A Clinical and Radiographic Comparison of Anteromedial and Anterolateral Trans-tibial PCL Reconstruction

Dong-Chul Lee; Oog-Jin Shon; Chul-Hyun Park; Young-Jin Ko

doi:10.4055/jkoa.2011.46.5.419

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Lee, Shon, Park, and Ko: A Clinical and Radiographic Comparison of Anteromedial and Anterolateral Trans-tibial PCL Reconstruction

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(5): 419-425.

Published online: 31 October 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.5.419

A Clinical and Radiographic Comparison of Anteromedial and Anterolateral Trans-tibial PCL Reconstruction

Dong-Chul Lee, M.D., Oog-Jin Shon, M.D., Chul-Hyun Park, M.D., Young-Jin Ko, M.D.

Department of Orthopedic Surgery, Yeungnam University Hospital, Daegu, Korea.

Correspondence to: Oog-Jin Shon, M.D. Department of Orthopaedic Surgery, Yeungnam University Hospital, 317-1, Daemyong-dong, Nam-gu, Daegu 705-717, Korea. TEL: +82-53-620-3640, FAX: +82-53-628-4020, ossoj@med.yu.ac.kr

Received 24 August 2010 Accepted 9 June 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this clinical study was to compare the outcomes of anteromedial and anterolateral trans-tibial approachs in arthroscopic PCL reconstruction.

Materials and Methods

Between January 2004 and December 2007, 40 patients (40 knees, which underwent PCL reconstruction, with a follow-up of more than 1.6 years) were surveyed in the areas of clinical and radiographic results and individual satisfaction. Forty knees with isolated PCL rupture were reviewed retrospectively. They were divided into two groups of equal size according to the transtibial approach used: anteromedial or anterolateral. The evaluation parameters included activities and functional outcomes using the Lysholm and Tegner score, single leg hop test and individual satisfaction using the IKDC score. Radiographic results were analyzed using the posterior drawer radiography with manual methods and the Telos device, and the changes in the tibial tunnel diameter were measured.

Results

Both groups showed improvements in the Lysholm and Tegner score. Both groups showed improvements in the single leg hop test. As far as individual satisfaction evaluation using the IKDC score was concerned, 85% of cases in both groups improved to nearly normal. Both groups showed improvements on the posterior drawer radiography. Tibial tunnel enlargement was also seen. The results of both groups demonstrated no statistically significant difference.

Conclusion

Both groups showed improvements in the clinical and radiographic results and in the individual satisfaction score. However, results of both groups demonstrated no statistically significant difference. Therefore, the long term results need to be studied.

Keywords: anteromedial, anterolateral, tibia tunnel, PCL reconstruction

Figures and Tables

Figure 1

Schematic diagrams of the knee in anteroposterior projection (A) and lateral projection (B) show anteromedial trans-tibia approach in AM and anterolateral approach in AL. Starting point of the tibial tunnel is 15 mm medially away from the tibial tuberosity in AM and 20 mm laterally away from the tibial tuberosity. The tunnel is made as 45° angle with respect to the joint line in AM and 50° angle with respect to the joint line in AL.

Figure 2

Postoperative radiographs of anteromedial (A) and anterolateral (B) transtibial PCL reconstruction.

Table 1

Patient Characteristics

Table 2

Change of Posterior Grading - Telos Stress Device (15 lb)

A-M, anteromedial; A-L, anterolateral; ( )=%.

References

1. Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am. 1980. 62:259–270.

2. Chuang TY, Ho WP, Chen CH, Liao YS, Chen WJ. Double-bundle posterior cruciate ligament reconstruction using inlay technique with quadriceps tendon-bone autograft. Arthroscopy. 2004. 20:e23–e28.

3. Becker R, Röpke M, Nebelung W. Clinical outcome of arthroscopic posterior cruciate ligament-plasty. Unfallchirurg. 1999. 102:354–358.

4. Fanelli GC, Edson CJ. Posterior cruciate ligament injuries in trauma patients: Part II. Arthroscopy. 1995. 11:526–529.

5. Kim SJ, Kim HK, Kim HJ. Arthroscopic posterior cruciate ligament reconstruction using a one-incision technique. Clin Orthop Relat Res. 1999. (359):156–166.

6. Sekiya JK, West RV, Ong BC, Irrgang JJ, Fu FH, Harner CD. Clinical outcomes after isolated arthroscopic single-bundle posterior cruciate ligament reconstruction. Arthroscopy. 2005. 21:1042–1050.

7. Bach BR, Daluga DJ, Mikosz R, Andriacchi TP, Seidl R. Force displacement characteristics of the posterior cruciate ligament. Am J Sports Med. 1992. 20:67–71.

8. Rong GW, Wang YC. The role of cruciate ligaments in maintaining knee joint stability. Clin Orthop Relat Res. 1987. (215):65–71.

9. Harner CD, Xerogeanes JW, Livesay GA, et al. The human posterior cruciate ligament complex: an interdisciplinary study. Ligament morphology and biomechanical evaluation. Am J Sports Med. 1995. 23:736–745.

10. Ohkoshi Y, Nagasaki S, Yamamoto K, et al. A new endoscopic posterior cruciate ligament reconstruction: minimization of graft angulation. Arthroscopy. 2001. 17:258–263.

11. Huang TW, Wang CJ, Weng LH, Chan YS. Reducing the "killer turn" in posterior cruciate ligament reconstruction. Arthroscopy. 2003. 19:712–716.

12. Kim SJ, Chang JH, Kang YH, Song DH, Park KY. Clinical comparison of anteromedial versus anterolateral tibial tunnel direction for transtibial posterior cruciate ligament reconstruction: 2 to 8 years' follow-up. Am J Sports Med. 2009. 37:693–698.

13. Wong T, Wang CJ, Weng LH, et al. Functional outcomes of arthroscopic posterior cruciate ligament reconstruction: comparison of anteromedial and anterolateral trans-tibia approach. Arch Orthop Trauma Surg. 2009. 129:315–321.

14. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985. (198):43–49.

15. Trickey EL. Injuries to the posterior cruciate ligament: diagnosis and treatment of early injuries and reconstruction of late instability. Clin Orthop Relat Res. 1980. (147):76–81.

16. Covey CD, Sapega AA. Injuries of the posterior cruciate ligament. J Bone Joint Surg Am. 1993. 75:1376–1386.

17. Ahn JH, Chung YS, Oh I. Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal. Arthroscopy. 2003. 19:101–107.

18. Keller PM, Shelbourne KD, McCarroll JR, Rettig AC. Nonoperatively treated isolated posterior cruciate ligament injuries. Am J Sports Med. 1993. 21:132–136.

19. Berg EE. Posterior cruciate ligament tibial inlay reconstruction. Arthroscopy. 1995. 11:69–76.

20. Bergfeld JA, McAllister DR, Parker RD, Valdevit AD, Kambic HE. A biomechanical comparison of posterior cruciate ligament reconstruction techniques. Am J Sports Med. 2001. 29:129–136.

21. Oakes DA, Markolf KL, McWilliams J, Young CR, McAllister DR. Biomechanical comparison of tibial inlay and tibial tunnel techniques for reconstruction of the posterior cruciate ligament. Analysis of graft forces. J Bone Joint Surg Am. 2002. 84:938–944.

22. McAllister DR, Markolf KL, Oakes DA, Young CR, McWilliams J. A biomechanical comparison of tibial inlay and tibial tunnel posterior cruciate ligament reconstruction techniques: graft pretension and knee laxity. Am J Sports Med. 2002. 30:312–317.

23. Burns WC 2nd, Draganich LF, Pyevich M, Reider B. The effect of femoral tunnel position and graft tensioning technique on posterior laxity of the posterior cruciate ligament-reconstructed knee. Am J Sports Med. 1995. 23:424–430.

24. Apsingi S, Nguyen T, Bull AM, Unwin A, Deehan DJ, Amis AA. Control of laxity in knees with combined posterior cruciate ligament and posterolateral corner deficiency: comparison of single-bundle versus double-bundle posterior cruciate ligament reconstruction combined with modified Larson posterolateral corner reconstruction. Am J Sports Med. 2008. 36:487–494.

25. Nyland J, Hester P, Caborn DN. Double-bundle posterior cruciate ligament reconstruction with allograft tissue: 2-year postoperative outcomes. Knee Surg Sports Traumatol Arthrosc. 2002. 10:274–279.

26. Ferkel RD, Fox JM, Wood D, Del Pizzo W, Friedman MJ, Snyder SJ. Arthroscopic "second look" at the GORE-TEX ligament. Am J Sports Med. 1989. 17:147–152.

27. Good L, Tarlow SD, Odensten M, Gillquist J. Load tolerance, security, and failure modes of fixation devices for synthetic knee ligaments. Clin Orthop Relat Res. 1990. (253):190–196.

28. Kim SJ, Shin JW, Lee CH, et al. Biomechanical comparisons of three different tibial tunnel directions in posterior cruciate ligament reconstruction. Arthroscopy. 2005. 21:286–293.

29. Ahn JH, Bae JH, Lee YS, Choi K, Bae TS, Wang JH. An anatomical and biomechanical comparison of anteromedial and anterolateral approaches for tibial tunnel of posterior cruciate ligament reconstruction: evaluation of the widening effect of the anterolateral approach. Am J Sports Med. 2009. 37:1777–1783.

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