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Background To demonstrate and compare results obtained with the transtibial double-bundle posterior cruciate ligament (PCL) reconstruction technique using two types of autografts in isolated and combined PCL lesions. Methods Fifty-two patients with isolated or combined PCL injuries underwent double-bundle PCL reconstruction and were retrospectively evaluated. Among them, 34 were reconstructed using ipsilateral quadriceps and semitendinosus tendon grafts, and 18 were reconstructed using bilateral hamstring tendon grafts. The criteria for outcome evaluation were: objective International Knee Documentation Committee (IKDC) score, Lysholm score, posterior stability (posterior drawer test and KT-1000TM), and rate of complications, comparing the two types of grafts and comparing isolated PCL and combined lesions. The minimum follow-up was two years. Results Significant improvements were found in all evaluation methods between the pre- and postoperative periods (all P .05). The whole sample had the following results: objective IKDC score, 96.2% classified as A/B; Lysholm score, 98.1% rated as good or excellent; and KT-1000, 98.1% with a side-to-side difference of up to five millimeters (65.4% with 0 to two millimeters). The complication rate was 9.6%, with no differences between the graft type that was used (P = .585). No significant difference was observed when comparing the results between isolated PCL injuries and combined injuries (all P > .05). Conclusions The proposed PCL reconstruction technique presented satisfactory results in both isolated and combined PCL lesions, and there were no differences between different types of autografts used. Level of evidence Level III.

Introduction Posterior Cruciate Ligament (PCL) avulsion may mimics PCL rupture with positive posterior drawer test. Treatment of choice to PCL avulsion is vary from open surgery to arthroscopic surgery. PCL reconstruction with augmentation is a rare procedure to be performed in treating PCL avulsion case. This case reported and suggested an augmentation procedure in PCL avulsion case. This study aims is to evaluate the knee functional score using augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Presentation of case We report 3 cases, 1 male and 2 females. The result of physical examination, X-ray examination, and MRI of the knee showed a PCL avulsion. Posterior drawer test showed grade 2 result. We performed an augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Knee scoring (IKDC, Modified Cincinnati, Tegner-Lysholm) collected pre-operative and 2 years post-operative. The result of knee scoring was significant improved in post-operative compare to before surgery. Conclusion Augmented PCL reconstruction can be considered to be an alternative treatment of PCL avulsion because the procedure has excellent post-operative knee scoring result.

To evaluate the clinical outcomes and graft maturation following posterior cruciate ligament reconstruction (PCLR) with preserved remnant and further analyze the correlated factors affecting graft maturation.Consecutive patients who underwent unilateral single-bundle PCLR with remnant preservation from January 2011 to October 2014 by the same senior doctor using tibialis anterior allografts and same surgical technique were included. At a follow-up of more than 2 years, range of motion (ROM) and posterior laxity assessed by posterior drawer test and the KT-1000 arthrometer were examined. Tegner, Lysholm, and International Knee Documentation Committee scores were evaluated. The graft maturation was assessed by a 3.0-T magnetic resonance imaging. Overall correlation analyses and multivariate regression analysis were performed to identify correlated factors of graft maturation, and then subgroups were divided and analyzed according to significant risk factor.Forty-three (84.3%) of 51 enrolled patients were successfully followed up (38.4 months, 24-54 months). All clinical scores improved significantly, and there were no complications. The results of KT-1000 difference revealed significant decline of posterior laxity (9.4 ± 1.5 vs 2.2 ± 1.5 mm; P.001). The MRI evaluation confirmed no ligament retears. Both correlation and regression analyses showed time from injury to surgery had a positive, statistically significant weak correlation with the signal intensity score (R = 0.38, P = .012; coefficient = 0.10; P = .036). Subgroup (group 1: time from injury to surgery3 months; group 2: 3-6 months; group 3: 6-12 months; group 4: ≥12 months) analysis showed there were no significant differences of clinical outcomes between subgroups, while MRI signal intensity was significantly lower in the group with shorter time from injury to surgery (P = .02).The remnant-preserved PCLR resulted in satisfactory clinical outcomes and graft maturation at a mean follow-up of 38.4 months. The time from injury to surgery showed a weak positive correlation with postoperative graft signal intensity on MRI.Level III, retrospective comparative study.

Purpose In this study, we compared femoral tunnel pairs that differ by group in a double-bundle Achilles tendon allograft posterior cruciate ligament (PCL) reconstruction. Methods Group 1 patients had femoral tunnels drilled nearly within the footprint area most proximal and most distal to the axis of the femur. Group 2 patients had femoral tunnels drilled eccentrically within the footprint along an axis nearly perpendicular to the axis of the femur. Patient assessments were made subjectively with preoperative and postoperative assessments of Lysholm rating scale, posterior drawer test, and dial test. Objective assessments used range of motion and quadriceps circumference. Group 1 contained 7 patients with a mean age of 32 years (range, 20 to 46 years). Group 2 contained 10 patients with a mean age of 32 years (range, 20 to 46 years). Results Group 2 patients had significantly less posterior laxity than group 1 patients. Postoperatively, 6 patients in group 1 (86%) had a positive posterior drawer test compared with 3 in group 2 (30%). Rotational laxity was identified by dial test results postoperatively in 3 patients in group 1 (43%) compared with 0% in group 2. Extension deficit occurred in 2 patients in group 1 (29%) and 1 patient in group 2 (10%). Flexion deficit occurred more than twice as frequently in group 1 (71% [5 patients]) than in group 2 (30% [3 patients]). There were no statistically significant differences for other comparisons. Conclusions The clinical outcomes support the group 2 method with femoral tunnel placement at the anterior-most and posterior-most portions of the femoral PCL insertion. The group 2 procedure described in this study incorporates advanced principles for successful outcomes with Achilles double-bundle PCL reconstruction. Level of Evidence Level III, case-control study.

Controversy regarding whether to reconstruct posterior cruciate ligament (PCL)-deficient knees and if so, how best to accomplish this task, continues. The PCL originates on the medial femoral condyle as 2 separate bundles and inserts on the posterior tibia below the joint line. Its key function is to prevent posterior translation of the leg in flexion. Diagnosis is best confirmed with history (blow to anterior tibia), physical examination (posterior drawer test), and imaging (stress radiographs and magnetic resonance imaging). Associated posterolateral injuries must be recognized (external rotation asymmetry). Nonoperative management has been associated with late patellofemoral and medial femoral condylar arthrosis. When operative intervention is elected, we prefer the tibial inlay technique to avoid problems associated with the killer turn seen with standard arthroscopic techniques. The tibial inlay procedure is described and illustrated in this article. Postoperative management (early prone motion), complications, and preliminary results are also discussed. We are encouraged with our early results with this technique and hope to report these in the peer-reviewed literature in the near future.