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.

A combined transglenoid and suture anchor technique for bony Bankart lesions.

We present a modified hybrid technique that is a combination of a transglenoid and suture anchor technique. Three-dimensional CT reconstruction is indicated for patients with bony fragments larger than 10 mm. First, a transglenoid technique is performed to reduce the bony fragment and then a suture anchor technique is performed to achieve a stable fixation. This combined technique is a useful arthroscopic procedure for the easy reduction and stable fixation of bony Bankart lesions.

Anterior cruciate ligament reconstruction with use of a single or double-bundle technique in patients with generalized ligamentous laxity.

BACKGROUND: In a patient with generalized ligamentous laxity, the risk of instability is greater with a conventionally reconstructed anterior cruciate ligament. The purpose of this study was to compare the clinical outcome of anterior cruciate ligament reconstruction done with a double-bundle technique with use of a quadriceps tendon-bone autograft and that of a single-bundle reconstruction with use of a bone-patellar tendon-bone autograft in patients with generalized ligamentous laxity. METHODS: The records of sixty-one patients who underwent anterior cruciate ligament reconstruction between June 2002 and October 2005 were evaluated. Thirty-two patients underwent a single-bundle reconstruction (group 1), and twenty-nine patients underwent a double-bundle reconstruction (group 2). Clinical outcomes were determined from data obtained before surgery and at the twenty-four-month follow-up visit. RESULTS: Postoperatively, the mean side-to-side difference (and standard deviation) in anterior tibial translation, measured with use of a KT-2000 arthrometer, was greater for group 1 (3.37 +/- 1.76 mm; range, 1.00 to 8.00 mm) than for group 2 (2.03 +/- 1.11 mm; range, 0.00 to 3.50 mm) (p = 0.02). Three patients in group 1 had a grade-1+ pivot shift, while no patient in group 2 had an abnormal pivot shift. The mean score on the Hospital for Special Surgery knee ligament questionnaire was 90.8 in group 1 and 92.1 in group 2, and the mean Lysholm score was 89.4 in group 1 and 91.1 in group 2. CONCLUSIONS: On the basis of the evaluation of ligamentous laxity measured by the KT-2000 arthrometer, a double-bundle anterior cruciate ligament reconstruction with use of a quadriceps tendon-bone autograft allows less anterior translation than does a single-bundle reconstruction with use of a bone-patellar tendon-bone autograft. However, we could not identify a significant difference in the functional outcome between the two techniques.

A modified arthroscopic anterior cruciate ligament double-bundle reconstruction technique with autogenous quadriceps tendon graft: remnant-preserving technique.

Several techniques of anterior cruciate ligament (ACL) double-bundle reconstruction have been introduced to improve the functional outcome and restore normal kinematics of the knee. Meanwhile, a remnant-preserving technique was developed to preserve the proprioception and to enhance the revascularization of the reconstructed ACL. We developed double-bundle ACL reconstruction technique using autogenous quadriceps tendon graft while preserving the remnant. With this technique, two femoral sockets and one tibial tunnel are made. To preserve the remnant of the ACL, the rotational direction of the reamer was set to counterclockwise just before perforation of the tibial tunnel. To pass the graft more easily without disturbance of the remnant, the graft passage was achieved through the tibial tunnel. We suggest that the remnant-preserving technique could be an effective alternative considering its mechanical stability as well as the proprioception and vascularization recovery in arthroscopic double-bundle ACL reconstruction.