Double-Bundle Posterior Cruciate Ligament Reconstruction Using a Non-Hardware Suspension Fixation Technique and 8 Strands of Autogenous Hamstring Tendons

Purpose

The purpose of this study was to evaluate the results of double-bundle posterior cruciate ligament (PCL) reconstruction using a non-hardware suspension fixation technique and 8 strands of autogenous hamstring tendons.

Methods

Twenty-two cases of isolated chronic PCL rupture were reconstructed arthroscopically with 8 strands of autogenous hamstring tendons in a double-bundle and 4-tunnel manner. Quadruple-stranded semitendinosus tendon graft and quadruple-stranded gracilis tendon graft were used to reconstruct the anterolateral bundle and posteromedial bundle, respectively. The grafts were fixed by use of a non-hardware suspension fixation technique.

Results

Nineteen patients were followed up for a minimum of 2 years. Before surgery, 15 patients had a 2+ posterior drawer test (PDT) and 4 patients had a 3+ PDT. At a minimum of 2 years after surgery, 17 patients (89.5%) had a negative PDT, 1 patient (5.3%) had a 1+ PDT, and 1 patient (5.3%) had a 2+ PDT. The mean KT-1000 examination results (MEDmetric, San Diego, CA) changed from 9.4 ± 1.8 mm preoperatively to 1.0 ± 1.0 mm postoperatively (P < .001). The stress radiography results changed from 10.6 ± 2.0 mm preoperatively to 2.0 ± 1.2 mm postoperatively (P < .001). According to the International Knee Documentation Committee knee examination form, the results were graded as normal in 15 patients (78.9%), nearly normal in 3 patients (15.8%), and abnormal in 1 patient (5.3%). The International Knee Documentation Committee subjective results increased from 65.6 ± 5.1 to 92.1 ± 3.7 (P < .001), and the Lysholm score increased from 63.5 ± 4.9 to 92.5 ± 4.1 (P < .001). The Tegner score was 5.1 before surgery and 6.3 at the last follow-up on average.

Conclusions

The results of this study showed that arthroscopic double-bundle PCL reconstruction by use of a non-hardware suspension suture fixation technique and 8 strands of autogenous hamstring tendons can yield normal results in 78.9% of patients and nearly normal results in 15.8% at a minimum of 2 years.

Level of Evidence

Level IV, therapeutic case series.

Key Words: Posterior cruciate ligament, Reconstruction, Hamstring tendon, Arthroscopy, Non-hardware fixation