Rupture of posterior cruciate ligament. Retrograde cortical tibial fixation
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Abstract
ObjectivesWe show the difficulties with the previous techniques that we used in Posterior Cruciate Ligament Reconstruction (PCL), our present technique of retrograde tibial fixing, and analyze retrospectively if we have improved the final result.MaterialOf 106 patients by surgery for PCL we did a retrospective study in 96 that have returned to work.ResultsBetween the previous techniques and ours, in the Rx posterior drawer test the differences were statistically significant.ConclusionOur technique, that subjectively we believed better, has improved the objective posterior drawer test. It was our target, because our patients are Workers’ Compensation claimers, and this is important in the amount of the compensation.
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Alonso, R. H. (2015). Rupture of posterior cruciate ligament. Retrograde cortical tibial fixation. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 80(4), 244-253. https://doi.org/10.15417/442
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Clinical Research
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References
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J Bone Joint Surg Am 1980;62:438-50.
2. Clancy WG Jr, Shelbourne KD, Zoellner GB, Keene JS, Reider B, Rosemberg TD. Treatment of knee joint instability secondary
to rupture of the PCL. Report of a new procedure. J Bone Joint Surg Am 1983;65:310-22.
3. Clancy WG Jr. Arthroscopic assisted posterior cruciate ligament reconstruction using autologous patellar tendon graft. Sport
Medicine 1993;1:129-35.
4. Ranalleta A. Fundamentos anatómicos para la reconstrucción del LCP. Revista Argentina de Artroscopia 1995;2:214-20.
5. Barrera Oro A, Lapera M, Gigante F. Lesiones del ligamento cruzado posterior. Tratamiento artroscópico. Revista Argentina de
Artroscopia 1997;4:39-43.
6. Barrera Oro A, Lapera MF, Gigante F, Cortes W. Insuficiencia ligamentaria múltiple de rodilla. Revista Argentina de Artroscopia
1998;5:24-31.
7. Skiya JK, Kurtz CA, Carr DR. Transtibial and tibial inlay double-boundle posterior cruciate ligament reconstruction: surgical
technique using a bifid bone-patellar tendon-bone allograft. Arthroscopy 2004;10:1095-100.
8. Lipscomb AB, Anderson AF, Norwig ED, Hovis WD, Brown DL. Isolated posterior cruciate ligament reconstruction: long-term
results. Am J Sports 1993;21:490-6.
9. Fanelli GC, Gianotti BF, Edson CJ. Current concepts review: The PCL arthroscopic evaluation and treatment. Arthroscopy
1994;10:673-88.
10. Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction.
Arthroscopy 1996;12:5-14.
11. Kim SH, Kim HK, Kim HJ. A modified endoscopic technique for posterior cruciate ligament reconstruction using allograft.
Arthroscopy 1998;14:643-8.
12. Ibrahim SA. Primary repair of the cruciate and collateral ligaments after traumatic dislocations of the knee. J Bone Joint Surg Br
1999;81:987-90.
13. Makino A, Muscolo L, Costa Paz M, Ayerza M. Reconstrucción artroscópica del LCP con doble fascículo. Revista Argentina de
Artroscopia 2000;7:58-62.
14. Fanelli GC. Arthroscopic PCL reconstruction transtibial tunnel technique: surgical technique and results. Arthroscopy
2002;18(Suppl 2):44-9.
15. Chen CH, Chen WJ, Shih CH. Arthroscopic reconstruction of the posterior cruciate ligament with quadruple hamstring tendon
graft: a double fixation method. J Trauma 2002;52(5):938-45.
16. Scranton PE, Bagenstose JE, Lantz BA, Friedman MJ, Khalfayan EE, Auld Mk. Quadruple hamstring anterior cruciate ligament
reconstruction: a multicenter study. Arthroscopy 2002;18:715-24.
17. Wang CJ, Chan YS, Weng LH. Posterior cruciate ligament reconstruction using hamstring tendon graft with remnant augmentation.
Arthroscopy 2005;11:1401.e1-1401.e3.
18. Chan YS, Yang SC, Chang CH, Chen AC, Yuan LJ, Hsu KY, Wang CJ. Arthroscopic reconstruction of the posterior cruciate
ligament with use of a quadruple hamstring tendon graft with 3- to 5- year follow-up. Arthroscopy 2006;7:762-70.
19. Chen CH, Chuang TY, Wang KC, Chen WJ, Shih CH. Arthroscopic posterior cruciate ligament reconstruction with hamstring
tendon autograft: results with a minimum 4-year follow-up. Knee Surg Sports Traumatol Arthrosc 2006;11:1045-54.
20. Fanelli GC, Edson CJ, Reinheimer KN, Beck J. Arthroscopic single-bundle versus double-bundle posterior cruciate ligament
reconstruction. Arthroscopy 2008;6:e26.
21. Kim SH, Kim SJ, Chun YM, Choi DH, Hwang BY, Yoon JY, et al. Clinical comparison of remnant-preserving and conventional
technique in PCL reconstruction. Arthroscopy 2011;10:e235.
22. Brand J, Hamilton D, Selby J, Pienkowski D, Caborn Dnm, Johnson DL. Biomechanical comparison of quadriceps tendon
fixation with patelar tendon bone plug interference fixation in cruciate ligament reconstruction. Arthroscopy 2000;16:805-12.
23. Chen CH, Chen WJ, Shih CH. One-incision endoscopic technique for posterior cruciate ligament reconstruction with quadriceps
tendon-patellar bone autograft. Arthroscopy 2001;17:329-32.
24. Chen CH, Chen WJ, Shih CH. Arthroscopic reconstruction of the posterior cruciate ligament: a comparison of quadriceps tendon
autograft and quadruple hamstring tendon graft. Arthroscopy 2002;18:603-12.
25. Margheritini F, Mancini L, Mauro CS, Mariani PP. Stress radiography for quantifying posterior cruciate ligament deficiency.
Arthroscopy 2003;7:706-11.
26. Schulz MS, Russe K, Lampakis G, Strobel MJ. Reliability of stress radiography for evaluation of posterior knee laxity. Am J
Sports Med 2005;33:502-6.
27. Jung TM, Reinhardt C. Stress Radiography to measure posterior cruciate ligament insufficiency: a comparison of five different
techniques. Knee Surg Sports Traumatol Arthrosc 2006;11:1116-21.
28. Garavaglia G, Lubbeke A, Dubois-Ferriere V, Suva D, Fritschy D, Menetrey J. Accuracy of stress radiography techniques in
grading isolated and combined posterior knee injuries: a cadaveric study. Am J Sports Med 2007;35:2051-6.
29. Singhalat W, Lawhorn KW, Howell SM, Hull ML. How four weeks of implantation affect the strength and stiffness of a tendon
graft in a bone tunnel: a study of two fixation devices in an extraarticular model in ovine. Am J Sports Med 2002;30:506-13.
30. Scheffler SU, Südkamp NP, Göckenjan A, Hoffmann RFG, Weiler A. Biomechanical comparison of hamstring and patellar
tendon graft anterior cruciate ligament reconstruction techniques: the impact of fixation level and fixation method under cycling
loading. Arthroscopy 2002;18:304-15.
31. Song EK, Rowe SM, Chung JY, Moon ES, Lee KB. Failure of osteointegration of hamstring tendon autograft after anterior
cruciate ligament reconstruction. Arthroscopy 2004;20:424-8.
32. Weimann A, Rodieck M, Zantop T, Hassenpflug J, Petersen W. Primary stability of hamstring graft fixation with biodegradable
suspension versus interference screws. Arthroscopy 2005;21:266-74.
33. Prodromos CC, Joyce BT, Shi K, Keller BL. A meta-analysis of stability after anterior cruciate ligament reconstruction as a
function of hamstring versus patellar tendon graft and fixation type. Arthroscopy 2005;21:1202-8.
34. Fanelli GC, Orcutt DR, Edson CJ. The multiple-ligament injured knee: evaluation, treatment and results. Arthroscopy
2005;21:471-86.
35. Strobel MJ, Schulz MS, Petersen WJ, Eichhorn HJ. Combined anterior cruciate ligament, posterior cruciate ligament, and
posterolateral corner reconstruction with autogenous hamstring grafts in chronic instabilities. Arthroscopy 2006;22:182-92.
36. Hayashi R, Kitamura N, Kondo E, Anaguchi Y, Tohyama H, Yasuda K. Simultaneous anterior and posterior cruciate ligament
reconstruction in chronic knee instabilities: surgical concepts and clinical outcome. Knee Surg Sports Traumatol Arthrosc
2008;8:763-9.
37. Nicodeme JD, Löcherbach C, Jolles BM. Tibial tunnel placement in posterior cruciate ligament reconstruction: a systematic
review. Knee Surg Sports Traumatol Arthrosc 2014;7:1556-62.
38. Berg E. PCL Tibial inlay reconstruction. Arthroscopy 1995;11:69-76.
39. Kim SJ, Choi CH, Kim HS. Arthroscopic posterior cruciate ligament tibial inlay reconstruction. Arthroscopy 2004;20(Suppl
1):149-54.
40. Seon JK, Song EK. Reconstruction of isolated posterior cruciate ligament injuries: a clinical comparison of the transtibial and
tibial inlay techniques. Arthroscopy 2006;1:27-32.
41. MacGillivray JD, Shubin Stein BE, Park M, Allen AA, Wickiewicz TL, Warren RF. Comparison of tibial versus transtibial
techniques for isolated posterior cruciate ligament reconstruction: minimum 2-year follow-up. Arthroscopy 2006;3: 320-8
J Bone Joint Surg Am 1980;62:438-50.
2. Clancy WG Jr, Shelbourne KD, Zoellner GB, Keene JS, Reider B, Rosemberg TD. Treatment of knee joint instability secondary
to rupture of the PCL. Report of a new procedure. J Bone Joint Surg Am 1983;65:310-22.
3. Clancy WG Jr. Arthroscopic assisted posterior cruciate ligament reconstruction using autologous patellar tendon graft. Sport
Medicine 1993;1:129-35.
4. Ranalleta A. Fundamentos anatómicos para la reconstrucción del LCP. Revista Argentina de Artroscopia 1995;2:214-20.
5. Barrera Oro A, Lapera M, Gigante F. Lesiones del ligamento cruzado posterior. Tratamiento artroscópico. Revista Argentina de
Artroscopia 1997;4:39-43.
6. Barrera Oro A, Lapera MF, Gigante F, Cortes W. Insuficiencia ligamentaria múltiple de rodilla. Revista Argentina de Artroscopia
1998;5:24-31.
7. Skiya JK, Kurtz CA, Carr DR. Transtibial and tibial inlay double-boundle posterior cruciate ligament reconstruction: surgical
technique using a bifid bone-patellar tendon-bone allograft. Arthroscopy 2004;10:1095-100.
8. Lipscomb AB, Anderson AF, Norwig ED, Hovis WD, Brown DL. Isolated posterior cruciate ligament reconstruction: long-term
results. Am J Sports 1993;21:490-6.
9. Fanelli GC, Gianotti BF, Edson CJ. Current concepts review: The PCL arthroscopic evaluation and treatment. Arthroscopy
1994;10:673-88.
10. Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction.
Arthroscopy 1996;12:5-14.
11. Kim SH, Kim HK, Kim HJ. A modified endoscopic technique for posterior cruciate ligament reconstruction using allograft.
Arthroscopy 1998;14:643-8.
12. Ibrahim SA. Primary repair of the cruciate and collateral ligaments after traumatic dislocations of the knee. J Bone Joint Surg Br
1999;81:987-90.
13. Makino A, Muscolo L, Costa Paz M, Ayerza M. Reconstrucción artroscópica del LCP con doble fascículo. Revista Argentina de
Artroscopia 2000;7:58-62.
14. Fanelli GC. Arthroscopic PCL reconstruction transtibial tunnel technique: surgical technique and results. Arthroscopy
2002;18(Suppl 2):44-9.
15. Chen CH, Chen WJ, Shih CH. Arthroscopic reconstruction of the posterior cruciate ligament with quadruple hamstring tendon
graft: a double fixation method. J Trauma 2002;52(5):938-45.
16. Scranton PE, Bagenstose JE, Lantz BA, Friedman MJ, Khalfayan EE, Auld Mk. Quadruple hamstring anterior cruciate ligament
reconstruction: a multicenter study. Arthroscopy 2002;18:715-24.
17. Wang CJ, Chan YS, Weng LH. Posterior cruciate ligament reconstruction using hamstring tendon graft with remnant augmentation.
Arthroscopy 2005;11:1401.e1-1401.e3.
18. Chan YS, Yang SC, Chang CH, Chen AC, Yuan LJ, Hsu KY, Wang CJ. Arthroscopic reconstruction of the posterior cruciate
ligament with use of a quadruple hamstring tendon graft with 3- to 5- year follow-up. Arthroscopy 2006;7:762-70.
19. Chen CH, Chuang TY, Wang KC, Chen WJ, Shih CH. Arthroscopic posterior cruciate ligament reconstruction with hamstring
tendon autograft: results with a minimum 4-year follow-up. Knee Surg Sports Traumatol Arthrosc 2006;11:1045-54.
20. Fanelli GC, Edson CJ, Reinheimer KN, Beck J. Arthroscopic single-bundle versus double-bundle posterior cruciate ligament
reconstruction. Arthroscopy 2008;6:e26.
21. Kim SH, Kim SJ, Chun YM, Choi DH, Hwang BY, Yoon JY, et al. Clinical comparison of remnant-preserving and conventional
technique in PCL reconstruction. Arthroscopy 2011;10:e235.
22. Brand J, Hamilton D, Selby J, Pienkowski D, Caborn Dnm, Johnson DL. Biomechanical comparison of quadriceps tendon
fixation with patelar tendon bone plug interference fixation in cruciate ligament reconstruction. Arthroscopy 2000;16:805-12.
23. Chen CH, Chen WJ, Shih CH. One-incision endoscopic technique for posterior cruciate ligament reconstruction with quadriceps
tendon-patellar bone autograft. Arthroscopy 2001;17:329-32.
24. Chen CH, Chen WJ, Shih CH. Arthroscopic reconstruction of the posterior cruciate ligament: a comparison of quadriceps tendon
autograft and quadruple hamstring tendon graft. Arthroscopy 2002;18:603-12.
25. Margheritini F, Mancini L, Mauro CS, Mariani PP. Stress radiography for quantifying posterior cruciate ligament deficiency.
Arthroscopy 2003;7:706-11.
26. Schulz MS, Russe K, Lampakis G, Strobel MJ. Reliability of stress radiography for evaluation of posterior knee laxity. Am J
Sports Med 2005;33:502-6.
27. Jung TM, Reinhardt C. Stress Radiography to measure posterior cruciate ligament insufficiency: a comparison of five different
techniques. Knee Surg Sports Traumatol Arthrosc 2006;11:1116-21.
28. Garavaglia G, Lubbeke A, Dubois-Ferriere V, Suva D, Fritschy D, Menetrey J. Accuracy of stress radiography techniques in
grading isolated and combined posterior knee injuries: a cadaveric study. Am J Sports Med 2007;35:2051-6.
29. Singhalat W, Lawhorn KW, Howell SM, Hull ML. How four weeks of implantation affect the strength and stiffness of a tendon
graft in a bone tunnel: a study of two fixation devices in an extraarticular model in ovine. Am J Sports Med 2002;30:506-13.
30. Scheffler SU, Südkamp NP, Göckenjan A, Hoffmann RFG, Weiler A. Biomechanical comparison of hamstring and patellar
tendon graft anterior cruciate ligament reconstruction techniques: the impact of fixation level and fixation method under cycling
loading. Arthroscopy 2002;18:304-15.
31. Song EK, Rowe SM, Chung JY, Moon ES, Lee KB. Failure of osteointegration of hamstring tendon autograft after anterior
cruciate ligament reconstruction. Arthroscopy 2004;20:424-8.
32. Weimann A, Rodieck M, Zantop T, Hassenpflug J, Petersen W. Primary stability of hamstring graft fixation with biodegradable
suspension versus interference screws. Arthroscopy 2005;21:266-74.
33. Prodromos CC, Joyce BT, Shi K, Keller BL. A meta-analysis of stability after anterior cruciate ligament reconstruction as a
function of hamstring versus patellar tendon graft and fixation type. Arthroscopy 2005;21:1202-8.
34. Fanelli GC, Orcutt DR, Edson CJ. The multiple-ligament injured knee: evaluation, treatment and results. Arthroscopy
2005;21:471-86.
35. Strobel MJ, Schulz MS, Petersen WJ, Eichhorn HJ. Combined anterior cruciate ligament, posterior cruciate ligament, and
posterolateral corner reconstruction with autogenous hamstring grafts in chronic instabilities. Arthroscopy 2006;22:182-92.
36. Hayashi R, Kitamura N, Kondo E, Anaguchi Y, Tohyama H, Yasuda K. Simultaneous anterior and posterior cruciate ligament
reconstruction in chronic knee instabilities: surgical concepts and clinical outcome. Knee Surg Sports Traumatol Arthrosc
2008;8:763-9.
37. Nicodeme JD, Löcherbach C, Jolles BM. Tibial tunnel placement in posterior cruciate ligament reconstruction: a systematic
review. Knee Surg Sports Traumatol Arthrosc 2014;7:1556-62.
38. Berg E. PCL Tibial inlay reconstruction. Arthroscopy 1995;11:69-76.
39. Kim SJ, Choi CH, Kim HS. Arthroscopic posterior cruciate ligament tibial inlay reconstruction. Arthroscopy 2004;20(Suppl
1):149-54.
40. Seon JK, Song EK. Reconstruction of isolated posterior cruciate ligament injuries: a clinical comparison of the transtibial and
tibial inlay techniques. Arthroscopy 2006;1:27-32.
41. MacGillivray JD, Shubin Stein BE, Park M, Allen AA, Wickiewicz TL, Warren RF. Comparison of tibial versus transtibial
techniques for isolated posterior cruciate ligament reconstruction: minimum 2-year follow-up. Arthroscopy 2006;3: 320-8