Long-term results of posterior cruciate ligament reconstruction using tibial flexor tendon autograft
Background. Damage to the posterior cruciate ligament (PCL) is one of more severe injuries of the knee joint. An accurate knowledge of anatomy, biomechanics and mechanisms of damage to the knee joint and its ligamentous apparatus is fundamental in the diagnosis, reconstruction and subsequent treatment. Data about PCL trauma are very variable. Such damages occur much more often than they are suspected. This is explained by the fact that PCL ruptures are not very common in clinical practice, so they are missed, and patients only years later are referred for pain in the hip and patella, as well as pain sensations in the medial knee. The method of choice in PCL reconstruction is reparative surgeries using single or twobundle graft. Regardless of chosen technique of reconstruction, the most important factor for the functional result is the positioning of PCL graft. Controversy about the method of PCL plasty is determined by the absence of consensus on the most acceptable technique and low specific weight of results with complete restoration of knee joint stability. Objective: based on the analysis of functional and radiological results, as well as complications, to evaluate the efficiency of the posterior cruciate ligament reconstruction using tibial flexor tendon autograft by the transtibial method. Materials and methods. Between 2004 and 2015, 47 patients (38 men and 9 women) were operated for acute or chronic instability of PCL. This study includes both isolated PCL reconstructions and combined multiligament reparative surgeries. Revision operations were not performed. In 7 (14.89 %) cases, there were isolated ruptures of PCL, and in 40 (85.11 %) — combined injuries. In 23 (48.94 %) patients, ligament rupture was a result of sport injuries, in 12 (25.53 %) — road accidents and in 12 (25.53 %) cases — other factors. The surgeries were performed arthroscopically using the standard technique of channel drilling: the femoral — through the anterolateral access and the tibial — transtibially. A graft was used from the semitendinous and gracilis muscles (one bundle). If there was a combined damage to the PCL with a rupture of the posterolateral angle of the knee joint, then we used LaPrade technique. Five patients (10.64 %) had previously undergone knee joint surgery: in 2 cases (4.46 %), anterior cruciate ligament (ACL) was restored; in one case (2.13 %) — ACL, PCL and medial collateral ligament; in 2 cases (4.46 %) — PCL. Results. Subjective evaluation showed the following positive results: 23 out of 27 patients who were examined in the longterm period were satisfied with the treatment outcome. The overwhelming number of individuals did not have significant pain according to the Visual Analogue Scale, and 81.15 % of the patients were satisfied with the result and were ready to undergo surgery again if necessary. The objective data of Lysholm and Gillquist functional scales — on average 76.75 ± 17.18 (38–100) points, Tegner — on average 5 (1–9), KOOS — 78.14 ± 19.78 (0–100), IKDC A2 (12.5 %), B8 (50 %), C4 (25 %), D2 (12.5 %) indicate a significant improvement in the function of the knee joints. Xray evaluation showed the progression of osteoarthritis. Conclusions. The surgical treatment of PCL injuries with tibial flexor tendon autograft using the transtibial technique of drilling a channel in the tibia is an effective method that has allowed obtaining positive treatment outcomes.
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