohmann E., Glatt V., Tetsworth K. Early or delayed reconstruction in multi-ligament knee injuries: A systematic review and meta-analysis. Knee. 2017;24(5):909-16.
  18. Lind M., Nielsen TG., Behrndtz K. Both isolated and multi-ligament posterior cruciate ligament reconstruction results in improved subjective outcome: results from the Danish Knee Ligament Reconstruction Registry. Knee Surg Sports Traumatol Arthrosc. 2018;26(4):1190-6.
  19. Миронов С.П., Орлецкий А.К., Авдеев А.Е. Одномоментное восстановление передней и задней крестообразных связок коленного сустава при их травматическом повреждении. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2004;2:37-40.



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