Arthroscopic Posterior Cruciate Ligament Research Articles

What Is the Optimal Position of Low Tibial Tunnel in Transtibial Posterior Cruciate Ligament Reconstruction? A Quantitative Analysis Based on 2D CT Images and 3D Knee Models.

There is currently no consensus on the optimal placement of the low tibial tunnel for posterior cruciate ligament (PCL) reconstruction. This study aimed to perform the quantitative measurements of the optimal tangential low tibial-tunnel (OTLT) parameters based on 2D CT images and 3D virtual knee models and expect to provide reference data for clinical creation of the OTLT during the arthroscopic transtibial PCL reconstruction. This was a retrospective CT image study. A total of 101 patients between January 2018 and December 2020 were included in our study for analysis. The CT image data of included patients were imported into Mimics software to create the 3D knee models, and the OTLT for PCL reconstruction was simulated on 2D CT images and 3D knee models, respectively. With that, the distances of the tunnel's entry (ADT) and exit points (BDT) to the tibial plateau, the length of the tunnel (LT), and the angle of the tunnel (AT) were measured. Variables were compared using the independent t-test or the Mann-Whitney u test. Correlation analyses between the data and patient demographic factors were performed using the Pearson or Spearman correlation analysis. One-way ANOVA was used to compare differences among height subgroups. The mean ADT, LT, and AT on 2D CT images were 57.96 ± 5.34 mm, 39.92 ± 5.49 mm, and 37.23° ± 4.57° respectively, smaller than the values on 3D knee models (61.86 ± 6.80 mm, 45.56 ± 4.27 mm, and 48.17° ± 6.12°, all p values < 0.001). While the mean BDT on 2D CT images was significantly larger than 3D knee models (35.28 ± 3.07 mm vs. 29.72 ± 3.00 mm, p < 0.001). The BDT showed larger in males than females, the LT showed larger in the taller group, and the AT seemed to be larger in females and shorter people (all p values < 0.05). The quantitative parameters of the OTLT based on 2D CT images and 3D knee models can be used as reference data for clinical surgeons to build an anteromedial OTLT during the arthroscopic transtibial PCL reconstruction.

Posterior Cruciate Ligament Reconstruction Improves Sexual Health Postoperatively

PurposeThe purpose of this study was to investigate changes in sexual function and quality of life following arthroscopic posterior cruciate ligament (PCL) reconstruction. MethodsPatients aged between 18 and 45 years who underwent PCL reconstruction were considered for inclusion. At the time of hospital admission, each patient was asked to complete the New Sexual Satisfaction Scale-Short Form (NSSS-S), before injury (preinjury) and at the time of hospital admission (preoperative). In addition, patients were followed for a minimum of 24 months (final follow-up). Quality of life was measured using the Anterior Cruciate Ligament Quality of Life Questionnaire (ACL-QOL) at hospital admission (preoperative) and at the 24-month follow-up visit (final follow-up). ResultsA total of 35 patients were included in the study; 24 (68.6%) were male, and 11 were female (31.4%). The mean age at the time of surgery was 29.23 ±7.52 years, and the mean follow-up duration was 52.97 ±22.69 months. In all patients, the hamstring tendon was used. Sexual activity at the last follow-up visit was significantly different from that preoperatively (p=0.024), while no difference was observed between the preinjury and last follow-up values (p=0.243). Sexual activity was more frequent before injury than preoperatively (p=0.009). Quality of life at the last follow-up visit was significantly better than that preoperatively (p<0.001). ConclusionsReconstructive surgery after PCL injury improves the sexual health of patients regardless of age or sex.

Surgical Showdown: Comparative Evaluation of Functional Outcomes and Complications in Isolated Tibial Avulsion: A Comprehensive Analysis of Open and Arthroscopic Fixation over a 2-Year Period: A Systematic Review

Introduction: Tibia avulsion fractures of the posterior cruciate ligament (PCL) can be treated surgically with arthroscopic repair or open reduction and internal fixation. The approach is simpler but risks soft tissue and neurovascular injury due to the difficulty of accessing the ligament's tibial attachment. Open surgery is effective and provides direct visualization. Meanwhile, arthroscopy is less invasive and promotes fast recovery. Method: Using predetermined criteria, the authors conducted a search to identify relevant studies. After reaching a consensus among the authors, Retrospective Case Series, Retrospective Comparative Series, Prospective Randomized Controlled Trials were included. Utilizing the Coleman methodology score, the analytical quality of each study presented was assessed in terms of its methodology. The outcome measures included the comparison of Lysholm score and the complications between open versus arthroscopic fixation in Isolated Tibial Avulsions. Result: The initial electronic search found 1,470 articles. Rigid inclusion and exclusion criteria reduced the initial number of studies to 12. This included 7 studies on the open posterior approach, 7 on arthroscopic fixation, and 2 on direct comparison. The study found that arthroscopic PCL avulsion in knee outcomes had better Lysholm scores than open surgery. Arthroscopy yielded better results with fewer complications, but the mini open technique was sometimes comparable. Conclusion: The results of the study indicate that arthroscopic approach yielded more favorable postoperative Lysholm scores compared to the open approach in cases of PCL avulsion. The utilization of arthroscopy resulted in superior outcomes with a reduced incidence of complications, although in certain instances, the mini open technique demonstrated comparable efficacy to arthroscopy.

Comparison of the efficacy of LARS ligament and autogenous hamstring tendon plus high-strength suture in posterior cruciate ligament reconstruction

To compare the clinical efficacy of ligament advanced reinforcement system (LARS) and autogenous hamstring tendon plus high-strength suture in arthroscopic reconstruction of posterior cruciate ligament(PCL). A total of 96 patients with simple PCL injury treated with arthroscopic posterior cruciate ligament reconstructive surgery admitted to our hospital between August 2019 and December 2021 were selected for complete follow-up. There were 78 males and 18 females, 40 cases of left leg and 56 cases of right leg, the aged from 20 to 56 years old with an average of (32.50±8.68 ) years old. The transplants were divided into two groups:LARS group (52 cases) and autogenous hamstring tendon plus high-strength suture group (44 cases). In the LARS group, there were 42 males and 10 females;with an average age of (31.84±8.62) years old;body mass index (BMI) was (24.73±2.29) kg﹒m-2;7 mm LARS was used to reconstruct PCL. In the autologous tendon group, there were 36 males and 8 females, with an average age of (33.06±8.99) years old, BMI was (23.52±2.16) kg·m-2, and the PCL was reconstructed with four strands of hamstring tendons and three pieces of Ethibond suture. All patients underwent functional rehabilitation guided exercise and were followed up regularly after surgery to objectively evaluate the stability of the knee joint by KT-1000 measurement of knee relaxation, and subjective evaluation of knee function by Lysholm score, Tegner score, and International Knee Documentation Council (IKDC) score. Data from preoperative, 3, 6, and 12 month follow-up were collected and analyzed by SPSS software to compare postoperative recovery and ligament relaxation between the two groups of patients. Ninety-six patients were followed up for 12 months. KT-1000 measurement of knee joint in autogenous tendon group and LARS group before operation [(10.73±1.46) points vs (10.55±1.53) points], 6 months after operation[(3.02±0.75) points vs (2.35±0.60) points], 12 months after operation[(3.77±1.76) points vs (2.44±0.60) points]. There was significant difference between the two groups at 6 and 12 months after operation (P<0.05), but there was no significant difference between the two groups at 3 months after operation (P>0.05). In the autogenous tendon group and LARS group, before operation and 12 months after operation, total Lysholm score [(40.6±16.8), (91.25±6.35) points vs (51.92±18.52), (92.35±5.30) points], Tegner score[(1.8±0.7), (5.8±0.6) points vs(1.7±0.8)、(5.7±0.7) points] and total IKDC score[(54.50±6.33), (83.90±3.93) points vs (54.40±4.24), (83.62±3.64) points], the differences were statistically significant (P<0.05), indicating that the knee function of the two groups was improved after surgery. At 3 and 6 months after operation in the autogenous tendon group and LARS group, the total Lysholm score[(65.86±11.54), (74.60±6.46) points vs (73.46±6.42), (86.73±4.62) points], Tegner score[(2.5±0.6), (3.5±0.5) points vs (4.3±0.7), (5.0±1.4) points], the total scores of IKDC [(55.78±2.68), (70.62±4.74) points vs (65.31±4.60), (79.71±2.93) points]. The difference between two groups was statistically significant (P<0.05). The results showed that the function of the knee joint in the LARS group was better than that the autologous tendon group. However, at 12 months after the operation, there was no significant difference in the score of knee joint function between the two groups (P>0.05). The results showed that the stability of LARS group was better than that of autologous tendon group. Both the autogenous hamstring tendon plus high-strength suture and LARS reconstruction can significantly improve the knee function and stability, with satisfactory postoperative results. Howervr the LARS provides superior postoperative stability.

Feasibility and accuracy of robot-assisted tunnel placement in anatomic arthroscopic posterior cruciate ligament reconstruction.

Feasibility and accuracy of robot-assisted tunnel placement in anatomic arthroscopic posterior cruciate ligament reconstruction.

Comparison of intraoperative effects of computer navigation-assisted and simple arthroscopic reconstruction of posterior cruciate ligament tibial tunnel

To compare the intraoperative effects of computer navigation-assisted versus simple arthroscopic reconstruction of posterior cruciate ligament (PCL) tibial tunnel. The clinical data of 73 patients with PCL tears who were admitted between June 2021 and June 2022 and met the selection criteria were retrospectively analysed, of whom 34 cases underwent PCL tibial tunnel reconstruction with navigation-assisted arthroscopy (navigation group) and 39 cases underwent PCL tibial tunnel reconstruction with arthroscopy alone (control group). There was no significant difference in baseline data between the two groups, including gender, age, body mass index, side of injury, time from injury to surgery, preoperative posterior drawer test, knee range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups ( P>0.05). The perioperative indicators (operation time and number of guide wire drillings) were recorded and compared between the two groups. The angle between the graft and the tibial tunnel and the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes respectively were measured on MRI at 1 day after operation. The knee ROM, Tegner score, Lysholm score, and IKDC score were evaluated before operation and at last follow-up. The operation time in the navigation group was shorter than that in the control group, and the number of intraoperative guide wire drillings was less than that in the control group, the differences were significant ( P<0.05). Patients in both groups were followed up 12-17 months, with an average of 12.8 months. There was no perioperative complications such as vascular and nerve damage, deep venous thrombosis and infection of lower extremity. During the follow-up, there was no re-injuries in either group and no revision was required. The results showed that there was no significant difference in the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes between the two groups ( P>0.05), but the angle between the graft and the tibial tunnel was significantly greater in the navigation group than in the control group ( P<0.05). At last follow-up, 30, 3, 1 and 0 cases were rated as negative, 1+, 2+, and 3+ of posterior drawer test in the navigation group and 33, 5, 1, and 0 cases in the control group, respectively, which significantly improved when compared with the preoperative values ( P<0.05), but there was no significant difference between the two groups ( P>0.05). At last follow-up, ROM, Tegner score, Lysholm score, and IKDC score of the knee joint significantly improved in both groups when compared with preoperative values ( P<0.05), but there was no significant difference in the difference in preoperative and postoperative indicators between the two groups ( P>0.05). Computer-navigated arthroscopic PCL tibial tunnel reconstruction can quickly and accurately prepare tunnels with good location and orientation, with postoperative functional scores comparable to arthroscopic PCL tibial tunnel reconstruction alone.

Outcome of Arthroscopic All-Inside Posterior Cruciate Ligament Reconstruction Using the Posterior Trans-Septal Approach.

Posterior Cruciate Ligament (PCL) reconstruction is a complex surgical procedure and often challenging. The newer posterior trans-septal portal technique is thought to make tibial tunnel preparation easier with better visualization of the tibial attachment site. It is also thought to lower the risk of neurovascular injuries. The aim of this study was to evaluate the functional and clinical outcomes of patients who underwent arthroscopic all-inside PCL reconstruction using the posterior trans-septal portal at our institute. This was a retrospective study with prospectively collected data between 2016 and 2020. Data collected were age, gender, types of graft used, range of movement, posterior drawer test grade, KOOS score, Lysholm knee scoring scale, and post-operative complications. All patients underwent pre- and post-operative PCL rehabilitation. A total of 36 patients (26 males and 10 females) were identified from our database. The mean age was 35.2years. Mean time from injury to surgery was 20months. Mean follow-up was 41.2months (range, 13-72months). Twenty cases involved multi-ligament injuries and another 16 patients had isolated PCL injury. Post-operative mean posterior drawer test grade improved from 2.7 to 0.7 (p < 0.001). Knee range of movement was 116.3 degrees pre-operatively and 115.6 degrees postoperatively (p = 0.814). Lysholm knee scoring scale improved from 50.9 to 91.0 (p < 0.001). KOOS score improved from 65.1 to 77.2 (p = 0.196). One patient required manipulation under anesthesia for stiffness. No patients needed any additional surgical procedures. All PCLs were clinically intact at the final follow-up. Greater visualization of the PCL tibial attachment minimizes the 'killer turn' giving a huge advantage to this technique. Arthroscopic all-inside PCL reconstruction using the posterior trans-septal portal technique is a safe, reliable and reproducible procedure. From our study, it shows that post-operative clinical and functional outcomes improved significantly.

Is posterior knee arthroscopy using posterior portals necessary for orthopedic surgeons? The latest evidence on applications and techniques.

Various uses of posterior knee arthroscopy have been shown, including all-inside repair of posterior meniscal lesions, posterior cruciate ligament (PCL) reconstruction or PCL avulsion fixation, extensile posterior knee synovectomy for pigmented villonodular synovitis or synovial chondromatosis, posterior capsular release in the setting of knee flexion contractures, and loose bodies removal. Posterior arthroscopy provides direct access to the posterior meniscal borders for adequate abrasion and fibrous tissue removal. This direct view of the knee posterior structures enables the surgeon to create a stronger biomechanical repair using vertical mattress sutures. During PCL reconstruction, posterior arthroscopy gives the surgeon proper double access to the tibial insertion site, which can result in less acute curve angles and the creation of a more anatomic tibial tunnel. Moreover, it gives the best opportunity to preserve the PCL remnant. Arthroscopic PCL avulsion fixation is more time-consuming with a larger cost burden compared to open approaches, but in the case of other concomitant intra-articular injuries, it may lead to a better chance of a return to pre-injury activities. The high learning curve and overcaution of neuromuscular injury have discouraged surgeons from practicing posterior knee arthroscopy using posterior portals. Evidence for using posterior portals by experienced surgeons suggests fewer complications. The evidence suggests toward learning posterior knee arthroscopy, and this technique must be part of the education about arthroscopy. In today's professional sports world, where the quick and complete return of athletes to their professional activities is irreplaceable, the use of posterior knee arthroscopy is necessary.

Posterolateral Rotational Knee Instability: Evolution and Current Trends in Surgical Treatment

Background. Diagnostics and treatment of patients with chronic posterior and posterolateral instability of the knee is one of the most understudied problems of modern orthopedics. This is due to rather low frequency of this pathology, as well as to complex anatomy of tendoligamentous structures of the posterolateral part of the knee joint. Steadily increasing number of foreign publications dedicated to this topic say that there is no common approach to the tactics of surgical treatment of patients of this category at the moment.&#x0D; Aim of review to evaluate the main trends of surgical treatment of this pathology according to the stage of involvement of various anatomical structures responsible for posterolateral rotational instability in the pathologic process.&#x0D; Results. Despite a large number of methods of surgical treatment of posterolateral corner injuries, when analyzing modern publications, several main trends concerning posterolateral instability of the knee joint can be identified. In case of type 1 posterolateral instability, an isolated arthroscopic posterior cruciate ligament plasty is the most optimal. As for types 3 and 4, today such anatomical techniques as Larson and LaPrade have completely replaced the methods of non-anatomical reconstruction of the posterolateral corner. In addition, a large number of publications have recently appeared concerning arthroscopic techniques of these surgeries. The most important problem concerns the extent and the methods of surgical intervention in case of type 2 instability. Authors of the article consider that an arthroscopic posterior cruciate ligament plasty combined with popliteal tendon plasty is the most optimal for such category of patients.&#x0D; Conclusion. The actual problem is the question of the method of surgical treatment in case of type 2 instability. The optimal technique for such patients is arthroscopic posterior cruciate ligament plasty combined with popliteal tendon plasty.

Balloon Catheter Technique for Prevention of Vascular Injuries During Arthroscopic Posterior Cruciate Ligament Reconstruction

Balloon Catheter Technique for Prevention of Vascular Injuries During Arthroscopic Posterior Cruciate Ligament Reconstruction

Arthroscopic Primary Repair of Posterior Cruciate Ligament Using Ring Suture Attached to Adjustable Loop Device

Arthroscopic Primary Repair of Posterior Cruciate Ligament Using Ring Suture Attached to Adjustable Loop Device

PCL Reconstruction Surgery in Third Grade PCL Rupture: A Case Series

Objective: The PCL is the largest and strongest intraarticular ligament of the knee joint, comprising of 2 functional bundles: the larger anterolateral bundle (ALB) and the smaller posteromedial bundle (PMB). Posterior cruciate ligament (PCL) tears comprise 3% of outpatient knee injuries. The treatment of complete, isolated PCL tears remains controversial. Some studies have reported good outcomes after conservative treatment of partial PCL tears, while others have reported poor results at long-term follow-up with disabling symptoms and functional limitations. This case series reported the first experience of PCL reconstruction in our institution and its associated outcome. Methods: This prospective case series was conducted from January to December 2021. Two patients were included in this case series. All the patients were diagnosed with PCL tear by an Orthopaedic surgeon. clinical examination, knee radiograph, and MRI were obtained in both patients. All patients underwent arthroscopic PCL reconstruction by a single senior Orthopaedic surgeon. Physical therapy was performed after the surgery. Clinical evaluation was followed up for 9 months. The outcome in this case series was the posterior drawer test and range of motion. Result: Two patients were included in this case series. A favorable outcomes were noted following PCL reconstruction surgery. There were negative posterior drawer test, posterior sag sign, and full range of motion in both patients. Conclusion: A PCL reconstruction surgery provided a satisfactory clinical outcome in terms of posterior drawer test, posterior sag sign, and range of motion. PCL reconstruction surgery is recommended in patients who present with grade 3 PCL injury.

Midterm Outcomes After Revision Posterior Cruciate Ligament Reconstruction With a Single-Bundle Transtibial Autograft.

Background:There is a lack of consensus regarding the optimal technique for revision posterior cruciate ligament (PCL) reconstruction.Purpose:To evaluate midterm outcomes after revision PCL reconstruction using a single-bundle transtibial autograft.Study Design:Case series; Level of evidence, 4.Methods:We reviewed 17 patients who underwent revision PCL reconstruction performed in our medical center by a single surgeon from 2003 to 2016. The cohort included 12 male and 5 female patients with a mean age of 31.3 years (range, 17-48 years). All of the patients underwent single-bundle transtibial reconstruction using the same surgical technique and were reviewed at a minimum of 4 years postoperatively. Preoperative and postoperative posterior stress radiography was performed. The preoperative tibial slope and tibiofemoral angle were also measured. Preoperative and postoperative functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) subjective and objective scores as well as the Lysholm score.Results:The most common factor that contributed to the failure of primary surgery was misplaced tunnels, especially on the femoral side. There were 2 patients who had grade 2 laxity preoperatively, and 15 patients had grade 3 laxity preoperatively. At the latest follow-up, all 17 patients had grade 1 laxity. On posterior stress radiography, posterior displacement improved from 10.8 ± 2.1 mm preoperatively to 2.9 ± 1.1 mm at the latest follow-up (P < .001). The IKDC subjective score improved from 34.9 ± 6.8 preoperatively to 75.3 ± 15.7 postoperatively (P < .001), and the Lysholm score improved from 38.1 ± 10.0 preoperatively to 88.5 ± 7.6 postoperatively (P < .001). All patients reached the minimal clinically important difference (MCID) for the Lysholm score, and 94% reached the MCID for the IKDC subjective score, with 65% reaching the Patient Acceptable Symptom State.Conclusion:According to the findings of this study, arthroscopic revision PCL reconstruction with a single-bundle transtibial autograft offered satisfactory outcomes at midterm follow-up.

Eradication and graft retention can be achieved in the treatment for acute septic arthritis after primary posterior cruciate ligament reconstruction: analysis of 1561 reconstructions.

Acute septic arthritis after arthroscopic posterior cruciate ligament (PCL) reconstruction is a rare but severe complication. Optimal management has not been established. The purposes of this study were to analyze clinical findings and to retrospectively evaluate the graft-retaining treatment regimen. From 2010 to 2021, a total of 1561 primary PCL reconstructions were performed at our institution. Seven patients with septic arthritis were identified and retrospectively analyzed with regard to incidence, clinical manifestations, treatment, postoperative clinical course and follow-up results. The mean interval from PCL reconstruction to the onset of symptoms was 11.0 ± 4.0days. Staphylococcus aureus was the most commonly found pathogen. Eradication was achieved in all patients after a mean of 1.1 ± 0.4 procedures, with graft retention in all patients. The mean duration of antibiotic treatment was 5.7 ± 1.5weeks. At the last follow-up, there was no recurrence, graft insufficiency or osteoarthritis. Arthroscopic graft-retaining treatment combined with individual antibiotic therapy, eradication and good to excellent functional results can be achieved, which might encourage surgeons to try to retain the graft as much as possible. Level IV.

Evaluation of the Clinical Outcome of Arthroscopic Posterior Cruciate Ligament Reconstruction with Peroneus Longus Tendon

Evaluation of the Clinical Outcome of Arthroscopic Posterior Cruciate Ligament Reconstruction with Peroneus Longus Tendon

Easy Arthroscopic Transseptal Approach of the Knee

Background: The arthroscopic approach to the posterior compartment of the knee is always challenging. This easy arthroscopic transseptal approach allows safe access to the posterior compartment of the knee, avoiding any potential neurovascular injury. Indications: Indications include arthroscopic posterior cruciate ligament (PCL) reconstruction, fixation of avulsion fractures of the tibial attachment of the PCL, arthroscopic posterolateral corner reconstruction, removal of loose bodies from the posterior compartment, PCL cyst removal, ramp repair, and arthroscopic arthrolysis of the posterior compartment. Technique Description: Using a posteromedial portal, a shaver is introduced with the tip in direct contact with the medial side of the septum facing anteriorly, away from the popliteal neurovascular bundle. The scope is then inserted into the posterolateral compartment to visualize the lateral side of the septum while the shaver remains in the posteromedial compartment. The septum is then released until the tip of the shaver is visible. The shaver is then removed and the scope can now be inserted from the posteromedial portal to the posterolateral compartment through the released septum. Results: The transseptal approach can be performed without any additional risk if the shaver remains centrally on the inferior aspect of the septum. Therefore, the risk of iatrogenic injury of the middle genicular artery is minimized. Likewise, with the knee flexed to 90°, there is no risk of damaging the popliteal neurovascular bundle. Having a precise knowledge of the anatomy of the posterior compartment of the knee minimizes any risks of the transseptal approach, avoiding any additional surgical time whilst facilitating the indicated operation. Conclusion: This easy arthroscopic transseptal approach allows safe access to the posterior compartment of the knee, avoiding any potential neurovascular injury.

Concurrent Needle and Standard Arthroscopy for Posterior Cruciate Ligament Reconstruction

Concurrent Needle and Standard Arthroscopy for Posterior Cruciate Ligament Reconstruction

Comparative study on effectiveness of posterior-posterior triangulation technique and anteroposterior approach for arthroscopic posterior cruciate ligament reconstruction

To investigate the effectiveness of the posterior-posterior triangulation technique for arthroscopic posterior cruciate ligament (PCL) reconstruction by comparing with the anteroposterior approach. Retrospective analysis was performed on 40 patients who underwent arthroscopic PCL reconstruction between February 2016 and February 2020. The PCLs were reconstructed via anteroposterior approach in 20 patients (anteroposterior approach group) and posterior-posterior triangulation technique in 20 patients (posterior-posterior triangulation technique group). There was no significant difference in gender, age, cause of injury, injury side, disease duration, preoperative International Knee Documentary Committee (IKDC) score, and Lysholm score between the two groups ( P>0.05). The operation time, surgical complications, and postoperative posterior drawer test, Lysholm score, and IKDC score were recorded and compared between the two groups. The operation time was (65.25±10.05) minutes in the anteroposterior approach group and (56.15±8.15) minutes in the posterior-posterior triangulation technique group, and the difference was significant ( t=3.145, P=0.003). All incisions healed by first intention, and there was no complication such as vascular and nerve injuries or infection. Patients were followed up (27.05±11.95) months in the anteroposterior approach group and (21.40±7.82) months in the posterior-posterior triangulation technique group, with no significant difference ( t=1.770, P=0.085). At last follow-up, the posterior drawer tests were positive in 4 cases (3 cases of stageⅠand 1 case of stage Ⅱ) of the anteroposterior approach group and in 1 case (stageⅠ) of the posterior-posterior triangulation technique group, showing no significant difference between the two groups ( P=0.342). At last follow-up, Lysholm score and IKDC score in both groups were significantly higher than those before operation ( P<0.05). The above functional scores in the posterior-posterior triangulation technique group were significantly higher than those in the anteroposterior approach group ( P<0.05). Imaging reexamination showed that the position, shape, and tension of the grafts were well in both groups, and the grafts were covered with the synovium in the posterior-posterior triangulation technique group, the meniscofemoral ligaments were well preserved. There was no re-rupture of the reconstructed ligament during follow-up. Compared to the anteroposterior approach, the posterior-posterior triangulation technique provides a clearer view under arthroscopy, no blind spot, sufficient operating space, and relative safety. Moreover, it is easier to retain the remnant and the meniscofemoral ligaments, and can obtain good short-term effectiveness.

The treatment of posterolateral knee instability with combined arthroscopic popliteus bypass and PCL reconstruction provides good-to-excellent clinical results in the mid-term follow-up.

The purpose of this study was to evaluate the clinical outcomes of patients who were treated with an arthroscopic popliteus bypass (PB) technique, in cases of a posterolateral rotational instability (PLRI) and a concomitant posterior cruciate ligament (PCL) injury of the knee. This was a retrospective case series in which 23 patients were clinically evaluated after a minimum of 2years following arthroscopic PB and combined PCL reconstruction. Lysholm, Tegner and Knee Injury and Osteoarthritis Outcome scores as well as visual analog scales (VAS) for joint function and pain were evaluated. Posterior laxity was objectified with stress radiography and a Rolimeter examination. Rotational instability was graded with the dial test. 23 patients were available for follow-up, 46.0 ± 13.6 months after surgery. The median time interval from the initial injury to the surgery was 6.0 (3.5;10.5) months. The postoperative Lysholm Score was 95.0 (49-100); the Tegner Score changed from 6.0 (3-10) before the injury to 5.0 (0-10) at the follow-up examination (p = 0.013). The side-to-side difference on stress radiography (SSD) of posterior translation changed from 10.4 (6.6-14.8) mm before the injury to 4.0 (0.2-5.7) mm postoperatively (p < 0.01). Rotational instability was reduced to grade A (82.6%) or B (17.4%) (IKDC). The Rolimeter SSD was 2.0 (0-3) mm at the follow-up examination.VASFunction 0 (0-5), VAS pain 0 (0-6). The arthroscopic PB graft technique provided good-to-excellent clinical results in the mid-term follow-up in patients with type A PLRI and concomitant PCL injury. However, an exact differentiation of lateral, rotational and dorsal instabilities of posterolateral corner (PLC) injuries is crucial,for the correct choice of therapy, as cases with lateral instabilities require more complex reconstruction techniques. Arthroscopic posterolateral corner reconstruction is a safe procedure with a high success rate in the mid-term follow-up. IV.

No difference in subjective and objective clinical outcomes between arthroscopic transtibial and open inlay posterior cruciate ligament reconstruction techniques in the treatment of multi-ligamentous knee injuries

No difference in subjective and objective clinical outcomes between arthroscopic transtibial and open inlay posterior cruciate ligament reconstruction techniques in the treatment of multi-ligamentous knee injuries