Functional outcomes following PCL reconstruction surgery using an all-inside approach with graft reinforcement
ESSKA Academy. Thakrar R. Nov 8, 2019; 284440; epESMA-34 Topic: Arthroscopic Surgery
Mr. Raj Ramesh Thakrar
Mr. Raj Ramesh Thakrar
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Introduction: Posterior cruciate ligament (PCL) tears are a relatively rare pathology comprising approximately 3% of acute knee trauma. Despite recent advances in the anatomical and biomechanical function of the ligament, the approach to management remains controversial with many groups still advocating conservative treatment.
Aim: This study aims to report the clinical and functional outcomes following PCL reconstruction using an all inside technique with graft reinforcement.
Method: The hospital's ligament database was used to identify all patients whom underwent PCL reconstruction between 2012 to 2016, using an all inside technique with FibreTape graft reinforcement and double suspensory fixation on the tibia and femur. Individuals were prospectively followed up at 6 month, 1 year and 2 year intervals with clinical assessment, goniometric range of motion and KT1000 measurements. In addition, patient reported outcome measure was captured in the form of Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm and Tegner activity scores.
Results: 19 patients (13 male, 6 female) were identified who fulfilled the study criteria,with a mean age of 35 years. 26% (5 cases) presented with an isolated PCL injury. Of the multiligament cases (14), 71% had an associated ACL injury and 21% posterolateral corner injury. At 2 years follow-up a statistically significant improvement in KOOS (64 vs 79, p< 0.05) and Lysholm (55 vs 80, p< 0.05) scores was identified. Tegner activity score showed improvement by 1-point post operatively, but this was not statistically significant. Clinical assessment of function demonstrated an improved range of motion with obliteration of a fixed flexion deformity (ROM 3-127° preop vs -2-128° postop) following surgery. KT 1000 assessment show no side to side difference in anteroposterior instability when compared to the non-operated side. There were no reports of PCL graft failure at 2 years. There were no perioperative complications to report.
Conclusion: With increasing evidence of morbidity and reduced function associated with PCL deficiency, reconstructive surgery may be proposed as a suitable option in the appropriate patient. Early results from our series of an all inside technique with FibreTape graft reinforcement demonstrates a safe surgical option with excellent outcomes in relation to clinical function and patient satisfaction at 2 years.
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