Abstract
Purpose: To evaluate the clinical outcome and the incidence of degenerative changes in 25
patients with 25 knees undergoing surgical reconstruction for combined posterior cruciate
ligament (PCL) and posterolateral instabilities of the knee with 2–5-year follow-up.
Materials and methods: This series included 16 men and 9 women with an average age of 28 years. The average
time from injury to surgery was 10 (range 2–24) months, and the average follow-up
time was 40 (range 32–60) months. The mechanisms of injury were 88% due to trauma,
and 12% sports related. Arthroscopic single bundle posterior cruciate reconstruction
and reconstruction of the posterolateral structures were performed in all cases. Clinical
evaluations included functional assessment, ligament laxity and radiograph of the
knee. The results were correlated with the duration of injury, the severity of ligament
laxity and the follow-up time.
Results: The overall results were 68% satisfactory (28% excellent and 40% good) and 32% unsatisfactory
(20% fair and 12% poor). Despite functional improvement, complete restoration of ligament
stability was observed in only 44% of the knees, while 36% of the knees showed mild
(<5 mm), and 20% moderate (5–10 mm) ligament laxity. There was no correlation of the clinical outcome with the duration
from injury to surgery. The incidence of degenerative changes of the affected knee
was 44%, and the rate correlated with the severity of ligament laxity, the duration
from injury to surgery and the length of follow-up time.
Conclusion: Despite the functional improvement, the currently devised surgical techniques only
have modest success in restoration of ligament stability in knees with combined PCL
and posterolateral instabilities. Further improvement in surgical technique including
a dynamic reconstruction of the popliteus tendon complex seems necessary. The rate
of degenerative changes of the affected knee appeared proportional to the duration
of injury, the severity of ligament laxity and the length of follow-up time. The results
of this study led us to recommend early surgical reconstruction for knees with combined
posterior cruciate and posterolateral instabilities.
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References
Ahlbäck S. Osteoarthritis of the knee. A radiographic investigation. Acta Radiol 1968;(Suppl 277):7–72.
- Acute combined posterior cruciate and posterolateral instabilities of the knee.Am. J. Sports Med. 1984; 12: 204-208
- Clinical outcome of arthroscopic posterior cruciate ligament-plasty.Unfallchirurg. 1999; 102: 54-358
- Ipsilateral knee injury with femoral fracture. Examination under anesthesia and arthroscopic evaluation.Clin. Orthop. 1994; 300: 178-182
- The natural history of rupture of the posterior cruciate ligament.Rev. Chir. Orthop. Reparatrice. Appar. Mot. 1988; 74: 35-43
- Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction.Arthroscopy. 1996; 12: 521-530
Fleming Jr RE, Blatz DJ, McCarroll JR. Posterior problems in the knee; posterior cruciate insufficiency and posterolateral rotatory insufficiency. Am J Sports Med 1981;9(2):107–13.
- The role of the posterolateral and cruciate ligament in the stability of the knee.J. Bone Joint Surg. 1987; 69: 233-242
- Limits of movement in the human knee.J. Bone Joint Surg. 1988; 70: 88-97
- Chronic posterolateral rotatory instability of the knee.J. Bone Joint Surg. 1985; 67: 351-359
- The posterolateral drawer test and external rotational recurvatum test for posterolateral rotatory instability of the knee.Clin. Orthop. 1980; 147: 82-87
- Arthroscopic posterior cruciate ligament reconstruction using a one-incision technique.Clin. Orthop. 1999; 359: 156-166
- Chronic instability after posterior cruciate ligament injury. Tactics, techniques, and results.Unfallchirurg. 1999; 102: 824-838
- The posterior cruciate ligament.Arch. Orthop. Trauma Surg. 1985; 104: 53-56
- Surgical reconstruction of severe chronic posterolateral complex injuries of the knee using allograft tissues.Am. J. Sports Med. 1995; 23: 2-12
- Surgical restoration to treat chronic deficiency of the posterolateral complex and cruciate ligament of the knee joint.Am. J. Sports Med. 1996; 24: 415-426
- Pathomechanics of posterior sag of the tibia in posterior cruciate ligament deficient knees. An experimental study.Am. J. Sports Med. 1988; 16: 630-636
- Detailed analysis of proprioception in normal and ACL-deficient knees.J. Bone Joint. Surg. (Br). 1999; 81-B: 764-768
- The role of cruciate ligaments in maintaining knee joint stability.Clin. Orthop. 1987; 215: 65-71
- Injuries to the posterior cruciate ligament: diagnosis and treatment of early injuries and reconstruction of late instability.Clin. Orthop. 1980; 147: 76-81
- Anatomy, biomechanics and physical findings in posterolateral knee instability.Clin. Sports Med. 1994; 13: 599-614
- Operative treatment of posterolateral instability of the knee.Clin. Sports Med. 1994; 13: 615-627
- The role of the cruciate and posterolateral ligaments in stability of the knee.Am. J. Sports Med. 1995; 23: 436-441
- Posterior cruciate ligament.Arch. Orthop. Trauma. Surg. 2000; 120: 525-528
- Effects of knee position, graft tension and mode of fixation in posterior cruciate ligament reconstruction.Arthroscopy. 2002; 18: 496-500
Article info
Publication history
Accepted:
April 6,
2002
Identification
Copyright
© 2002 Elsevier Science Ltd. Published by Elsevier Inc. All rights reserved.
