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Tibiofemoral and patellofemoral kinematics after reconstruction of an isolated posterior cruciate ligament injury: in vivo analysis during lunge.

ABSTRACT: The actual in vivo tibiofemoral and patellofemoral kinematics of the posterior cruciate ligament (PCL)-reconstructed knee joint are unknown.Current single-bundle PCL reconstruction is unable to correct the abnormal tibiofemoral and patellofemoral kinematics caused by rupture of the ligament.Controlled laboratory study/case series; Level of evidence, 4.Seven patients with an isolated PCL injury in 1 knee and the contralateral side intact were included in the study. Magnetic resonance and dual fluoroscopic imaging techniques were used to compare the tibiofemoral and patellofemoral kinematics between the intact contralateral (control group), PCL-deficient, and PCL-reconstructed knee during physiologic loading with a single-legged lunge. Data were collected preoperatively and 2 years after single-bundle reconstruction.The PCL reconstruction reduced the abnormal posterior tibial translation in PCL-deficient knees to levels not significantly different from those of the intact knee. Posterior cruciate ligament deficiency resulted in an increased lateral tibial translation between 75 degrees and 120 degrees of flexion, and reconstruction was unable to restore these values to normal. No differences were detected among the groups in varus-valgus and internal-external rotation. The PCL reconstruction reduced the increased patellar flexion of PCL-deficient knees between 90 degrees and 120 degrees of knee flexion and the lateral shift at 120 degrees . The abnormal patellar rotation and tilt seen in PCL deficiency at flexion angles of 75 degrees and greater persisted after reconstruction.Single-bundle PCL reconstruction was successful in restoring normal anteroposterior translation of the tibia, as well as the patellar flexion and shift. However, single-bundle PCL reconstruction was unable to achieve the same success in mediolateral translation of the tibia or in the patellar rotation and tilt.The persistent abnormal mediolateral translation of the tibia, as well as decreased patellar rotation and tilt, provide a possible explanation for the development of cartilage degeneration after reconstruction of an isolated PCL injury.

SUBMITTER: Gill TJ

PROVIDER: S-EPMC3832057 | biostudies-literature | 2009 Dec

REPOSITORIES: biostudies-literature

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Tibiofemoral and patellofemoral kinematics after reconstruction of an isolated posterior cruciate ligament injury: in vivo analysis during lunge.

Gill Thomas J TJ Van de Velde Samuel K SK Wing David W DW Oh Luke S LS Hosseini Ali A Li Guoan G

The American journal of sports medicine 20090902 12

<h4>Background</h4>The actual in vivo tibiofemoral and patellofemoral kinematics of the posterior cruciate ligament (PCL)-reconstructed knee joint are unknown.<h4>Hypothesis</h4>Current single-bundle PCL reconstruction is unable to correct the abnormal tibiofemoral and patellofemoral kinematics caused by rupture of the ligament.<h4>Study design</h4>Controlled laboratory study/case series; Level of evidence, 4.<h4>Methods</h4>Seven patients with an isolated PCL injury in 1 knee and the contralate ...[more]

PMID: 19726621

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Project description:BackgroundDegeneration of the tibiofemoral articular cartilage often develops in patients with posterior cruciate ligament deficiency, yet little research has focused on the etiology of this specific type of cartilage degeneration. In this study, we hypothesized that posterior cruciate ligament deficiency changes the location and magnitude of cartilage deformation in the tibiofemoral joint.MethodsFourteen patients with a posterior cruciate ligament injury in one knee and the contralateral side intact participated in the study. First, both knees were imaged with use of a specific magnetic resonance imaging sequence to create three-dimensional knee models of the surfaces of the bone and cartilage. Next, each patient performed a single leg lunge as images were recorded with a dual fluoroscopic system at 0 degrees, 30 degrees, 60 degrees, 75 degrees, 90 degrees, 105 degrees, and 120 degrees of knee flexion. Finally, the three-dimensional knee models and fluoroscopic images were used to reproduce the in vivo knee position at each flexion angle with use of a previously described image-matching method. With use of these series of knee models, the location and magnitude of peak tibiofemoral cartilage deformation at each flexion angle were compared between the intact contralateral and posterior cruciate ligament-deficient knees.ResultsIn the medial compartment of the posterior cruciate ligament-deficient knees, the location and magnitude of peak cartilage deformation were significantly changed, compared with those in the intact contralateral knees, between 75 degrees and 120 degrees of flexion, with a more anterior and medial location of peak cartilage deformation on the tibial plateau as well as increased deformation of the cartilage. In the lateral compartment, no significant differences in the location or magnitude of peak cartilage deformation were found between the intact and posterior cruciate ligament-deficient knees.ConclusionsThe altered kinematics associated with posterior cruciate ligament deficiency resulted in a shift of the tibiofemoral contact location and an increase in cartilage deformation in the medial compartment beyond 75 degrees of knee flexion. The magnitude of the medial contact shift in the posterior cruciate ligament-deficient knee was on the same order as that of the anterior contact shift.

Project description:Many techniques have been described for posterior cruciate ligament (PCL) reconstruction, but residual laxity remains an ongoing challenge. Suture or tape augmentation during ligament reconstruction has become a popular option to prevent graft elongation but comes at the expense of additional costs due to implants for augment fixation, and concern for stress shielding of the graft if the augment and graft are not equally tensioned. We introduce a technique for postless tape augmentation during allograft PCL reconstruction that allows for equal tensioning of graft and augment through the use of a sheath and screw construct without the need for additional implants for augment fixation. Technique Video Video 1 This technique demonstrates a case using postless tape augmentation during posterior cruciate ligament (PCL) reconstruction. The tibial and femoral tunnels are first created with the assistance of an accessory posteromedial portal and drilling under direct arthroscopic and fluoroscopic visualization. An Achilles tendon allograft with a bone plug is used as the allograft. The bone plug and soft tissue are shaped to fit within 10-mm tunnels. A 2.5-mm suture tape (Dynatape, Depuy-Mitek, Johnson and Johnson, Raynham, MA) is then passed through a 2.5-mm drill hole in the bone block, which will be used as the postless augment for the graft. High-tensile strength suture (#2 Orthocord, Depuy-Mitek, Johnson and Johnson) is then passed through the end of the bone block and two additional high-tensile strength sutures (#2 Orthocord, Depuy-Mitek, Johnson and Johnson) are sutured into the soft tissue portion of the graft, in a Krackow suture pattern, to assist with graft passage. The graft is then passed through the tunnels in a retrograde fashion with the assistance of a shuttling suture. Once the graft has been passed out the femur, and the bone plug is fully seated in the most proximal extent of the tibial tunnel, it is secured in place using a metal interference screw, which is confirmed fluoroscopically. Final fixation of the graft is then performed with the knee placed at 90° of flexion, application of an anterior drawer, and insertion of a screw and sheath into the tunnel. It is essential to maintain tension on the allograft and tape during all steps of tibial screw and sheath placement. No additional fixation is required in the femur, as both the allograft and tape are well secured with the sheath and screw.

Dataset Information

Tibiofemoral and patellofemoral kinematics after reconstruction of an isolated posterior cruciate ligament injury: in vivo analysis during lunge.

Publications

Tibiofemoral and patellofemoral kinematics after reconstruction of an isolated posterior cruciate ligament injury: in vivo analysis during lunge.

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