Effectiveness analysis of arthroscopic reconstruction of posterior cruciate ligament with embedded “tibial tendon bolt” fixation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Zhengping , ZHANG Chunyu , LIAN Yongyun ,  LU Daifeng

Department of Orthopedics, the Fourth Affiliated Hospital of Harbin Medical University, Haerbin Heilongjiang, 150001, P. R. China;

Corresponding author：

LU Daifeng, Email: ludaifengletter@163.com

Keywords：

Knee; arthroscopy; posterior cruciate ligament injury; ligament reconstruction

DOI：

10.7507/1002-1892.202111076

Video：

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Objective To evaluate the effectiveness of arthroscopic reconstruction of posterior cruciate ligament (PCL) with embedded “tibial tendon bolt” fixation. Methods The clinical data of 32 patients who underwent arthroscopic reconstruction of PCL using embedded “tibial tendon bolt” fixation through the tibial “8”-shaped tunnel between February 2012 and April 2016 were analyzed retrospectively. There were 23 males and 9 females, aged 15-57 years (mean, 39.9 years). The causes included traffic accident injury in 12 cases and sports injury in 20 cases. The clinical manifestations were swelling of knee joint, tenderness of knee joint space, and (+) Ⅲ degree in posterior drawer test; McMurry test (+) in 13 cases, valgus stress test (+) in 8 cases, Lachman test (+) in 9 cases, and Dial test (+) in 2 cases. The preoperative Lysholm score was 18.8±10.9, the International Knee Documentation Committee (IKDC) score was 18.0±15.2, and the detection value of KT-1000 was (14.34±2.73) mm. The time from injury to operation was 8-225 days, with a median of 11 days. Results All 32 patients were followed up 25-36 months, with an average of 26.4 months. The patients had no tenderness of joint space, and the McMurry tests were all (−). At last follow-up, the Lysholm score and IKDC score were 90.2±2.4 and 87.2±6.2, respectively, which were significantly improved when compared with preoperative ones (t=−38.400, P<0.001; t=−27.190, P<0.001). The results of posterior drawer test were (−) in 21 cases, (+) Ⅰ degree in 9 cases, and (+) Ⅱ degree in 2 cases. At 1 and 2 years after operation, the detection value of KT-1000 were (5.56±2.28) mm and (5.87±1.78) mm, respectively, which were significantly improved when compared with preoperative values (P<0.05). Conclusion The application of arthroscopic reconstruction of PCL using embedded “tibial tendon bolt” fixation through the tibial “8”-shaped tunnel is an effective, simple, and safe surgical procedure.

Citation： SUN Zhengping, ZHANG Chunyu, LIAN Yongyun, LU Daifeng. Effectiveness analysis of arthroscopic reconstruction of posterior cruciate ligament with embedded “tibial tendon bolt” fixation. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(4): 420-424. doi: 10.7507/1002-1892.202111076 Copy

1.	Lee DY, Kim DH, Kim HJ, et al. Posterior cruciate ligament reconstruction with transtibial or tibial inlay techniques: A meta-analysis of biomechanical and clinical outcomes. Am J Sports Med, 2018, 46(11): 2789-2797.
2.	Noyes FR, Barber-Westin SD. Posterior cruciate ligament revision reconstruction, part 1: causes of surgical failure in 52 consecutive operations. Am J Sports Med, 2005, 33(5): 646-654.
3.	Noyes FR, Barber-Westin SD. Posterior cruciate ligament revision reconstruction, part 2: results of revision using a 2-strand quadriceps tendon-patellar bone autograft. Am J Sports Med, 2005, 33(5): 655-665.
4.	Wajsfisz A, Bajard X, Plaweski S, et al. Surgical management of combined anterior or posterior cruciate ligament and posterolateral corner tears: for what functional results? Orthop Traumatol Surg Res, 2014, 100(8 Suppl): S379-S383.
5.	Rochecongar G, Plaweski S, Azar M, et al. Management of combined anterior or posterior cruciate ligament and posterolateral corner injuries: a systematic review. Orthop Traumatol Surg Res, 2014, 100(8 Suppl): S371-S378.
6.	Park SH, Moon SW, Lee BH, et al. The sagittal plane angle and tunnel-related complications in double-bundle anterior cruciate ligament reconstruction using the transportal technique: an in vivo imaging study. Arthroscopy, 2015, 31(2): 283-292.
7.	Kim JG, Chang MH, Lim HC, et al. An in vivo 3D computed tomographic analysis of femoral tunnel geometry and aperture morphology between rigid and flexible systems in double-bundle anterior cruciate ligament reconstruction using the transportal technique. Arthroscopy, 2015, 31(7): 1318-1329.
8.	Watanabe S, Takahashi T, Hino K, et al. Short-term study of the outcome of a new instrument for all-inside double-bundle anterior cruciate ligament reconstruction. Arthroscopy, 2015, 31(10): 1893-1902.
9.	Song EK, Park HW, Ahn YS, et al. Transtibial versus tibial inlay techniques for posterior cruciate ligament reconstruction: long-term follow-up study. Am J Sports Med, 2014, 42(12): 2964-2971.
10.	Gwinner C, Jung TM, Schatka I, et al. Posterior laxity increases over time after PCL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2019, 27(2): 389-396.
11.	Johnson DH, Fanelli GC, Miller MD. PCL 2002: indications, double-bundle versus inlay technique and revision surgery. Arthroscopy, 2002, 18(9 Suppl 2): 40-52.
12.	韦钊岚, 韦朝喜, 于波, 等. 经前交叉韧带腋下胫骨定位的后交叉韧带重建术. 中国矫形外科杂志, 2021, 29(4): 350-352, 356.
13.	Ettinger M, Wehrhahn T, Petri M, et al. The fixation strength of tibial PCL press-fit reconstructions. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2): 308-314.
14.	Chuang TY, Ho WP, Chen CH, et al. Non-hardware posterior cruciate ligament reconstruction using knot/press-fit technique with periosteum-enveloped hamstrings tendon autograft. Am J Sports Med, 2011, 39(5): 1081-1089.
15.	Ishibashi Y, Rudy TW, Livesay GA, et al. The effect of anterior cruciate ligament graft fixation site at the tibia on knee stability: evaluation using a robotic testing system. Arthroscopy, 1997, 13(2): 177-182.
16.	Paessler HH, Mastrokalos DS. Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. A new and innovative procedure. Orthop Clin North Am, 2003, 34(1): 49-64.
17.	L’Insalata JC, Klatt B, Fu FH, et al. Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc, 1997, 5(4): 234-238.
18.	Weiler A, Hoffmann RF, Bail HJ, et al. Tendon healing in a bone tunnel. Part Ⅱ: Histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy, 2002, 18(2): 124-135.
19.	Boszotta H. Arthroscopic anterior cruciate ligament reconstruction using a patellar tendon graft in press-fit technique: surgical technique and follow-up. Arthroscopy, 1997, 13(3): 332-339.
20.	Lu D, Xiao M, Lian Y, et al. Comparison of the operation of arthroscopic tibial inlay and traditional tibial inlay for posterior cruciate ligament reconstruction. Int J Clin Exp Med, 2014, 7(10): 3193-3201.
21.	Osti M, Krawinkel A, Benedetto KP. In vivo evaluation of femoral and tibial graft tunnel placement following all-inside arthroscopic tibial inlay reconstruction of the posterior cruciate ligament. Knee, 2014, 21(6): 1198-1202.
22.	Fujimoto E, Sasashige Y, Masuda Y, et al. Serial magnetic resonance imaging study of posterior cruciate ligament reconstruction or augmentation using hamstring tendons. Orthop Traumatol Surg Res, 2014, 100(7): 755-760.

1. Lee DY, Kim DH, Kim HJ, et al. Posterior cruciate ligament reconstruction with transtibial or tibial inlay techniques: A meta-analysis of biomechanical and clinical outcomes. Am J Sports Med, 2018, 46(11): 2789-2797.
2. Noyes FR, Barber-Westin SD. Posterior cruciate ligament revision reconstruction, part 1: causes of surgical failure in 52 consecutive operations. Am J Sports Med, 2005, 33(5): 646-654.
3. Noyes FR, Barber-Westin SD. Posterior cruciate ligament revision reconstruction, part 2: results of revision using a 2-strand quadriceps tendon-patellar bone autograft. Am J Sports Med, 2005, 33(5): 655-665.
4. Wajsfisz A, Bajard X, Plaweski S, et al. Surgical management of combined anterior or posterior cruciate ligament and posterolateral corner tears: for what functional results? Orthop Traumatol Surg Res, 2014, 100(8 Suppl): S379-S383.
5. Rochecongar G, Plaweski S, Azar M, et al. Management of combined anterior or posterior cruciate ligament and posterolateral corner injuries: a systematic review. Orthop Traumatol Surg Res, 2014, 100(8 Suppl): S371-S378.
6. Park SH, Moon SW, Lee BH, et al. The sagittal plane angle and tunnel-related complications in double-bundle anterior cruciate ligament reconstruction using the transportal technique: an in vivo imaging study. Arthroscopy, 2015, 31(2): 283-292.
7. Kim JG, Chang MH, Lim HC, et al. An in vivo 3D computed tomographic analysis of femoral tunnel geometry and aperture morphology between rigid and flexible systems in double-bundle anterior cruciate ligament reconstruction using the transportal technique. Arthroscopy, 2015, 31(7): 1318-1329.
8. Watanabe S, Takahashi T, Hino K, et al. Short-term study of the outcome of a new instrument for all-inside double-bundle anterior cruciate ligament reconstruction. Arthroscopy, 2015, 31(10): 1893-1902.
9. Song EK, Park HW, Ahn YS, et al. Transtibial versus tibial inlay techniques for posterior cruciate ligament reconstruction: long-term follow-up study. Am J Sports Med, 2014, 42(12): 2964-2971.
10. Gwinner C, Jung TM, Schatka I, et al. Posterior laxity increases over time after PCL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2019, 27(2): 389-396.
11. Johnson DH, Fanelli GC, Miller MD. PCL 2002: indications, double-bundle versus inlay technique and revision surgery. Arthroscopy, 2002, 18(9 Suppl 2): 40-52.
12. 韦钊岚, 韦朝喜, 于波, 等. 经前交叉韧带腋下胫骨定位的后交叉韧带重建术. 中国矫形外科杂志, 2021, 29(4): 350-352, 356.
13. Ettinger M, Wehrhahn T, Petri M, et al. The fixation strength of tibial PCL press-fit reconstructions. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2): 308-314.
14. Chuang TY, Ho WP, Chen CH, et al. Non-hardware posterior cruciate ligament reconstruction using knot/press-fit technique with periosteum-enveloped hamstrings tendon autograft. Am J Sports Med, 2011, 39(5): 1081-1089.
15. Ishibashi Y, Rudy TW, Livesay GA, et al. The effect of anterior cruciate ligament graft fixation site at the tibia on knee stability: evaluation using a robotic testing system. Arthroscopy, 1997, 13(2): 177-182.
16. Paessler HH, Mastrokalos DS. Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. A new and innovative procedure. Orthop Clin North Am, 2003, 34(1): 49-64.
17. L’Insalata JC, Klatt B, Fu FH, et al. Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc, 1997, 5(4): 234-238.
18. Weiler A, Hoffmann RF, Bail HJ, et al. Tendon healing in a bone tunnel. Part Ⅱ: Histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy, 2002, 18(2): 124-135.
19. Boszotta H. Arthroscopic anterior cruciate ligament reconstruction using a patellar tendon graft in press-fit technique: surgical technique and follow-up. Arthroscopy, 1997, 13(3): 332-339.
20. Lu D, Xiao M, Lian Y, et al. Comparison of the operation of arthroscopic tibial inlay and traditional tibial inlay for posterior cruciate ligament reconstruction. Int J Clin Exp Med, 2014, 7(10): 3193-3201.
21. Osti M, Krawinkel A, Benedetto KP. In vivo evaluation of femoral and tibial graft tunnel placement following all-inside arthroscopic tibial inlay reconstruction of the posterior cruciate ligament. Knee, 2014, 21(6): 1198-1202.
22. Fujimoto E, Sasashige Y, Masuda Y, et al. Serial magnetic resonance imaging study of posterior cruciate ligament reconstruction or augmentation using hamstring tendons. Orthop Traumatol Surg Res, 2014, 100(7): 755-760.

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Effectiveness analysis of arthroscopic reconstruction of posterior cruciate ligament with embedded “tibial tendon bolt” fixation

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