The purpose of this study was to confirm the contribution of long leg cast immobilization to posterior stability after reconstruction of isolated posterior cruciate ligament (PCL) injuries.
Of 84 patients who underwent arthroscopic PCL reconstruction between November 2006 and December 2009, 44 patients were randomly assigned to 2 groups and analyzed prospectively. For 22 patients (the cast group), long leg cast immobilization was applied until postoperative week 5 and then a 0° locking brace was worn until week 12. Full weight bearing was allowed immediately after operation. For the other 22 patients (the brace group), only a 0° locking brace was applied until postoperative week 12 without cast immobilization. Range of motion (ROM), clinical scores, Telos device (Telos, Marburg, Germany) posterior stress radiographic assessment results and International Knee Documentation Committee (IKDC) grades of both groups were analyzed preoperatively and at postoperative years 1 and 2.
The mean preoperative side-to-side difference on Telos posterior stress radiographs was 11.3 ± 2.5 mm in the cast group and 12.7 ± 2.1 mm in the brace group, revealing no differences between the 2 groups (P = .743), but postoperatively the mean difference measured 2.5 ± 1.9 mm and 4.8 ± 2.4 mm, respectively, showing a significantly smaller difference in the cast group (P = .004); the improvement was 8.8 mm and 7.9 mm, respectively, and was statistically significant (P = .021). Preoperative IKDC grades were not different between the 2 groups (P > .05), but 2 years postoperatively, the cast group showed a significantly better distribution of grades (P = .012). The mean ROM, Lysholm scores, IKDC subjective scores, and Tegner scores 2 years postoperatively were not significantly different between the 2 groups (P > .05).
The patients immobilized with long leg casts until 5 weeks after PCL reconstruction showed significantly better results in Telos posterior stress radiographs and distribution of IKDC grades 2 years postoperatively and did not show limited ROM when compared with the patients who wore braces only. However, IKDC subjective scores were not found to be different between the 2 groups.
Level of Evidence
Level I, prospective randomized comparative study.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Arthroscopy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Posterior cruciate ligament: Anatomy, biomechanics, and outcomes.Am J Sports Med. 2012; 40: 222-231
- Single-bundle versus double-bundle posterior cruciate ligament reconstruction: Scientific rationale and surgical technique.Instr Course Lect. 2006; 55: 497-507
- Single-bundle versus double-bundle posterior cruciate ligament reconstruction. arthroscopy.Arthroscopy. 2009; 25: 1470-1477
- Rehabilitation of isolated and combined posterior cruciate ligament injuries.Clin Sports Med. 1994; 13: 649-677
- The knee: Form, function, and reconstruction.Springer, Berlin1983
- Posterior cruciate ligament rehabilitation: How slow should we go?.Arthroscopy. 2008; 24: 234-235
- Current concepts review: The posterior cruciate ligament.J Knee Surg. 2010; 23: 61-72
- Active non-operative treatment of acute isolated posterior cruciate ligament injury with cylinder cast immobilization.Knee Surg Sports Traumatol Arthrosc. 2008; 16: 729-733
- Clinical outcomes after isolated arthroscopic single-bundle posterior cruciate ligament reconstruction.Arthroscopy. 2005; 21: 1042-1050
- Cruciate ligament forces in the human knee during rehabilitation exercises.Clin Biomech (Bristol, Avon). 2000; 15: 176-187
- Evaluation and treatment of posterior cruciate ligament injuries: Revisited.Am J Sports Med. 2004; 32: 1765-1775
- Isolated posterior cruciate ligament reconstruction: Is non-aggressive rehabilitation the right protocol?.Orthop Traumatol Surg Res. 2010; 96: 256-262
- Evaluation of clinical and magnetic resonance imaging results after treatment with casting and bracing for the acutely injured posterior cruciate ligament.Arthroscopy. 2011; 27: 1679-1687
- Arthroscopic double-bundle augmentation of posterior cruciate ligament using split Achilles allograft.Arthroscopy. 2005; 21: 1436-1442
- A prospective randomized study comparing arthroscopic single-bundle and double-bundle posterior cruciate ligament reconstructions preserving remnant fibers.Am J Sports Med. 2011; 39: 474-480
- Biomechanical evaluation of double bundle augmentation of posterior cruciate ligament using finite element analysis.Clin Biomech (Bristol, Avon). 2010; 25: 1042-1046
- Healing of the patellar tendon autograft after posterior cruciate ligament reconstruction—a process of ligamentization? An experimental study in a sheep model.Am J Sports Med. 1992; 20: 558-566
- Staging of patellar tendon autograft healing after posterior cruciate ligament reconstruction.Clin Orthop. 1993; 286: 271-282
- Serial magnetic resonance imaging evaluation of the patellar tendon after posterior cruciate ligament reconstruction.Arthroscopy. 2002; 18: 38-45
- Dependence of cruciate-ligament loading on muscle forces and external load.J Biomech. 1997; 30: 1015-1024
- A musculoskeletal model of the knee for evaluating ligament forces during isometric contractions.J Biomech. 1997; 30: 163-176
- Pattern of anterior cruciate ligament force in normal walking.J Biomech. 2004; 37: 797-805
- Excessive compression of the human tibio-femoral joint causes ACL rupture.J Biomech. 2005; 38: 2311-2316
- Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared.J Bone Joint Surg Br. 1994; 76: 745-749
- Importance of tibial slope for stability of the posterior cruciate ligament deficient knee.Am J Sports Med. 2007; 35: 1443-1449
- Effects of increasing tibial slope on the biomechanics of the knee.Am J Sports Med. 2004; 32: 376-382
- Comparison of tibiofemoral joint forces during open-kinetic-chain and closed-kinetic-chain exercises.J Bone Joint Surg Am. 1993; 75: 732-739
- Rehabilitation of the multiple-ligament-injured knee.Clin Sports Med. 2000; 19: 545-571
- Anterior positioning of tibia during motion after anterior cruciate ligament injury.Med Sci Sports Exerc. 2001; 33: 1063-1072
Published online: January 25, 2013
Accepted: October 16, 2012
Received: March 31, 2012
Supported by a research grant from Smith & Nephew, Andover, MA.
The authors report that they have no conflicts of interest in the authorship and publication of this article.
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.