One-stage arthroscopically assisted anterior and posterior cruciate ligament reconstruction☆

Abstract 

Purpose: To retrospectively evaluate 15 consecutive patients who underwent simultaneous isolated, arthroscopically assisted anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction. Type of Study: Case series. Methods: A bone–patellar tendon–bone autograft was used as the PCL substitute and doubled hamstring tendons were used as the ACL graft. The IKDC evaluation form and the HSS, Lysholm, and Tegner clinical rating scales were used to make clinical evaluations. Anteroposterior translation was measured with the KT-2000 arthrometer and stress view radiography. Results: At final IKDC evaluation, 3 patients (20%) were graded A, 7 (46.7%) were graded B, 3 (20%) were graded C, and 1 patient (6.7%) was graded D. One patient underwent revision surgery in another hospital for severe postoperative residual laxity. Two C-graded patients had an unsatisfactory outcome as a result of serious complications related to knee injuries. All patients with a grade A or B returned to sports activity. At stress view examination, mean posterior side-to-side translation measured at the lateral tibial plateau was 5.8 ± 1.1 mm and the mean translation at the medial tibial plateau was 7.3 ± 1.5 mm; the mean anterior dislocation was 3.3 ± 0.4 mm. The preoperative HSS score rated an average of 32 ± 9. Postoperatively, the average score reached was 89.6 ± 8.3. The preoperative Lysholm score was 65.5 ± 9.1 (range, 48 to 78) in patients with chronic lesions and at follow-up was 95.1 ± 4.5 (range, 88 to 100). The average Tegner activity score decreased in patients with chronic lesions from 6.9 ± 1.7 (range, 4 to 9) before injury to 5.5 ± 1.6 (range, 2 to 9) at follow-up (P = .053 ). At follow-up, 7 patients (50%) returned to their preinjury level after surgery. Conclusions: These results show the effectiveness and safety of simultaneous arthroscopic reconstruction of both cruciate ligaments using autografts that can adequately restore satisfactory stability, even in the presence of minimal peripheral laxity (1° or 2°). We conclude that the use of autografts can restore ligament function with good patient compliance and without significant surgical complications.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 7 (September), 2001: pp 700–707

Keywords:  Anterior cruciate ligament, Posterior cruciate ligament, Arthroscopy, Knee dislocation