Progress in prevention and treatment of knee laxity after posterior cruciate ligament reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

RUAN Zhaohui , SHI Zhengliang , YUAN Ping , YANG Xianguang ,  LI Yanlin

Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China;

Corresponding author：

LI Yanlin, Email: liyanlin@kmmu.edu.cn

Keywords：

Posterior cruciate ligament reconstruction; knee laxity; biomechanics; postoperative rehabilitation

DOI：

10.7507/1002-1892.202505021

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the research progress on knee laxity of biomechanics and prevention and treatment after posterior cruciate ligament (PCL) reconstruction. Methods The domestic and international literature on the prevention and treatment of knee laxity after PCL reconstruction in recent years were extensively reviewed and analyzed. Results Different degrees of knee laxity often occur after PCL reconstruction, which can lead to poor prognosis in patients. The causes are associated with a variety of factors, including abnormal graft remodeling (such as differences in healing time and biomechanics among different types of grafts), tunnel position deviation (such as graft wear caused by the “killer turn” effect), and mechanical factors in postoperative rehabilitation (such as improper early weight-bearing and range of motion). These factors may promote graft elongation, increase early posterior tibial translation, and thereby induce knee laxity. Conclusion While PCL reconstruction improves knee stability, it is crucial to focus on and prevent postoperative knee laxity. However, current surgical methods are limited by factors such as graft characteristics, surgical technique flaws, and rehabilitation protocols, and thus cannot fully correct the issue of abnormal postoperative laxity. Surgical techniques and treatment strategies still need further improvement and optimization to enhance patients’ postoperative outcomes and quality of life.

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1. Logterman SL, Wydra FB, Frank RM. Posterior cruciate ligament: Anatomy and biomechanics. Curr Rev Musculoskelet Med, 2018, 11(3): 510-514.
2. Bingol I, Oktem U, Kaymakoglu M, et al. PCL injury following high energy trauma: associated injuries and postoperative complications “insights from a national registry study”. J Orthop Surg Res, 2024, 19(1): 490. doi: 10.1186/s13018-024-04927-1.
3. Brown JS, Mogianos K, Roemer FW, et al. Clinical, patient-reported, radiographic and magnetic resonance imaging findings 11 years after acute posterior cruciate ligament injury treated non-surgically. BMC Musculoskelet Disord, 2023, 24(1): 365. doi: 10.1186/s12891-023-06480-0.
4. Sanders TL, Pareek A, Barrett IJ, et al. Incidence and long-term follow-up of isolated posterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc, 2017, 25(10): 3017-3023.
5. Schroven W, Vles G, Verhaegen J, et al. Operative management of isolated posterior cruciate ligament injuries improves stability and reduces the incidence of secondary osteoarthritis: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2022, 30(5): 1733-1743.
6. Wind WM Jr, Bergfeld JA, Parker RD. Evaluation and treatment of posterior cruciate ligament injuries: revisited. Am J Sports Med, 2004, 32(7): 1765-1775.
7. Ahn S, Lee YS, Song YD, et al. Does surgical reconstruction produce better stability than conservative treatment in the isolated PCL injuries? Arch Orthop Trauma Surg, 2016, 136(6): 811-819.
8. 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.
9. Loeb AE, Ithurburn MP, Kidwell-Chandler A, et al. Technique and outcomes of posterior cruciate ligament repair with augmentation. Orthop J Sports Med, 2024, 12(1): 23259671231213988. doi: 10.1177/23259671231213988.
10. Oehme S, Moewis P, Boeth H, et al. PCL insufficient patients with increased translational and rotational passive knee joint laxity have no increased range of anterior-posterior and rotational tibiofemoral motion during level walking. Sci Rep, 2022, 12(1): 13232. doi: 10.1038/s41598-022-17328-3.
11. Krott NL, Wengle L, Whelan D, et al. Single and double bundle posterior cruciate ligament reconstruction yield comparable clinical and functional outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2022, 30(7): 2388-2399.
12. Ochiai S, Hagino T, Senga S, et al. Treatment Outcome of Reconstruction for isolated posterior cruciate injury: Subjective and objective evaluations. J Knee Surg, 2019, 32(6): 506-512.
13. Kim YM, Lee CA, Matava MJ. Clinical results of arthroscopic single-bundle transtibial posterior cruciate ligament reconstruction: a systematic review. Am J Sports Med, 2011, 39(2): 425-434.
14. Marom N, Ruzbarsky JJ, Boyle C, et al. Complications in posterior cruciate ligament injuries and related surgery. Sports Med Arthrosc Rev, 2020, 28(1): 30-33.
15. Morita Y, Tajima T, Yamaguchi N, et al. Risk factors of failure results after double-bundle reconstruction with autogenous hamstring grafts for isolated posterior cruciate ligament rupture cases. Sci Rep, 2024, 14(1): 6192. doi: 10.1038/s41598-024-56953-y.
16. 赵正吕, 李彦林, 王旭, 等. 后交叉韧带重建移植物的特点与选择. 中国组织工程研究, 2022, 26(10): 1615-1619.
17. Cugat R, Alentorn-Geli E, Cuscó X, et al. Articulated bone block for posterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft: Surgical technique to facilitate graft passage. Arthrosc Tech, 2018, 7(2): e131-e137.
18. Hiraga Y, Ishibashi Y, Tsuda E, et al. Biomechanical comparison of posterior cruciate ligament reconstruction techniques using cyclic loading tests. Knee Surg Sports Traumatol Arthrosc, 2006, 14(1): 13-19.
19. Sollberger VD, Korthaus A, Barg A, et al. Long-term results after anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon autograft with a minimum follow-up of 10 years-a systematic review. Arch Orthop Trauma Surg, 2023, 143(7): 4277-4289.
20. Johnson P, Mitchell SM, Görtz S. Graft considerations in posterior cruciate ligament reconstruction. Curr Rev Musculoskelet Med, 2018, 11(3): 521-527.
21. Dai W, Leng X, Wang J, et al. Quadriceps tendon autograft versus bone-patellar tendon-bone and hamstring tendon autografts for anterior cruciate ligament reconstruction: A systematic review and meta-analysis. Am J Sports Med, 2022, 50(12): 3425-3439.
22. Migliorini F, Pintore A, Oliva F, et al. Allografts as alternative to autografts in primary posterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2023, 31(7): 2852-2860.
23. Belk JW, Kraeutler MJ, Purcell JM, et al. Autograft versus allograft for posterior cruciate ligament reconstruction: An updated systematic review and meta-analysis. Am J Sports Med, 2018, 46(7): 1752-1757.
24. Balsly CR, Cotter AT, Williams LA, et al. Effect of low dose and moderate dose gamma irradiation on the mechanical properties of bone and soft tissue allografts. Cell Tissue Bank, 2008, 9(4): 289-298.
25. Bourgeault-Gagnon Y, Leang AK, Bédard S, et al. Estimated diameter increase from a 4S to a 6S hamstring graft configuration-A cadaveric study. SICOT J, 2023, 9: 34. doi: 10.1051/sicotj/2023033.
26. Li J, Wang J, Li Y, et al. A prospective randomized study of anterior cruciate ligament reconstruction with autograft, γ-irradiated allograft, and hybrid graft. Arthroscopy, 2015, 31(7): 1296-1302.
27. Li J, Kong F, Gao X, et al. Prospective randomized comparison of knee stability and proprioception for posterior cruciate ligament reconstruction with autograft, hybrid graft, and γ-irradiated allograft. Arthroscopy, 2016, 32(12): 2548-2555.
28. Trasolini NA, Rick Hatch GF. Suture augmentation: An alternative to reconstruction for incomplete posterior cruciate ligament injuries in the multiple ligament-injured knee. Arthrosc Tech, 2018, 7(3): e239-e243.
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