Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up

Abstract

Purpose: This study presents the 2- to 10-year (24 to 120 month) results of 41 chronic arthroscopically assisted combined posterior cruciate ligament (PCL)-posterolateral reconstructions evaluated preoperatively and postoperatively using Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales, KT-1000 arthrometer testing, stress radiography, and physical examination. Type of study:Case series. Methods:This study population included 31 men and 10 women with 24 left and 17 right chronic PCL-posterolateral knee injuries with functional instability. The knees were assessed before and after surgery with arthrometer testing, 3 different knee ligament rating scales, stress radiography, and physical examination. PCL reconstructions were performed using the arthroscopically assisted single femoral tunnel-single bundle transtibial tunnel PCL reconstruction technique using fresh-frozen Achilles tendon allografts in all 41 cases. In all 41 cases, posterolateral instability reconstruction was performed with combined biceps femoris tendon tenodesis, and posterolateral capsular shift procedures. Results: Postoperative physical examination revealed normal posterior drawer and tibial stepoff in 29 of 41 (70%) knees. Posterolateral stability was restored to normal in 11 of 41 (27%) knees, and tighter than normal knee was found in 29 of 41(71%) knees evaluated with the external rotation thigh foot angle test. A 30° varus stress testing was normal in 40 of 41 (97%) knees, and grade 1 laxity in 1 of 41 (3%) knees. Postoperative KT-1000 arthrometer testing mean side to side difference measurements were 1.80 mm (PCL screen) and 2.11 mm (corrected posterior; P = .001). The postoperative stress radiographic mean side-to-side difference measurement measured at 90° of knee flexion and 32 lb of posterior directed force applied to the proximal tibia using the Telos device was 2.26 mm ( P = .001). Postoperative Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scale mean values were 91.7, 4.92, and 88.7, respectively ( P = .001). All objective parameters showed a statistically significant improvement from preoperative status. Conclusions: Chronic combined PCL-posterolateral instabilities can be successfully treated with arthroscopic PCL reconstruction using fresh-frozen Achilles tendon allograft combined with posterolateral corner reconstruction using biceps tendon tenodesis combined with posterolateral capsular shift procedure. Statistically significant improvement is noted ( P = .001) from the preoperative condition at 2 to 10 years’ follow-up evaluation using objective parameters of knee ligament rating scales, arthrometer testing, stress radiography, and physical examination. Level of Evidence:Level IV, case series (no historical or control group).