Clinical comparisons of the anatomical reconstruction and modified biceps rerouting technique for chronic posterolateral instability combined with posterior cruciate ligament reconstruction.

BACKGROUND: The purpose of this study was to describe a one-stage operation for posterior cruciate ligament reconstruction with use of an Achilles tendon-bone allograft and a posterolateral corner reconstruction with use of two different methods, with a comparison of clinical outcomes in the two groups. METHODS: Our study included forty-six patients who had undergone posterior cruciate ligament reconstruction with use of an Achilles tendon-bone allograft and posterolateral corner reconstruction with either anatomical reconstruction of the lateral collateral ligament and popliteus tendon with use of a tibialis posterior tendon allograft (twenty-one patients; Group A) or the modified biceps rerouting tenodesis (twenty-five patients; Group B) in an alternating fashion. Patients were assessed for knee instability with use of the dial test at 30° and 90°, together with varus and posterior stress radiography. RESULTS: At the two-year follow-up evaluation, although no significant difference was found on posterior stress radiography (mean and standard error, 5.7 ± 0.4 mm for Group A compared with 4.8 ± 0.4 mm for Group B), Group A showed more improvement than Group B on the dial test (16° ± 1° vs. 13° ± 1° at 30° and 17° ± 1° vs. 14° ± 1° at 90°; p = 0.001 for both) and varus stress radiography (3.6 ± 0.3 mm vs. 2.6 ± 0.3 mm; p = 0.024), in the Lysholm (29.5 ± 2.4 vs. 22.3 ± 2.3; p = 0.037) and the International Knee Documentation Committee knee scores (p = 0.041), and less terminal flexion loss (4.0° ± 1.2° vs. 8.8° ± 1.3°; p = 0.013). CONCLUSIONS: Combined with posterior cruciate ligament reconstruction, anatomical posterolateral corner reconstruction of the popliteus tendon and lateral collateral ligament showed better outcomes compared with the modified biceps rerouting tenodesis, although the mean differences of varus and external rotatory stability between the groups were relatively small. However, the overall difference might have been reduced by the negative value caused by overcorrection in Group B. This study demonstrated that anatomical posterolateral corner reconstruction is a reliable alternative method in addressing posterolateral corner and posterior cruciate ligament insufficiency of the knee, a finding that ideally should be tested in a randomized controlled trial.

Peel-off injury at the tibial attachment of the posterior cruciate ligament in children.

BACKGROUND: Careful review of the literature seldom reveals peel-off-type injuries at the tibial attachment of the posterior cruciate ligament in children. PURPOSE: The purpose of this research is to describe the diagnosis and treatment of peel-off injuries at the tibial ligament-osseous junction of the posterior cruciate ligament in children. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between February 2001 and May 2007, 6 patients with diagnosed peel-off injuries at the tibial attachment of the posterior cruciate ligament were surgically treated. All patients were boys from 12 to 13 years of age (mean, 12.3 years). Plain radiographs were normal, but magnetic resonance imaging and arthroscopic findings revealed complete avulsion of the posterior cruciate ligament at the tibial attachment without an osseous fragment. The authors retrospectively reviewed the clinical presentations, diagnostic tests, surgical procedures, and the results of the treatment. The mean follow-up was 37.3 months (range, 25-53 months). RESULTS: Five of the 6 patients had returned to their preinjury levels of activities. The mean side-to-side difference in posterior translation as measured with the KT-2000 arthrometer and stress radiographs was 2.3 mm (range, 0.7-5.2 mm) and 2.9 mm (range, 0.3-6.4 mm), respectively. The mean Lysholm score was 95 points (range, 90-100 points). According to the assessment with the International Knee Documentation Committee form, 2 patients were classified as A, 3 as B, and 1 as C. CONCLUSION: The authors could diagnose peel-off injuries at the tibial attachment of the posterior cruciate ligament in children by careful examinations and arthroscopic surgeries. Satisfactory outcomes without any complications were obtained through the arthroscopic reattachment and fixation using multiple sutures in the case of the avulsed stump that was not split.