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Original Article| Volume 23, ISSUE 4, P420-427.e2, April 2007

Arthroscopic Reconstruction of the Posterior Cruciate Ligament by Using a Quadriceps Tendon Autograft: A Minimum 5-Year Follow-up

      Purpose: We prospectively assessed 22 consecutively treated patients to determine the effectiveness and safety of arthroscopically assisted posterior cruciate ligament (PCL) reconstruction by using a quadriceps tendon autograft. Methods: Twenty-two patients with isolated PCL injury who underwent PCL reconstruction with a quadriceps tendon autograft were enrolled in the prospective study. The average follow-up period was 66 months (range, 60-76). Follow-up included Lysholm knee scores, Tegner activity scores, International Knee Documentation Committee (IKDC) score, thigh muscle assessment, and radiographic assessment. Results: The mean preoperative Lysholm score for 22 knees was 67 (range, 50 to 75), and the mean postoperative Lysholm score was 89 (range, 75 to 98). Nineteen of 22 patients (86%) displayed good or excellent results in the final assessment. The mean preoperative Tegner score for 22 knees was 3 (range, 2 to 5), whereas the mean postoperative Tegner score was 6 (range, 3 to 9). There were statistically significant improvements in Lysholm score (P = .009), Tegner score (P = .039), postoperative KT-1000 arthrometer (MEDmetric, San Diego, CA) scores (P = .006), final IKDC rating (P = .035), and thigh atrophy and muscle strength (P < .05) when compared with preoperative data. Regarding IKDC final rating, 82% of the patients (18 of 22) were assessed as normal or nearly normal (grade A or B). Conclusions: After follow-up for more than 60 months, the analytical results showed patients achieved satisfactory function after PCL reconstruction by using a quadriceps tendon–patellar bone autograft. This study suggests that a quadriceps tendon autograft is sufficiently large and strong and can achieve good ligament function after reconstruction. Level of Evidence: Level IV, therapeutic study.

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      References

        • Harner C.D.
        • Livesay G.A.
        • Kashiwaguchi S.
        • Fujie H.
        • Choi N.Y.
        • Woo S.L.
        Comparative study of the size and shape of human anterior and posterior cruciate ligaments.
        J Orthop Res. 1995; 13: 429-434
        • Gollehon D.L.
        • Torzilli P.A.
        • Warren R.F.
        The role of the posterolateral and cruciate ligaments in the stability of the human knee.
        J Bone Joint Surg Am. 1987; 69: 233-242
        • Fowler P.J.
        • Messieh S.S.
        Isolated posterior cruciate ligament injuries in athletes.
        Am J Sports Med. 1987; 15: 553-557
        • Shelbourne K.D.
        • Davis T.J.
        • Patel D.V.
        The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries.
        Am J Sports Med. 1999; 27: 276-283
        • Keller P.M.
        • Shelbourne K.D.
        • McCarroll J.R.
        • Rettig A.C.
        Non-operatively treated isolated posterior cruciate ligament injuries.
        Am J Sports Med. 1993; 21: 132-136
        • Rubinstein Jr, R.A.
        • Shelbourne K.D.
        • McCarroll J.R.
        • et al.
        The accuracy of the clinical examination in the setting of posterior cruciate ligament injury.
        Am J Sports Med. 1994; 22: 550-557
        • Torg J.S.
        • Barton T.M.
        • Pavlov H.
        • et al.
        Natural history of the posterior cruciate ligament-deficient knee.
        Clin Orthop Relat Res. 1989; 246: 208-216
        • Kim S.J.
        • Kim H.K.
        • Kim H.J.
        Arthroscopic posterior cruciate ligament reconstruction using a one-incision technique.
        Clin Orthop Realt Res. 1999; 359: 156-166
        • Chen C.H.
        • Chen W.J.
        • Shih C.H.
        Arthroscopic reconstruction of the posterior cruciate ligament: A comparison of quadriceps tendon autograft and quadruple hamstring tendon graft.
        Arthroscopy. 2002; 18: 603-612
        • Chen C.H.
        • Chen W.J.
        • Shih C.H.
        Arthroscopic reconstruction of the posterior cruciate ligament with quadruple hamstring tendon graft: A double fixation method.
        J Trauma. 2002; 52: 938-945
        • Lysholm J.
        • Gillquist J.
        Evaluation of knee ligament surgery results with a special emphasis on use of a scoring scale.
        Am J Sports Med. 1982; 10: 150-154
        • Tegner Y.
        • Lysholm J.
        Rating system in the evaluation of knee ligament injuries.
        Clin Orthop Relat Res. 1985; 198: 43-49
        • Hefti F.
        • Muller W.
        • Jakob R.P.
        • Staubli H.U.
        Evaluation of knee ligament lesions with the IKDC form.
        Knee Surg Sports Traumatol Arthrosc. 1993; 1: 226-234
      1. Daniel D.M. Akeson W. O’Conner J. Knee ligaments-structure, function, injury, and repair. Raven, New York1990
        • Flandry F.
        • Hunt J.P.
        • Terry G.C.
        • Hughston J.C.
        Analysis of subjective knee complaints using visual analog scales.
        Am J Sports Med. 1991; 19: 112-118
        • Ahlback S.
        Osteoarthritis of the knee.
        Acta Radiol. 1968; 277: 7-72
        • Shino K.
        • Horibe S.
        • Nakata K.
        • et al.
        Conservative treatment of isolated injuries to the posterior cruciate ligament in athletes.
        J Bone Joint Surg Br. 1995; 77: 895-900
        • Dandy D.J.
        • Pusey R.J.
        The long-term results of unrepaired tears of the posterior cruciate ligament.
        J Bone Joint Surg Br. 1982; 64: 92-94
        • Pinczewski L.A.
        • Thuresson P.
        • Otto D.
        • Nyquist F.
        Arthroscopic posterior cruciate ligament reconstruction using four-strand hamstring tendon graft and interference screws.
        Arthroscopy. 1997; 13: 661-665
        • Deehan D.J.
        • Salmon L.J.
        • Russell V.J.
        • Pinczewski L.A.
        Endoscopic single-bundle cruciate ligament reconstruction: Results at minimum 2-year follow-up.
        Arthroscopy. 2003; 19: 955-962
        • Wang C.J.
        • Chen H.S.
        • Huang T.W.
        Outcome of arthroscopic single bundle reconstruction for complete posterior cruciate ligament tear.
        Injury. 2003; 34: 747-751
        • Sekiya J.K.
        • West R.V.
        • Ong B.C.
        • Irrgang J.J.
        • Fu F.H.
        • Harner C.D.
        Clinical outcome after isolated arthroscopic single-bundle posterior cruciate ligament reconstruction.
        Arthroscopy. 2005; 21: 1042-1050
        • Mariani P.P.
        • Adriani E.
        • Adriani E.
        • Maresca G.
        Arthroscopic posterior cruciate ligament reconstruction with bone-tendon-bone patellar graft.
        Knee Surg Sports Traumatol Arthrosc. 1997; 5: 239-344
        • Shelton W.R.
        • Papendick L.
        • Dukes A.D.
        Autograft versus allograft anterior ligament reconstruction.
        Arthroscopy. 1997; 13: 446-449
        • Buck B.E.
        • Malinin T.I.
        • Brown M.D.
        Bone transplantation and human immunodeficiency virus: An estimated risk of acquired immunodeficiency syndrome (AIDS).
        Clin Orthop Relat Res. 1989; 240: 129-136
        • Peterson R.K.
        • Shelton W.R.
        Allograft versus autograft patellar tendon anterior cruciate ligament reconstruction: A 5-year follow-up.
        Arthroscopy. 2001; 17: 9-13
        • Kim S.J.
        • Min B.H.
        Arthroscopic intraarticular interference screw technique of posterior cruciate ligament reconstruction: One-incision technique.
        Arthroscopy. 1994; 10: 319-323
        • Clancy Jr, W.G.
        • Pandya R.D.
        Posterior cruciate ligament reconstruction with patellar tendon autograft.
        Clin Sports Med. 1994; 13: 561-570
        • Marshall J.L.
        • Warren R.F.
        • Wickiewicz T.
        • et al.
        The ACL: A technique of repair and reconstruction.
        Clin Orthop Relat Res. 1979; 143: 97-106
        • Stäubli H.U.
        The quadriceps tendon-patellar bone construct for ACL reconstruction.
        Sports Med Arthrosc Rev. 1997; 5: 59-67
        • Fulkerson I.P.
        • Langeland R.
        An alternative cruciate reconstruction graft: The central quadriceps tendon.
        Arthroscopy. 1995; 11: 252-254
        • Stäubli H.U.
        • Schatzmann L.
        • Brunner P.
        • et al.
        Quadriceps tendon and patellar ligament: Cryosectional anatomy and structural properties in young adults.
        Knee Surg Sports Trauma Arthrosc. 1996; 4: 100-110
        • Harris N.L.
        • Smith D.A.
        • Lamoreaux L.
        • et al.
        Central quadriceps tendon for anterior cruciate ligament reconstruction.
        Am J Sports Med. 1997; 25: 23-28