Reconstruction of the Posterior Cruciate Ligament by the Modified Tibial Inlay Method / 대한정형외과학회잡지

PURPOSE: To introduce the modified tibial inlay technique and evaluate the clinical results of 44 patients who underwent PCL reconstruction by this method and were followed-up for more than 2 years. MATERIALS AND METHODS: The clinical results were assessed using the Orthopadishe Arbeitsgruppe Knie (OAK) and International Knee Documentation Committee (IKDC) knee scoring systems. The integrities of the reconstructed PCLs were assessed using posterior stress radiographs and the manual maximum displacement test using a KT-1000 (TM) arthrometer. RESULTS: The average 65.8+/-9.4 OAK score, 10.8+/-4.6 mm displacement by stress radiographs and 9.4+/-4.1 mm displacement by KT-1000 (TM) arthrometer, were improved to an average 87.5+/-7.8, 3.4+/-0.4 mm, 2.7+/-0.9 mm, respectively, at the last follow-up. By the IKDC and OAK scoring systems, 35 cases (79%) and 40 cases (90%), respectively, showed satisfactory clinical outcome. A second arthroscopic examination was performed in 20 of 44 cases. No case showed rupture of the grafted tendon. However, 3 cases showed recurrence of posterior instability, which requried a retightening at the tibial bone block site. CONCLUSION: The modified tibial inlay technique may improve the quality of outcome of arthroscopic PCL reconstruction, because this technique can avoid grafted tendon abrasion at the posterior orifice, and this preserve the remnant PCL bundle, and it allows the retightening of loose grafted tendon to be performed easily.

Arthroscopic Posterior Cruciate Ligament Reconstruction with Two Graft Tendons by Combined Femoral Dual Tunnel and Modified Tibial Inlay Method

From July 1997, Authors have reconstructed the posterior cruciate ligament(PCL) deficient knees with two graft tendons; an autogenous bone-patellar tendon-bone (BPTB) and a semitendinosus tendon. At Femoral side, the two graft tendons were fixed through the two tunnels which were made at the site of foot print of PCL. The original site of anterolateral bundle of the PCL was reconstructe(I with the autogenous BPTB and the original site of posteromedial bundle with the semitendinosus tendon. At tibial side, the two graft tendons were fixed by modified inlay technique; the BPTB was fixed with a cancellous screw and the semitendinosus tendon with staples. Seven cases were followed up more than six months and authors evaluated the results with the KT-1000TM arthrometer and the posterior stress radiographs by Telos stress dcvice and compared the resu]t of injured knee with the uninjured side of each patient. The results of manual maximal displacement test with arthrometer were less than 4 mm in six patients and 8 rnm in one patient at last follow up. The average distance of posterior displacement on stress radiographs was 10.3 mm preoperatively and 2.7 mm at final follow up period. Six of the seven patients had a good stability on posterior stress radiographs compared with the uninjured side. One patient had posterior knee insta- bility on stress radiographs due to loosening of the grafted tendon and retightening of the grafted tendon was performed through the posterior approach to the proximal tibia. The original idea of femoral dual tunnel method in PCL reconstructiori is to reconstruct the PCL more anatomically and the modified tibial inlay technique can solve the problern of graft tendon abrasion at the posterior opening of the tibial tunnel in transtibial tunnel method and retightening of the loose grafted tendon is simple than the other methods of PCL reconstruction. Authors expect that this combined femoral dual tun- nel and modified tibial inlay method may improve the quality of the outcome of the arthroscopic PCL reconstruction.

Reliability of the Manual Maximal Displacement Test and Quadriceps Active Test with KT-1000 TM Arthrometer in the assessment of Posterior Instability of the Knee

Authors measured the degree of posterior instability of the knee in 21 patitients who had posterior cruciate ligament(PCL) injury or have been reconstructed the PCL by using the manual maximal displacement test and quadriceps active test with KT-1000 arthrometer. To compare the reliability between the manual maximal displacement test and the quadriceps active test, two testers participated in the experiment. One tester was a novice and the other tester had substantial clinical experiences with the KT-1000 arthrometer. The quadriceps neutra! Angle was measured in the uninjured knee, and then quadriceps active test was done. Manual maximal displacement test and Quadriceps active test were done by each tester. In manual maximal displacement test, the Pearson correlation coefficient of the uninjured knee between two testers was 0.852 and that of PCL injured knee between two testers was 0.802. In quadriceps achive test, the Pearson correlation coefficient between two testers was 0.173. As a result, the manual maximal displacement test was more reliable for th measurement of the degree of the posterior instability in patients with posterior cruciate ligament tear or reccnstruction.