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Double Bundle Posterior Cruciate Ligament Reconstruction in 100 Patients at a Mean 3 Years Follow-up: Comparable Functional Outcomes to Anterior Cruciate Ligament Reconstructions Can Be Achieved
Author(s):
Chahla J. (United States of America)
Chahla J. (United States of America)
Affiliations:
ESSKA Academy. Chahla J. May 9, 2018; 209788; P17-1067 Topic: Arthroscopic Surgery
Dr. Jorge Chahla
Dr. Jorge Chahla
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Abstract
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Objectives: To determine and compare outcomes after double-bundle PCL reconstructions in isolated versus combined injuries and acute versus chronic PCL reconstructions and to compare the outcomes of isolated double-bundle PCL reconstruction (DB PCLR) to isolated ACL reconstruction.

Methods: All patients who underwent a primary endoscopic DB PCLR for grade-III isolated or combined PCL tears between May 2010 and March 2015 were reviewed. Patient reported outcome scores (Tegner, Lysholm, WOMAC, SF-12) and objective posterior stress radiographs were collected preoperatively and at a minimum two-years postoperatively. A cohort subanalysis between isolated and combined, and acute versus chronic PCL reconstruction was additionally performed. Patients who underwent isolated ACL reconstructions over the same inclusion period as the isolated PCL reconstruction cohort were selected as a comparison group. Group comparisons involving postoperative outcomes were made using Mann-Whitney U-tests (MWU) for independent samples and Wilcoxon Signed-rank tests (WSR) for change-from-baseline comparisons of patient reported outcomes. Assuming non-parametric testing two-tailed testing and an alpha of 0.05, 100 PCL patients was sufficient to detect effect sizes of d=0.29 and d=0.41 with 80% power for matched pairs and independent samples tests, respectively.

Results: One hundred patients who underwent DB PCLR were included in this study. There were 31 isolated PCL injuries and 69 patients had concurrent combined PCL injuries requiring surgery. The mean follow-up for the PCL cohort was 2.9 years (range, 2-6 years). The median Tegner activity score improved from 2 to 5, Lysholm from 48 to 86, WOMAC from 35.5 to 5, and SF-12 PCS from 34 to 54.8 (all p values <0.001). The mean side-to-side difference (SSD) in posterior tibial translation on kneeling stress radiographs improved from 11.0 mm preoperatively to 1.6 mm postoperatively (p< 0.001). There were no differences in postoperative functional scores between isolated PCL reconstructions and PCL-based multiligament reconstructions (all p values >0.229). There was no significant difference in the reported outcome scores between acute and chronic reconstructions (all p values >0.087) except for Tegner scores (p< 0.001) and patient satisfaction (p=0.011) favoring acutely treated PCL injuries. There were no significant differences between patients who had an isolated DB PCLR and patients who underwent an isolated ACL reconstruction in postoperative outcome scores [all p values >0.064].

Conclusions: Significantly improved functional and objective outcomes were observed after anatomic-based DB PCLR at a mean 3 years follow-up, with low complication rates, regardless of concomitant ligamentous pathology or timing to surgery. Additionally, contrary to previous reports, comparable results were achieved compared to a control isolated ACL reconstruction cohort.

Keywords:
posterior cruciate ligament, anatomic, reconstruction, PCL, double bundle, stress radiographs.
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