Results of old posterior crutiate ligament [PCL] avulsion fixation of knee in St. A; Zahra hospital

Many references recommend reconstruction surgical method, for treatment of old posterior crutiate ligament avulsion [PCL], in spite of its adverse side effects, difficult surgical procedure and poor long term results. This study was conducted for the first time designed to determine the results of the treatment of the old PCL avulsion by open reduction and fixation. We tried to determine the efficacy of old PCL avulsion fixation, during a clinical trial with non-randomized sampling, on 15 patients. All patients had giving way instability, pain while climbing and pain while long walking; and had grade III PDT in physical examination. Data were analyzed by using Chi square test. The frequency of knee instability before and after operation, in 30 and 90 degree flexion, had significant difference [P<0.001]. Giving way, had significant difference before and after operation as well, [P<0.001]. The frequency of pain while walking and climbing, also had significant difference [P<0.001]. In the 15 patients who underwent PCL fixation, the grade of instability reduced to grade I. As therapeutic value of this method is the same as current renewal methods besides its easier procedure and less side effects, so it is recommended to use it necessarily in old PCL. Further studies with larger sample size and prolonged follow up are recommended

[Treatment of combined anterolateral posterolateral rotary instability without PLC reconstruction]

Combined anterolateral and posterolateral rotary instability are treated by correcting knee alignment, Anterior Cruciate Ligament [ACL] reconstruction and repair or reconstruction of the Posterolateral Complex [PLC]. Because of technical difficulties encountered in these operations and the need for more than two stages, and considering the controversy among the importance of Posterolateral Complex [PLC] in valgue knee, this study was performed to treat this instability by ACL reconstruction alone, after correction of varus, without reconstruction of the posterolateral complex and further extra-articular manipulation. This clinical trial was performed on 29 patients [29 knees] with combined anterolateral and posterolateral rotary instability. Instability signs were recorded. Arthroscopy was then performed. To correct alignment, a valgus osteotomy was done and then an ACL reconstruction carried out. Results after a mean of 23 months follow-up, were compared to the ones of before surgery. Fisher Exact test, chi [2] and Wilcoxon tests were used to analyze data. Pain was relieved in more than half and locking disappeared in all of the patients. giving way diminished from 79.3% to 6.9%. Special instability tests showed a significant improvement after surgery [P<0.001]. Most of the patients returned to the preinjury level of work or sports. Based on the results of this study, after correcting varus, ACL-reconstruction alone, without further invasive procedures on extra-articular structures and posterolateral complex, is sufficient to cure this instability, avoiding unneeded complications and longer rehabilitation

study of results of reconstructing posterior cruciate ligament using two-bundle graft from quadriceps muscle tendon

Many of the knees affected rupture of the posterior cruciate ligament [P.C.L] lack desirable function. Researchers are currently seeking surgical procedures of treating P.C.L rupture, which offer a reliable degree of objective and subjective knee stability after surgery. This study assesses the results of anatomical reconstruction of P.C.L using graft from the tendon of the quadriceps muscle. This is a descriptive prospective empirical trial involving 14 patients with clinical diagnosis of P.C.L rupture. The patients underwent arthroscopy to rule out other causes of knee discomfort. The patients complained of knee discomfort in spite of conservative treatment and many sessions of physiotherapy. Subjective symptoms of knee instability, i.e. giving way, pain after long walks and pain during climbing, as well as objective knee instability symptoms as assessed by posterior drawer test at 30° and 90 knee flexion, and neutral rotation were recorded and compared prior to and after surgery. The procedure entailed anatomical reconstruction of P.C.L using grafts taken from the tendon of quadriceps muscle and part of proximal patella. Two of 14 patients were excluded from the study due to their failure to refer for follow-up. The patients included 11 men and 1 woman with a mean age of 23 years. Patients displayed statistically meaningful improvement after surgery as regards subjective symptoms, i.e. giving way, pain after long walks and pain in climbing. Objective knee instability symptoms as evaluated by posterior drawer test at 30° and 90° knee flexion and neutral rotation also showed meaningful improvement compared to pre-surgery findings. Reconstruction of P.C.L is aimed at achieving normal knee kinematics and stability. The procedure used in this study entailed anatomical reconstruction of P.C.L. Given the objective and subjective results obtained, the use of this procedure is recommended by the author as the method of choice for reconstructing P.C.L