Arthroscopic anterior cruciate ligament reconstruction using autogenous hamstring tendon graft without detachment of the tibial insertion

This article describes a modified arthroscopic technique of anterior cruciate ligament reconstruction using quadrupled hamstring tendon graft. The autogenous semitendinosus and gracilis grafts are harvested without detachment of the tibial insertion. To obtain longer grafts, the accessory tibial insertions of the hamstring tendons are dissected. The EndoButton (Acufex Microsurgical, Andover, MA) is used for femoral fixation and two spiked staples are used for tibial fixation in a belt buckle fashion. Then the residual anterior laxity is restored by additional absorbable interference screw fixations. In this technique, more viable graft is obtained and more firm distal fixation is achieved by preservation of the tibial insertion of hamstring tendons.     

Anterior cruciate ligament reconstruction using hamstring tendon graft without detachment of the tibial insertion

Introduction: We report results of the anterior cruciate ligament reconstruction using a four-strand hamstring graft without detachment of the tibial insertion of the tendons. Material and Methods: In 74 patients the hamstring graft was fixed using an endobutton on the femoral side and a barbed staple on the tibial side. There were 69 male and 5 female patients. The mean age at the time of operation was 35.1 years (21–53 years). Postoperatively, an accelerated rehabilitation was followed with no protective braces. The mean follow-up period was 64 months (range 48 to 84 months). Results: All patients achieved full range of motion with a stable knee joint. The mean side-to-side difference using KT-1000 was 1.43 mm (SD 3.86). The average Lysholm score improved from 42 to 79.2 and the Tegner score improved from 3.4 to 5.9. Conclusion: Detachment of hamstring tendons from their tibial insertion is unnecessary and our results with accelerated rehabilitation without protective braces are satisfactory and comparable to other studies.     

Hamstring graft bacterial contamination during anterior cruciate ligament reconstruction: clinical and microbiological study

Purpose

Autograft preparation for anterior cruciate ligament (ACL) reconstruction has a potential for graft contamination. The purpose of this study was to evaluate the possibility of bacterial contamination of hamstring autograft during preparation and when dropped onto the operating room floor and methods of graft decontamination.

Methods

Sixty hamstring tendon autograft specimens were used as the test group. Excess tendon not used in the ACL procedure was divided into five segments. One segment, at the completion of preparation, was sent for culture as a control; the remaining four segments were dropped onto the floor adjacent to the surgical field for 15 seconds. One segment was cultured without undergoing any further treatment. Cultures were taken from each segment after immersion in 10 % povidone–iodine solution, 4 % chlorhexidine and bacitracin, respectively, for three minutes. Cultures of a skin swab and floor swab were taken at the same time and place that the ACL was dropped.

Results

Cultures of control graft tissue from ten patients (16.7 %) were positive for bacteria. No patient developed post-operative infection. Ninety organisms were identified, with Staphylococcus epidermidis being the most common isolate. Grafts rinsed in either bacitracin or 4 % chlorhexidine solutions were less likely to be culture positive.

Conclusions

A high rate of contamination can be expected during autograft preparation for ACL reconstruction. Soaking the hamstring autograft in either bacitracin or 4 % chlorhexidine solution is effective for decontamination, particulary if graft is dropped on the floor.

     

关节镜下保留残端重建前交叉韧带的临床前瞻性对照研究

目的 前瞻性评估保留残端对于前交叉韧带重建临床疗效的意义.方法 2008年8月至2009年9月共70例有韧带残端存留的前交叉韧带损伤患者入选本研究组,随机分为保留残端组(n=35)和对照组(n=35).分别采取关节镜下保留残端重建前交叉韧带和切除残端的前交叉韧带重建手术技术,移植物均使用同种异体肌腱.术后随访分别进行膝关节功能评分(IKDC分级和Lysholm评分)、客观稳定性评估(Lachman试验、轴移试验和KT-1000测量)、本体感觉功能测量和二次关节镜手术探查.结果 70例患者中共61例(87%)获得随访,平均随访时间13.1个月.两组的功能评分无显著差异:Lysholm评分:保留残端组96.4分,对照组94.9分(P=0.71);IKDC分级中A和B级:保留残端组30例,对照组29例(P=0.586).两组的客观稳定性评估无显著差异:KT-1000测量的侧-侧差值:保留残端组1.69 mm,对照组1.65 mm(P=0.83);Lachman试验阴性例数:保留残端组29例,对照组28例(P=1.00);轴移试验阴性例数:保留残端组31例,对照组27例(P=0.225).本体感觉的角度重复试验结果无显著差异:保留残端组4.56°,对照组4.28°(P=0.522).二次手术探查时发现的移植物滑膜覆盖率无显著差异:保留残端组85%,对照组84.2%.结论 保留残端同时使用异体肌腱移植重建前交叉韧带,对术后膝关节主观功能评分、稳定性和本体感觉和移植物滑膜覆盖程度并无促进作用.

Abstract：

Objective To evaluate the clinical significance of arthroscopic anterior cruciate ligament (ACL)reconstruction using the remnant-preserved technique.Methods From August 2008 to September 2009,70 cases with the remnant of injured ACL were included in the trials,which were randomized into the remnant preservation(RP)group and the control group,35 cases in each group.All patients in the two groups underwent arthroscopic ACL reconstruction surgeries,with ACL-remnant preserving technique in RP group and ACL-remnant resection in control group,respectively.The injured ACL was reconstructed with allograft in all cases.Postoperative follow-up assessment included the International Knee Documentation Committee(IKDC)grading and Lysholm score,Lachman test,pivot shift test and KT-1000 measurement,proprioception measurements and the arthroscopic second look evaluation.Results Sixty-one(61/70,87%)cases were available for an average of 13.1 months follow-up assessment postoperatively.There were no significant differences between the RP and control group in functional outcome as evaluated with Lysholm score(96.4 vs.94.9,P = 0.71)and IKDC grading(cases with A and B gradings:30 vs.29,P = 0.586).Regarding objective stability,there were no differences between the 2 group in mean side-to-side difference of KT-1000(1.69 mm vs.1.65 mm,P =0.83),Lachman test(negative cases:29 vs.28,P = 1.00)and pivot shift test(negative cases:31 vs.27,P =0.225).There was also no difference between the groups in proprioception evaluation measured with angle repetitive test(4.56°vs.4.28°,P=0.522).During second look arthroscopic examination,the grafts synoveal coverage rates were found to be 85% in the RP group and 84.2% in the control group,without significant difference(P＞0.05).Conclusions Arthroscopic ACL reconstruction with the remnant preserving technique using tendon allograft do not improve the postoperative knee-joint function scores,stability,proprioception and synovial coverage of grafts.     

异体肌腱保留残端重建前交叉韧带的前瞻性随机对照研究

目的 比较使用异体肌腱保留残端重建前交叉韧带(ACL)和标准ACL重建术的临床疗效. 方法 前瞻性地将2008年8月至2010年4月收治的符合纳入和排除标准的ACL损伤患者随机分为2组,分别使用保留残端的ACL重建术(保残组,45例)和切除残端的ACL重建术(对照组,45例),移植物均使用4股异体肌腱.两组患者术前一般资料比较差异均无统计学意义(P＞0.05),具有可比性.比较两组患者术后Lysholm评分、IKDC分级、稳定性检查(Lachman试验、轴移试验和KT-1000 测量)、滑膜覆盖情况及本体感觉测试结果.结果 保残组和对照组分别有39例和41例患者完成至少2年(平均25.7个月)的随访.保残组和对照组患者Lysholm评分分别为(96.0±6.0)分和(93.0±7.5)分,分别有97.4％ (38/39)和97.6％ (40/41)的患者评为IKDCA级或B级、97.4％ (38/39)和97.6％(40/41)的患者Lachman试验阴性、94.9％ (37/39)和87.8％ (36/41)的患者轴移试验阴性、KT-1000侧-侧差值分别为(1.6±1.7) mm和(1.8±1.8) mm、滑膜覆盖分型为A或B的分别有71.4％ (20/28)和70.4％ (19/27)、关节位置觉侧-侧差值分别为3.6°±1.8°和3.9°±2.2°,以上指标两组比较差异均无统计学意义(P＞0.05).保残组受伤至手术时间与Lysholm评分、KT-1000侧-侧差值、移植物滑膜覆盖情况和关节位置觉侧-侧差值无明显相关性(P＞0.05).结论 使用异体肌腱时,保留残端重建ACL与标准的ACL重建术相比,对膝关节术后稳定性、移植物滑膜覆盖及膝关节本体感觉恢复等无明显促进作用.     

正向、反向束间构型在前十字韧带双束重建中的临床效果比较

 目的比较关节镜下前十字韧带(anterior cruciate ligament. ACL)双束重建中正向、反向束间构型的初期临床效果。方法 2008年 4月至 2009年 8月.采用 8股自体腘绳肌肌腱双束重建 ACL治疗单纯 ACL损伤患者 97例.根据患者入: 时住: 号的奇偶数随机分成正向组(采用正向束间构型. 47例)和反向组(采用反向束间构型.50例).移植物均采用微型钢板纽扣进行悬吊式固定。术后患者随访期均超过 1年.根据 IKDC、Lysholm和 Tegner评分标准进行膝关节功能评估。结果术后随访 12~17个月.平均(13.71±1.32)个月。末次随访时.正向组 2例(4.2%)患者伸膝活动受限 10°.5例(10.6%)膝关节轻度屈曲受限(均<15°);反向组所有患者伸膝活动正常.4例(8.0%)屈曲受限约 5°。根据 Lachman试验.正向组 1例(2.1%)I度阳性和 1例(2.1%) II 度阳性.反向组 1例(2.0%) II 度阳性。 KT-1000(屈膝 30°.30N)双膝松弛度差异值正向组为(1.04±1.11) mm.反向组为(0.86±1.12) mm。按照 IKDC客观评级标准.正向组 46例(97.9%)正常或接近正常.反向组 48例(96.0%)正常或接近正常。根据 IKDC、 Lysholm和 Tegner评分标准.两组的差异均无统计学意义。结论采用 8股自体腘绳肌肌腱正向、反向束间构型双束重建 ACL均能有效地恢复膝关节稳定性.两组短期临床效果的差异无统计学意义。但反向束间构型能有效地防止移植物和髁间凹的撞击。     

The effect of different graft tensioning in anterior cruciate ligament reconstruction: A prospective randomized study

A prospective study was performed to establish the influence on stability of tensioning the graft after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft. There were 38 consecutive patients randomly divided into two groups; in the first group (19 patients) the graft was tensioned at 20 N, and in the second group the tension was 40 N. Evaluation included Lysholm scores, instrumented Lachman tests, IKDC level, and lateral radiographs to measure the tibia position versus the femur. One year after surgery we did not find any significant difference between the two groups. We conclude that the importance of graft tensioning has yet to be established in the clinical situation. Based on our results, graft tension of 20 N seems to be sufficient, without the risk of overconstraining the knee joint. (Arthroscopy 1998 Nov-Dec;14(8):845-50.)     

Hybrid hamstring graft tibial fixation in anterior cruciate ligament reconstruction

Tibial fixation of the anterior cruciate ligament hamstring tendon graft is commonly considered more problematic than femoral fixation. When interference screws are used for tibial hamstring tendon graft fixation, graft sometimes looses its tension, so a hybrid fixation (more than one method of fixation) must be applied. Biomechanical studies show that an implementation of interference screws combined with different indirect distal hamstring tendon fixation techniques can withstand much higher tearing forces when compared with one type of fixation. We made a technique of hybrid tibial fixation of the hamstring graft using round interference screws and an additional bi-cortical 4.5-mm diameter screw with a modified head that allows control over the initial tension of the graft.     

前交叉韧带重建胫骨栓桩与挤压螺钉固定的比较

[目的]评估膝关节前交叉韧带损伤胫骨栓桩固定及可吸收挤压钉固定的疗效。[方法] 2011～2016年治疗膝关节前交叉韧带损伤患者61例,股骨骨道均以Endobutton固定,其中胫骨骨道栓桩固定25例,胫骨骨道可吸收挤压钉固定36例,手术前后行Lachman试验、IKDC和Lysholm评分,以评估手术疗效。[结果] 61例患者均顺利接受手术,术中无血管神经损伤等严重并发症。术后栓桩组平均随访(13.62±1.23)个月,挤压钉组随访(14.72±1.16)个月。末次随访时栓柱钉组25例患者和挤压钉组36例患者均无明显疼痛、交锁和打软腿症状,前抽屉试验、轴移试验及Lachman试验均为阴性。两组的ROM均随时间延长有所增加,但差异无统计学意义(P0.05),不同时间点两组间ROM的差异均无统计学意义(P0.05)。术后6、12个月时两组的KT-1000值均较术前显著减少,差异有统计学意义(P0.05),而两组术后6个月与12个月的KT-1000值差异均无统计学意义(P0.05)。相同时间点两组间KT-1000值的差异均无统计学意义(P0.05)。随着时间延长,两组患者的Lysholm评分和IKDC 2000评分均显著增加,两组患者不同时间点的差异均有统计学意义(P0.05),但相同时间点两组间Lysholm评分和IKDC2000评分的差异均无统计学意义(P0.05)。[结论]前交叉韧带重建胫骨骨道可吸收挤压螺钉固定与皮质骨螺钉栓桩固定术后均取得较好疗效,两组相比较无明显差别,胫骨侧栓桩固定也是一种可靠的固定方法。     

保留并牵张缝合Rigidfix固定胫骨残迹的前交叉韧带重建

目的探讨关节镜下保留并牵张缝合固定胫骨残迹的前交叉韧带（ACL）重建方法,评估其临床效果。方法自2006年10月～2008年12月经关节镜下确诊ACL断裂,胫骨附丽处有残存纤维瘢痕组织79例（79膝）患者,采用保留残迹自体胭绳肌腱单束重建ACL,术中对原ACL残迹不做切除,分离、梳理其近端,用PDS线穿缝;将缝线经股骨道从Rigidfix横孔拉出以维持张力,打人横钉固定。术后随访30～37个月,平均32个月,依Daniel单腿水平跳跃试验、IKDC和Lysholm膝关节评分标准评价疗效。结果所有患者均获随访,2例出现小腿肌支血栓,抗凝治愈;1例切口浅层感染,引流抗炎治愈;1例出现关节纤维化,通过麻醉下手法松解康复。终末随访时稳定性检查：所有患者轴移试验阴性,4例前抽屉试验I。不稳,LachmantestI。阳性15例,Ⅱ。松弛2例。KT2000检查显示膝关节前向松弛度术后差值平均为（5．2±2．4）mm,术前为（10．1±2．7）mm,手术前后有统计学差异（t=6．835,P〈0．05）。关节活动度：7例伸膝滞缺5°,9例屈膝欠缺5°,有10°屈膝欠缺2例。Daniel单腿水平跳跃试验53例（67％）为正常,23例（29％）接近正常,3例异常。综合分析：Lysholm评分术前为（63．27±6．74）分,术后为（91．36±3．72分）,手术前后有统计学差异（t=7．354,P〈0．05）;24例（30％）IKDC评级正常,53例（67％）为接近正常,2例异常。结论本方法能最大程度地保留、并发挥ACL胫骨残端可能的功用,且可避免其发生髁间窝撞击;并能建立稳定的膝关节取得满意的临床疗效。     

自体与同种异体组织重建膝关节前交叉韧带的临床对比研究

目的　观察自体与同种异体移植物关节镜下重建膝关节前交叉韧带 (ACL)的疗效与差异。方法　将 5 3例ACLⅢ度损伤患者随机分为自体组织移植组 (A组 ,n =2 5 )和同种异体组织移植组 (B组 ,n =2 8)。A组包括骨 髌腱 骨 15例 ,4股半腱肌腱或半腱加股薄肌腱重建 10例 ;B组包括骨 髌腱 骨 18例 ,6股半腱加股薄肌腱 4例 ,2股胫后肌腱 4例 ,跟腱骨重建 2例。两组患者术前、术后均行理学检查、Lysholm Tegner和IKDC膝关节综合功能评定及关节活动度测量仪 (KT 2 0 0 0 )检测。随访 12～ 31个月 ,平均 19个月。结果　手术前后两组各项指标有显著差异 (P <0 0 5 ) ;但两组间术后除B组手术耗时短和术后发热时间较长外 ,其它各项指标均无明显统计学差异 (P >0 0 5 )。两组术后健、患侧对比 ,胫骨前移小于 3mm分别达 88%和 86 % ;而 >5mm分别占 4 %和 7 1% ;感染率为 0 %和 3 5 %。结论同种异体与自体移植物重建ACL疗效相近 ,对多发韧带损伤、韧带重建翻修及中老年或运动量较少的患者 ,同种异体移植组织仍是重建ACL良好的替代物     

保留与不保留残端重建前十字韧带的前瞻性随机对照研究

 目的 评估保留与不保留残端对重建前十字韧带（anterior cruciate ligament,ACL）的意义及临床疗效。方法 2010年1月至2012年10月,收治93例残端存留的ACL损伤患者,前瞻性随机将其分为保留组（保留残端）和不保留组（切除残端）。保留组48例,男34例,女14例;平均年龄30.4岁;左侧25例,右侧23例;损伤至手术时间13.5 d;合并内侧半月板损伤7例,外侧半月板损伤16例,内侧副韧带损伤4例。不保留组45例,男33例,女12例;平均年龄28.8岁;左侧22例,右侧23例;损伤至手术时间14.9 d;合并内侧半月板损伤7例,外侧半月板损伤12例,内侧副韧带损伤2例。两组重建ACL移植物均为自体四股腘绳肌腱。术后两组患者分别行膝关节功能评估、稳定性评估、本体感觉功能测量和二次关节镜手术探查。结果 82例患者完成随访,其中保留组42例,随访时间（25.4±1.9）个月;不保留组40例,随访时间（25.2±1.7）个月。IKDC分级：保留组A级32例,B级9例,C级1例;不保留组A级30例,B级8例,C级2例。Lysholm评分：保留组（95.9±5.2）分,不保留组（95.4±1.7）分。Lachman试验：保留组,阴性38例,1度阳性4例;不保留组,阴性36例,1度阳性4例。轴移试验：保留组,阴性37例,1度阳性5例;不保留组,阴性34例,1度阳性6例。KT-1000测量侧-侧差值：保留组（1.1±1.2） mm,不保留组（1.2±0.9） mm。本体感觉测量关节位置觉侧-侧差值：保留组3.6°±1.8°,不保留组3.9°±2.2°。以上指标两组均无明显差异。二次手术探查移植物滑膜覆盖分型,保留组A型11例,B型6例,C型2例,D型2例;不保留组A型10例,B型5例,C型2例,D型2例。结论 保留较不保留残端并使用自体肌腱移植重建ACL对术后膝关节主观功能、稳定性、本体感觉和移植物滑膜覆盖无促进作用。     

自体与异体骨-髌腱-骨移植物重建膝前十字韧带的远期疗效观察

目的 比较自体与异体骨-髌腱-骨(bone-patella tendon-bone,B-PT-B)移植物关节镜下重建膝关节前十字韧带(anterior cruciate ligament,ACL)的远期临床疗效.方法 对66例膝ACL断裂患者分别采用自体与异体B-PT-B移植物重建,其中自体组31例,异体组35例;观察两组手术前后生化、免疫学指标的变化以及全身和膝关节局部反应,以Lysholm评分及Larson评分比较术后疗效.结果 自体组29例获随访,随访时间5～10年,平均7年;异体组32例获随访,随访时间5～6.5年,平均6年.术后两组发热时间无明显差异,术后生化、免疫学指标均无明显异常.Lysholm评分:自体组(93.28±3.12)分,异体组(93.15±3.22)分,两组比较差异无统计学意义(P＞0.05).Lamon评分:自体组(93.12±2.15)分,异体组(92.75±3.25)分,两组比较差异无统计学意义(P＞0.05).术后复查X线片及MRI示:自体组5例出现骨隧道扩大,异体组6例出现骨隧道扩大.术后两组均有1例发生化脓性关节炎;异体组9例冈出现不同程度排斥反应而行镜下冲洗或穿刺冲洗,但无一例取出移植物;异体组1例患者术后移植物发生断裂而行重建术.结论 异体与自体B-PT-B移植物重建ACL远期临床疗效相近,可以获得较为满意的关节活动度及关节稳定性,均为重建ACL的良好移植物.     

自体与异体骨-髌腱-骨重建前交叉韧带临床疗效的比较

目的 比较自体与异体骨．髌腱-骨（B—PT-B）重建前交叉韧带（ACL）的疗效。方法 回顾性分析2002年2月至2006年1月采用B-PT-B术式重建ACL的患者187例,其中有完整随访资料共142例,其中男性93例,女性49例,年龄15～57岁（平均26岁）。按照异体和自体B—PT-B重建进行分组,其中自体组38例,异体组104例。术后随访时行X线和KT-1000检查,并按照IKDC、Lysholm、Irgang、Larson评分进行疗效评价。并采用分项评分对疼痛、肿胀和膝关节松弛度进行评估。结果142例患者随访时间6—43个月,平均24个月,所有患者随访时移植物位置良好,KT-1000检查双侧膝关节前向松弛度差值〈3mm。异体组：IKDC评分活动水平正常85例（81．7％）,Lysholm评分（82．8±8．5）分,Irgang（79．2±7．3）分,Larson（86．7±3．1）分。自体组：IKDC评分活动水平正常29例（76．3％）,Lysholm评分（84．6±9．5）分,Irgang（79．5±7．6）分,Larson（88．9±6．8）分。以上综合评分无显著性差异（P〉0．05）。分项评分中,疼痛评分：异体组（21．4±3．6）分,自体组（16．3±5．2）分（P=0．012）。肿胀评分：异体组（6．7±3．3）分,自体组（10．0±0．0）分（P=0．011）。关节稳定性评分：异体组（14．7±5．1）分,自体组（16．0±6．8）分（P=0．212）。结论 自体与异体B-PT-B重建ACL术后均可取得良好临床疗效。异体重建的总体临床效果接近自体重建,近期疗效预示其前景良好。     

LARS韧带与异体胫前肌腱保残重建损伤后交叉韧带的术后疗效对比研究

[目的]研究LARS人工韧带与异体胫前肌腱保残重建后交叉韧带(PCL)损伤术后的疗效差异,指导临床治疗。[方法]38例PCL损伤并进行重建的患者,根据术中采用移植物种类分成两组:LARS人工韧带组(19例)和异体胫前肌腱组(19例)。所有患者随访2年。评价指标包括:IKDC评分、Lysholm评分、Tegner评分和膝关节稳定度测量。[结果]与术前相比,两组患者术后的关节稳定性和功能指标均有显著改善(P0.05)。同时,LARS人工韧带组患者术后的关节稳定性显著强于异体胫前肌腱组(P0.05),而两组患者术后Lysholm评分、Tegner评分和IKDC评分结果差异无统计学意义(P0.05)。[结论]采用LARS人工韧带比采用异体胫前肌腱重建损伤的PCL更有利于患膝稳定性的恢复。     

Comparison of 2 femoral tunnel drilling techniques in anterior cruciate ligament reconstruction. A prospective randomized comparative study.

Background

To evaluate the length and position of femoral tunnel,and exam whether knee stability and clinical functional outcomes are superior in AMP method.

Methods

From August 2014 to February 2015, we prospectively recruited 104 patients undergoing anterior cruciate ligament reconstruction. They were randomized to anteromedial portal or transtibial method. All patients underwent Lysholm score, International Knee Documentation Committee score,Tegner score at pre-operative and last follow-up point as subjective assessment of clinical function. The Lachman test, the Pivot-shift test and KT-1000 were performed at the last follow-up as a evaluation of knee joint stability. We measured the length of femoral tunnel intraoperatively and at 1?week post-operatively, CT-based three-dimensional reconstruction was used to assess femoral tunnel location.

Results

The average follow-up time of anteromedial portal group was 25.7?±?6.8?months (range:12–36.5?months), and the average follow-up time of the transtibial group was 24.9?±?6.0?months (range:12–37?months). There was no significant difference between the groups pre-operative Lysholm score, IKDC score and Tegner scores. Both groups showed significantly improvement in these clinical function scores at follow up for their ACL reconstruction. However, there was no significant difference in the function scores between the two groups at last follow up. However, the mean femoral tunnel length in the anteromedial portal group was significantly shorter than that in the transtibial group. And tunnel location was significantly lower and deeper with the anteromedial portal technique than with the transtibial technique.

Conclusion

The use of anteromedial portal method resulted in a significantly lower and deeper placement of the femoral tunnel, and a shorter tunnel length compared to the transtibial method. However, there was no statistical difference in terms of clinical function and knee joint stability between the anteromedial portal method and the transtibial method.

Trial registration

Name of the registry: Chinese Clinical Trial Registry.The registration number: ChiCTR1800014874.The date of registration: 12 February, 2018.The study is retrospectively registered.

     

The effect of isometric graft posterior cruciate ligament reconstruction on anterior tibial translation

Eight fresh-frozen cadaver knees were studied to evaluate whether an isometrically placed posterior cruciate ligament (PCL) graft restores normal posterior tibial translation without overconstraining anterior tibial translation. Each knee was tested with a three-axis load cell in the intact state, after PCL sectioning, and after PCL reconstruction. After PCL reconstruction, posterior tibial displacement was restored to values observed in the intact state for all flexion angles except 60 degrees and 90 degrees. Anterior tibial translation was not significantly changed for any of the three states. These results indicate isometric reconstruction of the PCL significantly reduces posterior tibial translation without overconstraining anterior tibial translation.