Clinical research for reason analysis of posterior cruciate ligament reconstruction revision

Abstract

To study and analyze the clinical factors contributing to the failure of primary posterior cruciate ligament (PCL) reconstruction and to guide our clinical treatment. From November 2001 to May 2007, 8 patients underwent PCL reconstruction revision because of pathological instability after primary PCL reconstruction. And the clinical failure factors of the primary reconstruction were analyzed. One case was reconstructed with bone-patellar tendon-bone (B-T-B) autografts, 7 cases with hamstring tendon autograft. The most probable causes of failure were improper graft placement in 7 cases (both femoral bone tunnels were behind the predicted one and tibial tunnels were in front of the predicted one). The reconstructed PCL in 4 cases ruptured absolutely and had been absorbed. Three cases had obviously loosen but still partly linked reconstructed ligament. These 8 cases all received primary PCL revision reconstruction. Among them, 6 cases were reconstructed with autograft (using a single-bundle quadruple hamstring graft in 3 cases, double-bundle quadruple hamstring graft in 1 case, single-bundle B-T-B autograft in 2 case), and 2 cases were reconstructed with allograft (using a single-bundle and a double-bundle B-T-B allograft reconstruction). Incorrect bone tunnel placement is the major factor contributing to the surgical failure in many reasons for the failure of PCL reconstruction. So, it might be suggested that there is a great need for a more precise anatomical bone tunnel placement.