Modified Technique of Arthroscopic Posterior Cruciate Ligament Reconstruction



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Abstract

Basing on the anatomic examination results the main principles of safe bone tunnels formation at arthroscopic plasty of posterior cruciate ligament (PCL) were formulated. Additional instrumentation of original design and original surgical technique directed to minimization of the risk of popliteal artery injury at tibial bone tunnel formation were proposed. During the period from 2010 through 2013 twenty one patients with PCL injuries were operated on at endoscopic surgery department. In 20 n patients treatment results were assessed in 6 and 12 months after intervention. Evaluation was performed by clinical results, IKDC forms, Lysholm - Gillquist score and visual pain scale. Preoperatively mean point by IKDC questionnaires was 46.80±18.07, by Lysholm - Gillquist score - 51.62±20.34 and in 6 months postoperatively - 68.64±10.13 and 73.84±11.16, respectively, that was statistically significant higher than prior to operation (p<0.05). One year after intervention positive dynamics was present (p<0.01): mean point by IKDC made up 77.23±8.03, by Lysholm - Gillquist - 81.08±8.64. Evaluation result by IKDC form was recognized in 11 (55%) patients as good (group A), in 6 (30%) - as close to good (group B), in 2 (10%) - as satisfactory (group C) and in 1 patient - as poor (group D). The use of perfected technique enabled to decrease the duration of surgical intervention by 27 minutes at average but the long-term treatment results were as good as after standard surgical intervention.

About the authors

I. A Kuznetsov

Russian Scientific-Research Institute of Traumatology and Orthopaedics named after R.R. Vreden, St. Petersburg, Russia

N. F Fomin

Russian Scientific-Research Institute of Traumatology and Orthopaedics named after R.R. Vreden, St. Petersburg, Russia

D. A Shulepov

Russian Scientific-Research Institute of Traumatology and Orthopaedics named after R.R. Vreden, St. Petersburg, Russia

Email: shulepov@front.ru

M. V Ryabinin

Russian Scientific-Research Institute of Traumatology and Orthopaedics named after R.R. Vreden, St. Petersburg, Russia

Yu. N Orlov

Russian Scientific-Research Institute of Traumatology and Orthopaedics named after R.R. Vreden, St. Petersburg, Russia

M. R Salikhov

Russian Scientific-Research Institute of Traumatology and Orthopaedics named after R.R. Vreden, St. Petersburg, Russia

References

  1. Clendenin M.B., DeLee J.C., Heckman J.D. Interstitial tears of the posterior cruciate ligament of the knee. Orthopedics. 1980; 3 (8): 764-72.
  2. Fanelli G.C. Posterior cruciate ligament injuries in trauma patients. Arthroscopy. 1993; 9: 291-4.
  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 (1): 35-8.
  5. McAllister D.R., Petrigliano F.A. Diagnosis and treatment of posterior cruciate ligament injuries. Cur. Sports Med. Rep. 2007; 6 (5): 293-9.
  6. Trickey E.L. Injuries to the posterior cruciate ligament. Clin. Orthop. Relat. Res. 1980; 147: 76-81.
  7. Dandy D.J., Pusey R.J. The long term results of unrepaired tears of the posterior cruciate ligament. J. Bone Joint Surg. Br. 1982; 64 (1): 92-4.
  8. Keller P.M., Shelbourne K.D., McCarroll J.R., Rettig A.C. Nonoperatively treated isolated posterior cruciate ligament injuries. Am. J. Sports Med. 1993; 21 (1): 132-6.
  9. Fanelli G.C. Posterior cruciate ligament injuries. A practical guide to management. New York: Springer; 2001.
  10. MacGillivray J.D., Stein B.E., Park M., Allen A.A., Wickiewicz T.L., Warren R.F. Comparison of tibial inlay versus transtibial techniques for isolated posterior cruciate ligament reconstruction: minimum 2-year follow-up. Arthroscopy. 2006; 22 (3): 320-8.
  11. Seon J.K., Song E.K. Reconstruction of isolated posterior cruciate ligament injuries: a clinical comparison of the transtibial and tibial inlay techniques. Arthroscopy. 2006; 22 (1): 27-32.
  12. Wang C.J., Weng L.H., Hsu C.C., Chan Y.S. Arthroscopic single- versus double-bundle posterior cruciate ligament reconstructions using hamstring autograft. Injury. 2004; 35: 1293-9.
  13. Campbell R.B., Jordan S.S., Sekiya J.K. Arthroscopic tibial inlay for posterior cruciate ligament reconstruction. Arthroscopy. 2007; 23: 1356.e1-e4.
  14. Houe T., Jorgensen U. Arthroscopic posterior cruciate ligament reconstruction: one- vs. two-tunnel technique. Scand. J. Med. Sci. Sports. 2004; 14: 107-11.
  15. Mc Keon B.P., Bono J.V., Richmond J.C. Knee Arthroscopy. Berlin: Springer; 2009.
  16. Willems W.J., Jenner J.M., van der Hart C.P. Mid-term results of arthroscopic reconstruction in chronic posterior cruciate ligament instability. Knee Surg Sports Traumatol. Arthrosc. 2006; 14: 848-53.
  17. Yahya M.M., Mwipatayi B.P., Abbas M., Rao S., Sieunarine K. Popliteal artery injury: Royal Perth experience and literature review. ANZ J. Surg. 2005; 75 (10): 882-6.
  18. Barrett G.R. Arthroscopic knee ligament reconstruction. J. Miss State Med. Assoc. 1987; 28 (5):113-5.
  19. Kieser C. A review of the complications of arthroscopic knee surgery. Arthroscopy. 1992; Vol.8:79-83.
  20. Veltri D.M., Warren R.F., Silver G. Complications in posterior cruciate ligament surgery. Oper. Tech. Sports Med. 1993; 1: 154-8.
  21. Zawodny S.R., Miller M.D. Complications of posterior cruciate ligament surgery. Sports Med. Arthrosc. 2010; 18 (4): 269-74.
  22. Makino A., Costa-Paz M., Aponte-Tinao L., Ayerza M.A., Muscolo D.L. Popliteal artery laceration during arthroscopic posterior cruciate ligament reconstruction. Arthroscopy. 2005; 21 (11): 396.
  23. Van Dorp K.B., Breugem S.J., Driessen M.J. Popliteal pseudoaneurysm after arthroscopic posterior cruciate ligament reconstruction. Knee Surg. Relat Res. 2014; 26 (3): 187-9.
  24. Jackson D.W., Proctor C.S., Simon T.M. Arthroscopic assisted PCL reconstruction: a technical note on potential neurovascular injury related to drill bit configuration. Arthroscopy.1993; 9 (2): 224-7.
  25. Pace J.L., Wahl C.J. Arthroscopy of the posterior knee compartments: neurovascular anatomic relationships during arthroscopic transverse capsulotomy. Arthroscopy. 2010; 26 (5): 637-42.
  26. 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 [Kuznetsov I.A., Fomin N.F., Shulepov D.A. Topographic and anatomical approaches to the development of the protection system of the popliteal artery during arthroscopic posterior cruciate ligament plasty. Travmatologiya i ortopediya Rossii. 2012; 4 (66): 26-32 (in Russian)].
  27. Кузнецов И.А., Волоховский Н.Н., Рыбин А.В., Рябинин М.В., Шулепов Д.А. Артроскопическая реконструкция задней крестообразной связки коленного сустава. Травматология и ортопедия России. 2011; 2 (60): 118-24.

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