ARTHROSCOPIC SINGLE BUNDLE POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING HAMSTRING TENDONS THROUGH POSTERIOR TRANS-SEPTUM PORTAL APPROACH WITH PRESERVATION OF REMNANT POSTERIOR CRUCIATE LIGAMENT FIBERS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGLei , GAOQingfeng , MAZhensheng , SUNXin , MAChao , LIUZhikui , YANGMengqi , LIUZihong ,  HEYaohua

Department of Orthopaedics, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan Hebei, 063000, P. R. China;

Corresponding?author：

HEYaohua, Email: heyaohua@vip.163.com

Keywords：

Arthroscopy; Posterior cruciate ligament; Knee; Posterior trans-septum; Reconstruction

DOI：

10.7507/1002-1892.20150294

Video：

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Objective To introduce the arthroscopic single bundle posterior cruciate ligament (PCL) reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers, and to evaluate the clinical results. Methods Between June 2010 and April 2014, 57 patients with PCL rupture were treated with arthroscopic single bundle PCL reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers. There were 41 males and 16 females, aged 19-42 years (mean, 27.7 years). All the patients had history of injury. The results of posterior drawer test were positive, including 9 cases of grade Ⅱ and 48 cases of grade Ⅲ. The disease duration ranged from 2 weeks to 25 months (mean, 13 months). The Lysholm score and the range of motion of knee joint were used to evaluate the knee function. Results The operation performed smoothly, and no complications of blood vessel and nerve injuries and infection occurred. Primary healing was obtained in all incisions; no early complication occurred after operation. The patients were followed up 16.6 months on average (range, 12-20 months). At last follow-up, the knee range of motion returned to normal in all cases (120-130° in flexion). MRI at last follow-up showed good continuity of the PCL graft and complete healing of the remnant PCL tissues between the femoral and tibial attachments. The Lysholm score was significantly improved when compared with preoperative score (t=-27.429, P=0.000). Conclusion Arthroscopic single bundle PCL reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers has the advantages of firm fixation, simple operation, and good knee function recovery.

Citation： ZHANGLei, GAOQingfeng, MAZhensheng, SUNXin, MAChao, LIUZhikui, YANGMengqi, LIUZihong, HEYaohua. ARTHROSCOPIC SINGLE BUNDLE POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING HAMSTRING TENDONS THROUGH POSTERIOR TRANS-SEPTUM PORTAL APPROACH WITH PRESERVATION OF REMNANT POSTERIOR CRUCIATE LIGAMENT FIBERS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(11): 1364-1368. doi: 10.7507/1002-1892.20150294 Copy

1.	Shelbourne KD, Davis TJ, Patel DV. The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries. A prospective study. Am J Sports Med, 1999, 27(3):276-283.
2.	Cenni MH, do Nascimento BF, Carneiro GG, et al. Popliteal artery injury during posterior cruciate ligament reconstruction. Rev Bras Ortop, 2015, 50(3):348-351.
3.	de Queiroz AA, Janovsky C, da Silveira Franciozi CE, et al. Posterior cruciate ligament reconstruction by means of tibial tunnel:anatomical study on cadavers for tunnel positioning. Rev Bras Ortop, 2014, 49(4):370-373.
4.	Sun X, Zhang J, Qu X, et al. Arthroscopic posterior cruciate ligament reconstruction with allograft versus autograft. Arch Med Sci, 2015, 11(2):395-401.
5.	Levy BA, Fanelli GC, Miller MD, et al. Advances in posterior cruciate ligament reconstruction. Instr Course Lect, 2015, 64:543-554.
6.	桂鑒超, 王黎明, 張昊偉, 等. 跨膝關節后縱隔入路的建立及臨床應用. 中華外科雜志, 2006, 44(16):1106-1110.
7.	敖英芳, 程序, 胡躍林, 等. 后交叉韌帶重建后翻修原因分析. 中華外科雜志, 2009, 47(7):541-544.
8.	顧海峰, 胡勁濤, 趙晨, 等. 跨后縱膈入路與前方入路單束解剖重建后交叉韌帶的療效比較. 中華創傷骨科雜志, 2013, 15(11):942-946.
9.	Jung YB, Jung HJ, Yang JJ, et al. Characterization of spontaneous healing of chronic posterior cruciate ligament injury:Analysis of instability and magnetic resonance imaging. J Magn Reson Imaging, 2008, 27(6):1336-1340.
10.	Lee SH, Jung YB, Lee HJ, et al. Remnant preservation is helpful to obtain good clinical results in posterior cruciate ligament reconstruction:comparison of clinical results of three techniques. Clin Orthop Surg, 2013, 5(4):278-286.
11.	Yoon KH, Bae DK, Song SJ, et al. A prospective randomized study comparing arthroscopic single-bundle and double-bundle posterior cruciate ligament reconstructions preserving remnant fibers. Am J Sports Med, 2011, 39(3):474-480.
12.	Zantop T, Ferretti M, Bell KM, et al. Effect of tunnel-graft length on the biomechanics of anterior cruciate ligament-reconstructed knees:intra-articular study in a goat model. Am J Sports Med, 2008, 36(11):2158-2166.
13.	H?her J, Scheffler S, Weiler A. Graft choice and graft fixation in PCL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2003, 11(5):297-306.
14.	Chen CH, Chou SW, Chen WJ, et al. Fixation strength of three different graft types used in posterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2004, 12(5):371-375.
15.	Shon OJ, Lee DC, Park CH, et al. A comparison of arthroscopically assisted single and double bundle tibial inlay reconstruction for isolated posterior cruciate ligament injury. Clin Orthop Surg, 2010, 2(2):76-84.
16.	Li Y, Li J, Wang J, et al. Comparison of single-bundle and doublebundle isolated posterior cruciate ligament reconstruction with allograft:a prospective, randomized study. Arthroscopy, 2014, 30(6):695-700.
17.	Markolf KL, Feeley BT, Jackson SR, et al. Biomechanical studies of double-bundle posterior cruciate ligament reconstructions. J Bone Joint Surg (Am), 2006, 88(8):1788-1794.
18.	Kim SJ, Kim SH, Chun YM, et al. Clinical comparison of conventional and remnant-preserving transtibial single-bundle posterior cruciate ligament reconstruction combined with posterolateral corner reconstruction. Am J Sports Med, 2012, 40(3):640-649.

1. Shelbourne KD, Davis TJ, Patel DV. The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries. A prospective study. Am J Sports Med, 1999, 27(3):276-283.
2. Cenni MH, do Nascimento BF, Carneiro GG, et al. Popliteal artery injury during posterior cruciate ligament reconstruction. Rev Bras Ortop, 2015, 50(3):348-351.
3. de Queiroz AA, Janovsky C, da Silveira Franciozi CE, et al. Posterior cruciate ligament reconstruction by means of tibial tunnel:anatomical study on cadavers for tunnel positioning. Rev Bras Ortop, 2014, 49(4):370-373.
4. Sun X, Zhang J, Qu X, et al. Arthroscopic posterior cruciate ligament reconstruction with allograft versus autograft. Arch Med Sci, 2015, 11(2):395-401.
5. Levy BA, Fanelli GC, Miller MD, et al. Advances in posterior cruciate ligament reconstruction. Instr Course Lect, 2015, 64:543-554.
6. 桂鑒超, 王黎明, 張昊偉, 等. 跨膝關節后縱隔入路的建立及臨床應用. 中華外科雜志, 2006, 44(16):1106-1110.
7. 敖英芳, 程序, 胡躍林, 等. 后交叉韌帶重建后翻修原因分析. 中華外科雜志, 2009, 47(7):541-544.
8. 顧海峰, 胡勁濤, 趙晨, 等. 跨后縱膈入路與前方入路單束解剖重建后交叉韌帶的療效比較. 中華創傷骨科雜志, 2013, 15(11):942-946.
9. Jung YB, Jung HJ, Yang JJ, et al. Characterization of spontaneous healing of chronic posterior cruciate ligament injury:Analysis of instability and magnetic resonance imaging. J Magn Reson Imaging, 2008, 27(6):1336-1340.
10. Lee SH, Jung YB, Lee HJ, et al. Remnant preservation is helpful to obtain good clinical results in posterior cruciate ligament reconstruction:comparison of clinical results of three techniques. Clin Orthop Surg, 2013, 5(4):278-286.
11. Yoon KH, Bae DK, Song SJ, et al. A prospective randomized study comparing arthroscopic single-bundle and double-bundle posterior cruciate ligament reconstructions preserving remnant fibers. Am J Sports Med, 2011, 39(3):474-480.
12. Zantop T, Ferretti M, Bell KM, et al. Effect of tunnel-graft length on the biomechanics of anterior cruciate ligament-reconstructed knees:intra-articular study in a goat model. Am J Sports Med, 2008, 36(11):2158-2166.
13. H?her J, Scheffler S, Weiler A. Graft choice and graft fixation in PCL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2003, 11(5):297-306.
14. Chen CH, Chou SW, Chen WJ, et al. Fixation strength of three different graft types used in posterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2004, 12(5):371-375.
15. Shon OJ, Lee DC, Park CH, et al. A comparison of arthroscopically assisted single and double bundle tibial inlay reconstruction for isolated posterior cruciate ligament injury. Clin Orthop Surg, 2010, 2(2):76-84.
16. Li Y, Li J, Wang J, et al. Comparison of single-bundle and doublebundle isolated posterior cruciate ligament reconstruction with allograft:a prospective, randomized study. Arthroscopy, 2014, 30(6):695-700.
17. Markolf KL, Feeley BT, Jackson SR, et al. Biomechanical studies of double-bundle posterior cruciate ligament reconstructions. J Bone Joint Surg (Am), 2006, 88(8):1788-1794.
18. Kim SJ, Kim SH, Chun YM, et al. Clinical comparison of conventional and remnant-preserving transtibial single-bundle posterior cruciate ligament reconstruction combined with posterolateral corner reconstruction. Am J Sports Med, 2012, 40(3):640-649.

Chinese Journal of Reparative and Reconstructive Surgery

ARTHROSCOPIC SINGLE BUNDLE POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING HAMSTRING TENDONS THROUGH POSTERIOR TRANS-SEPTUM PORTAL APPROACH WITH PRESERVATION OF REMNANT POSTERIOR CRUCIATE LIGAMENT FIBERS

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